2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响

doi:10.19439/j.sjos.2018.03.013

上海口腔医学 ›› 2018, Vol. 27 ›› Issue (3): 280-284.doi: 10.19439/j.sjos.2018.03.013

2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响

聂萍，陶丽，朱妍菲，孙蕙珺，朱敏

上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科，国家口腔疾病临床研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海 200011

收稿日期:2018-01-08 修回日期:2018-03-26 出版日期:2018-07-20 发布日期:2018-07-20
通讯作者: 朱敏，E-mail:zminnie@126.com
作者简介:聂萍（1984-），女，硕士，主治医师，E-mail: nieping1011@sina.com
基金资助:
上海交通大学医工（理）交叉基金（YG2017QN12）；上海高校青年教师培养资助计划（shjdy029）

Evaluation of the effects of two different modes of orthognathic surgery on upper airway morphology in patients with skeletal Class Ⅲ malocclusion

NIE Ping, TAO Li, ZHU Yan-fei, SUN Hui-jun, ZHU Min.

Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center of Stomatology; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011, China

Received:2018-01-08 Revised:2018-03-26 Online:2018-07-20 Published:2018-07-20

摘要/Abstract

摘要： 目的： 建立骨性Ⅲ类错畸形患者正颌手术前、后上气道三维模型，比较不同正颌术式对骨性Ⅲ类错畸形患者上气道各截面积及容积的影响。方法： 28例骨性Ⅲ类错畸形患者经正颌-正畸联合会诊，制定手术方案，分为2组，实验A组（12例）为单纯双侧下颌支矢状劈开术（BSSRO）后退，即单颌手术组，实验B组（16例）为下颌骨BSSRO 后退 +上颌骨Le Fort I型截骨术前移，即双颌手术组。所有患者于正颌手术前（T1）和术后3个月（T2）分别行CT扫描，基于CT图像，应用Dolphin Imaging 11.7软件建立包含腭咽、舌咽和喉咽腔在内的上气道三维模型，测量、比较2组患者在正颌手术前、后的上气道各截面、腔隙的矢状径、冠状径、横截面积和容积改变的差异。采用SPSS 16.0 软件包进行统计学分析。结果： 在腭咽段，实验A组手术后各项数值均较术前减小；实验B组手术后除冠状径外，其余数值均较术前增大，且2组变化有显著差异（P<0.05）。在舌咽段及喉咽段，2组手术后数值均减小。在横截面积和容积方面，实验A组较实验B组减小更加明显，2组的减小量有显著差异（P<0.05）。结论： 与单颌手术相比，双颌手术对骨性Ⅲ类错畸形患者上气道形态的减小改变影响较小。

关键词: 骨性Ⅲ类错畸形, 正颌手术, 上气道

Abstract: PURPOSE: To establish three-dimensional models of upper airway pre- and post-orthognathic surgery in patients with skeletal Class Ⅲ malocclusion, and to compare the effects of different modes of orthognathic surgery on the cross-sectional areas and volumes of upper airway. METHODS: Twenty-eight patients with skeletal Class Ⅲ malocclusion were divided into 2 groups. Group A (12 patients) underwent bilateral sagittal split ramus osteotomy(BSSRO) for mandibular setback, named single jaw surgery group; group B (16 patients) underwent BSSRO + Le Fort I osteotomy for mandibular setback and maxillary advancement, named bimaxillary surgery group. All patients received CT scanning before (T1) and 3 months after surgery (T2). The three-dimensional models of the upper airway containing velopharynx, glossopharynx and laryngopharynx were established by using Dolphin Imaging 11.7 software. The changes of sagittal diameters, coronal diameters, cross-sectional areas and volumes of the upper airway were measured and compared between the two groups pre- and post- surgery (T1, T2) using SPSS 16.0 software package, respectively. RESULTS: In velopharynx, the values of group A were decreased after surgery, while the other values of group B were increased except the value of coronal diameter. There was a significant difference between the two groups (P<0.05). In glossopharynx and laryngopharynx, the values of group A and group B were both decreased after surgery. The reduction of the cross-sectional areas and volumes in group A were more obvious than group B (P<0.05). CONCLUSIONS: The amount of narrowing of the upper airway is smaller in patients undergoing bimaxillary surgery than in patients undergoing mandibular setback surgery.

Key words: Skeletal Cass Ⅲ malocclusion, Orthognathic surgery, Upper airway

中图分类号:

R782.2

聂萍，陶丽，朱妍菲，孙蕙珺，朱敏. 2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响[J]. 上海口腔医学, 2018, 27(3): 280-284.

NIE Ping, TAO Li, ZHU Yan-fei, SUN Hui-jun, ZHU Min.. Evaluation of the effects of two different modes of orthognathic surgery on upper airway morphology in patients with skeletal Class Ⅲ malocclusion[J]. Shanghai Journal of Stomatology, 2018, 27(3): 280-284.

参考文献

[1] 牛晓雯, 高辉, 张丽萍, 等. 骨性Ⅲ类患者双颌手术后软硬组织变化及其相关性研究[J]. 口腔医学研究, 2011, 27(7): 568-570.
[2] Enciso R, Nguyen M, Shigeta Y, et al. Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2010,109(2): 285-293.
[3] 钱玉梅, 陈丽萍, 吴亚东, 等. 人体上呼吸道三维数值模型的建立与气体流场数值模拟分析[J]. 上海口腔医学, 2010, 19(3): 310-314.
[4] 陶丽, 朱敏. 正颌手术对骨性Ⅲ类患者上气道及周围结构影响的研究 [J]. 口腔颌面外科杂志, 2014, 24(1): 72-76.
[5] Chen F, Terada K, Hanada K, et al. Predicting the pharyngeal airway space after mandibular setback surgery [J].J Oral Maxilofac Surg, 2005, 63(10): 1509-1514.
[6] 王宏伟, 齐素青, 王建国, 等. 下颌后退术后舌骨、舌体位置和咽腔间隙变化的锥形束CT分析 [J]. 华西口腔医学杂志, 2012, 30(6): 650-654.
[7] Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery[J]. J Oral Maxillofac Surg, 2000, 58(3): 282-285.
[8] 杨志诚, 李玲, 冯爽, 等. 下颌骨矢状劈开后退术对咽腔间隙及舌骨位置的影响 [J]. 口腔颌面外科杂志, 2016, 26(5): 331-334.
[9] Ingman T, Nieminen T, Hurmerinta K. Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions [J]. Eur J Orthod, 2004, 26(3): 321-326.
[10] Chen F, Terada K, Hua Y, et al. Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class Ⅲ skeletal deformities [J]. Am J Orthod Dentofacial Orthop, 2007, 131(3): 372-377.
[11] Kim MA, Kim BR, Choi JY, et al. Three-dimensional changes of the hyoid bone and airway volumes related to its relationship with horizontal anatomic planes after bimaxillary surgery in skeletal Class Ⅲ patients [J]. Angle Orthod, 2013, 83(4): 623-629.
[12] Becker OE, Avelar RL, G?elzer JG, et al. Pharyngeal airway changes in Class Ⅲ patients treated with double jaw orthognathic surgery-maxillary advancement and mandibular setback[J]. J Oral Maxillofac Surg, 2012, 70(11): e639-647.
[13] Hong JS, Park YH, Kim YJ, et al. Three-dimensional changes in pharyngeal airway in skeletal class Ⅲ patients undergoing orthognathic surgery[J]. J Oral Maxillofac Surg, 2011, 69(11): e401-408.
[14] Jakobsone G, Neimane L, Krumina G. Two- and three-dimensional evaluation of the upper airway after bimaxillary correction of Class Ⅲ malocclusion [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 110(2): 234-242.
[15] 闫明, 王宏伟, 李丽艳, 等. 正畸联合双颌手术治疗骨性Ⅲ类畸形对上气道长期影响的CBCT分析[J]. 口腔医学研究, 2016, 32(12): 1319-1322.

2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响

Evaluation of the effects of two different modes of orthognathic surgery on upper airway morphology in patients with skeletal Class Ⅲ malocclusion

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