Ishida M, Inoue Y, Suto Y, Okamoto K, Ryoke K, Higami S, Suzuki T, Kawahara R
Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
Psychiatry Clin Neurosci. 1998 Apr;52(2):227-9. doi: 10.1111/j.1440-1819.1998.tb01045.x.
Prosthetic mandibular advancement (PMA) was applied to nine patients with obstructive sleep apnea syndrome (OSAS) and its therapeutic usefulness, mechanism of action, and clinical indication were discussed based on polysomnographic findings and serial examination of upper airway before and during PMA treatment. Apnea hypopnea index significantly decreased during PMA treatment compared with the value before treatment (P < 0.01) and the rate of the treatment responder counted 78.1%. Cephalometric variables indicated forward and inferior advancement of mandible in our subjects. Magnetic resonance imaging of the upper airway during sleep revealed a marked improvement of velophanryngeal obstruction in most subjects. In addition, intraesophageal negative pressure during sleep decreased significantly. Our results confirmed the high therapeutic efficacy of PMA for OSAS and indicated forward advancement of the mandible and decrease of negative pressure loading on upper airway with PMA might suppress velopharyngeal collapse. Thus, PMA was regarded as one of the treatments of choice for OSAS occurring based on with velopharyngeal narrowing.
对9例阻塞性睡眠呼吸暂停综合征（OSAS）患者应用了下颌骨假体前移术（PMA），并根据多导睡眠图检查结果以及PMA治疗前后对上气道的系列检查，探讨了其治疗效果、作用机制及临床适应症。与治疗前相比，PMA治疗期间呼吸暂停低通气指数显著降低（P<0.01），治疗有效率为78.1%。头影测量变量表明，我们研究对象的下颌骨向前下方移位。睡眠期间上气道的磁共振成像显示，大多数研究对象的腭咽阻塞有明显改善。此外，睡眠期间食管内负压显著降低。我们的结果证实了PMA治疗OSAS的高效性，并表明PMA使下颌骨向前移位以及上气道负压负荷降低可能会抑制腭咽塌陷。因此，PMA被视为基于腭咽狭窄发生的OSAS的首选治疗方法之一。
