L'Estrange P R, Battagel J M, Harkness B, Spratley M H, Nolan P J, Jorgensen G I
Faculty of Dentistry, University of Queensland, Brisbane, Australia.
J Oral Rehabil. 1996 Oct;23(10):699-711. doi: 10.1046/j.1365-2842.1996.00416.x.
The aim of this study was to develop a method of studying the effects of mandibular advancement on oropharyngeal airway dimensions in the sagittal plane in conscious, supine patients. Six white, dentate, male patients with proven obstructive sleep apnoea had sagittal fluoroscopic recordings taken in the resting supine position. Images were recorded at four frames per second as the mandible was advanced with the teeth in contact to maximum protrusion and then opened. Software in the fluoroscopic imaging system permitted measurement of the change in mandibular position together with oropharyngeal airway dimensions expressed as the narrowest dimension observable in the post-palatal and post-lingual sites. Plotting of airway dimensions during mandibular advancement enabled estimation of the degree of protrusion associated with maximal airway benefits. Progressive mandibular advancement produced variable adaptive changes in the post-palatal and post-lingual regions of the oropharynx. The amount of airway opening appeared to be related to the horizontal and vertical relationships of the face and to the dimensions of the soft palate. The changes in post-palatal and post-lingual airway dimensions were not always identical, despite the observation that both tongue and soft palate were seen to move in unison, with close contact being maintained between the two structures. Jaw opening resulted in synchronous posterior movement of both tongue and soft palate, with consequent narrowing of oropharyngeal airspace. Fluoroscopy is a simple method of assessing upper airway changes with mandibular advancement in the conscious patient. The technique should facilitate the selection of subjects for whom mandibular advancement would seem advantageous. The nature of the adaptive response is dependent on individual structural variation. It is suggested that, where artificial mandibular advancement with dental devices is considered beneficial, jaw opening should be kept to a minimum.
本研究的目的是开发一种方法，用于研究清醒仰卧位患者下颌前伸对矢状面口咽气道尺寸的影响。六名经证实患有阻塞性睡眠呼吸暂停的白人、有牙男性患者在仰卧休息位进行了矢状面荧光透视记录。当牙齿接触下颌前伸至最大前突然后张开时，以每秒四帧的速度记录图像。荧光透视成像系统中的软件允许测量下颌位置的变化以及口咽气道尺寸，口咽气道尺寸以腭后和舌后部位可观察到的最窄尺寸表示。绘制下颌前伸过程中的气道尺寸图能够估计与最大气道益处相关的前突程度。下颌逐渐前伸在口咽的腭后和舌后区域产生了可变的适应性变化。气道开放量似乎与面部的水平和垂直关系以及软腭尺寸有关。尽管观察到舌头和软腭同步移动且两者结构之间保持紧密接触，但腭后和舌后气道尺寸的变化并不总是相同的。张口导致舌头和软腭同步向后移动，从而使口咽气道间隙变窄。荧光透视是评估清醒患者下颌前伸时上气道变化的一种简单方法。该技术应有助于选择下颌前伸似乎有益的受试者。适应性反应的性质取决于个体结构变异。建议在认为使用牙科装置进行人工下颌前伸有益的情况下，应将张口保持在最小程度。
