Hochban W, Brandenburg U, Peter J H
Phillips-University Marburg, Klinik für Mund-, Kiefer-, Gesichtschirurgie, Marburg/Lahn, Germany.
Sleep. 1994 Oct;17(7):624-9. doi: 10.1093/sleep/17.7.624.
In recent years obstructive sleep apnea syndrome has gained increasing interest. Treatment of choice is nasal continuous positive airway pressure ventilation during sleep for upper airway patency, which does not cure sleep apnea and has to be applied throughout a patient's lifetime. In respect to various underlying pathomechanisms, in certain cases with craniofacial disorders, causal therapy by craniofacial osteotomies seems possible. A series of 21 consecutive patients with maxillary and mandibular deficiency were treated primarily with a 10-mm maxillomandibular advancement by retromolar sagittal split osteotomy and Le Fort-I osteotomy, respectively. Obstructive sleep apnea syndrome was considerably improved in all patients. In 20 of 21 patients, the postoperative respiratory disturbance index (RDI) was reduced clearly to under 10, oxygen saturation rose and sleep quality improved. This was achieved by a maxillomandibular advancement of 10 mm without secondary refinements. In one patient the RDI could only be reduced to 20, probably due to insufficient maxillary advancement; oxygen desaturations still existed despite secondary corrections. These results indicate that successful surgical treatment is possible in a high percentage of selected patients with certain craniofacial characteristics. In addition to cardiorespiratory polysomnography there should be routine cephalometric evaluation of all patients. Maxillomandibular advancement should be offered as an alternative therapy to all patients with maxillary and/or mandibular deficiency or dolichofacial type in combination with narrow posterior airway space.
近年来，阻塞性睡眠呼吸暂停综合征越来越受到关注。首选的治疗方法是睡眠期间经鼻持续气道正压通气以保持上呼吸道通畅，这种方法并不能治愈睡眠呼吸暂停，且患者必须终身使用。针对各种潜在的发病机制，在某些伴有颅面疾病的病例中，通过颅面截骨术进行病因治疗似乎是可行的。连续21例上颌骨和下颌骨发育不全的患者分别接受了经磨牙后矢状劈开截骨术和Le Fort - I截骨术，主要进行了10毫米的上颌骨和下颌骨前移。所有患者的阻塞性睡眠呼吸暂停综合征均有显著改善。21例患者中有20例术后呼吸紊乱指数（RDI）明显降至10以下，血氧饱和度升高，睡眠质量改善。这是通过10毫米的上颌骨和下颌骨前移实现的，无需二次精细调整。1例患者的RDI仅降至20，可能是由于上颌骨前移不足；尽管进行了二次矫正，仍存在氧饱和度下降的情况。这些结果表明，对于某些具有特定颅面特征的选定患者，高比例的成功手术治疗是可能的。除了心肺多导睡眠图检查外，所有患者都应进行常规头影测量评估。对于所有上颌骨和/或下颌骨发育不全或长面型合并后气道间隙狭窄的患者，应提供上颌骨和下颌骨前移作为替代治疗方法。
