关于外科手术对骨性Ⅱ类错牙合畸形患者上气道及阻塞性睡眠呼吸暂停低通气综合征的影响

doi:10.13701/j.cnki.kqyxyj.2021.12.003

摘要/Abstract

摘要： 上气道的形态和通畅度与呼吸和睡眠质量密切相关。而下颌骨发育不足有可能促使骨性Ⅱ类错牙合畸形患者出现上气道狭窄现象,情况严重者会出现阻塞性睡眠呼吸暂停低通气综合征(OSAHS)。目前,临床治疗重度骨性Ⅱ类错牙合患者主要采取正畸-正颌联合治疗,术式主要包含下颌骨矢状劈开术、双颌前徙术、颏成形术及牵张成骨术等。为了更好地理解上气道形态与OSAHS之间的关系,探求骨性Ⅱ类错牙合患者更有效的临床治疗途径,本文将回顾不同手术方法对骨性Ⅱ类错牙合患者上气道及OSAHS的影响。

关键词: 骨性Ⅱ类错牙合, 上气道, 阻塞性睡眠呼吸暂停低通气综合征, 正畸-正颌联合治疗

Abstract: The shape and patency of upper airway are closely related to breathing and sleep quality. Inadequate mandibular development may promote upper airway stenosis in patients with skeletal class Ⅱ, or even cause obstructive sleep apnea hypopnea syndrome (OSAHS) in severe cases. At present, the clinical treatment of severe skeletal class Ⅱ patients mainly adopts a combination of orthodontic and orthognathic treatment. The surgical procedures mainly include mandibular sagittal splitting, maxillomandibular advancement, genioplasty, and distraction osteogenesis. In order to better understand the relationship between upper airway morphology and OSAHS, and to explore more effective clinical treatment approaches for patients with skeletal class Ⅱ, this article reviews the effects of different surgical methods on upper airway and OSAHS in patients with skeletal class Ⅱ.

Key words: skeletal class Ⅱ malocclusion, upper airway, obstructive sleep apnea hypopnea syndrome, orthodontic-orthognathic combined treatment

周颖, 胡敏. 关于外科手术对骨性Ⅱ类错牙合畸形患者上气道及阻塞性睡眠呼吸暂停低通气综合征的影响[J]. 口腔医学研究, 2021, 37(12): 1073-1075.

ZHOU Ying, HU Min. Effect of Surgery on Upper Airway and OSAHS of Skeletal Class Ⅱ Patients: a Review[J]. Journal of Oral Science Research, 2021, 37(12): 1073-1075.

参考文献

[1] 周炼,倪道凤,王兴,等.小颌畸形伴阻塞性睡眠呼吸暂停低通气综合征患者上气道CT测量[J].中国耳鼻咽喉头颈外科,2005,12(8):523-527.
[2] 朱德超,卢海燕. 下颌前移矫治器治疗成人阻塞性睡眠呼吸暂停低通气综合征的研究进展[J].口腔医学研究,2020,36(4):324-327.
[3] Parsi GK, Alsulaiman AA, Kotak B, et al. Volumetric changes of the upper airway following maxillary and mandibular advancement using cone beam computed tomography [J]. Int J Oral Maxillofac Surg, 2019, 48(2):203-210.
[4] Boyd SB, Walters AS, Waite P, et al. Long-term effectiveness and safety of maxillomandibular advancement for treatment of obstructive sleep apnea [J]. J Clin Sleep Med, 2015,11(7):699-708.
[5] Rana SS, Kharbanda OP, Agarwal B. Influence of tongue volume, oral cavity volume and their ratio on upper airway: A cone beam computed tomography study [J]. J Oral Biol Craniofac Res, 2020, 10(2):110-117.
[6] Wei W, Huang SW, Chen LH, et al. Airflow behavior changes in upper airway caused by different head and neck positions: Comparison by computational fluid dynamics [J]. J Biomech, 2017, 52:89-94.
[7] 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.
[8] 吕毛古,罗伟,缪东生,等.阻塞性睡眠呼吸暂停低通气综合征上气道螺旋CT测量[J].中国耳鼻咽喉颅底外科杂志,2009,15(1):35-38.
[9] 何权瀛, 陈宝元.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)解读[J].中华结核和呼吸杂志,2012,35(1): 7-8.
[10] Jorge C, Benítez I, Torres G, et al. The STOP-Bang and Berlin questionnaires to identify obstructive sleep apnoea in Alzheimer's disease patients [J]. Sleep Med, 2019, 57:15-20.
[11] Zhang C, Zhao L, Li CR, et al. Advancing and lengthening genioplasty in contouring of the receding and short chin [J]. J Craniofac Surg, 2017, 28(2):314-317.
[12] Altay MA, Quereshy FA, Williams JT, et al. Quantification of volumetric, surface area and linear airway changes after orthognathic surgery: a preliminary study [J]. Eur Oral Res, 2018, 52(1):36-42.
[13] Tan SK, Leung WK, Tang ATH, et al. How does mandibular advancement with or without maxillary procedures affect pharyngeal airways? An overview of systematic reviews [J]. PLoS One, 2017, 12(7):e0181146.
[14] Kochar GD, Sharma M, Roy Chowdhury SK, et al. Pharyngeal airway evaluation following isolated surgical mandibular advancement: A 1-year follow-up [J]. Am J Orthod Dentofacial Orthop, 2019, 155(2):207-215.
[15] Eggensperger N, Smolka K, Johner A, et al. Long-term changes of hyoid bone and pharyngeal airway size following advancement of the mandible [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005, 99(4):404-410.
[16] Park JH, Jung HD, Cha JY, et al. Hard and soft tissue changes and long-term stability after vertical height reduction genioplasty using biodegradable fixation [J]. Int J Oral Maxillofac Surg, 2019, 48(8):1051-1056.
[17] Rojas R, Chateau R, Gaete C, et al. Genioglossus muscle advancement and simultaneous sliding genioplasty in the management of sleep apnoea [J]. Int J Oral Maxillofac Surg, 2018,47(5):638-641.
[18] Cheng A. Genioglossus and genioplasty advancement [J]. Atlas Oral Maxillofac Surg Clin North Am, 2019, 27(1):23-28.
[19] Santos Junior JF, Abrahao M, Gregorio LC, et al. Genioplasty for genioglossus muscle advancement in patients with obstructive sleep apnea-hypopnea syndrome and mandibular retrognathia [J]. Braz J Otorhinolaryngol, 2007, 73(4):480-486.
[20] Song SA, Chang ET, Certal V, et al. Genial tubercle advancement and genioplasty for obstructive sleep apnea: A systematic review and meta-analysis [J]. The Laryngoscope, 2017, 127(4):984-992.
[21] Torres HM, Valladares-Neto J, Torres EM, et al. Effect of genioplasty on the pharyngeal airway space following maxillomandibular advancement surgery [J]. J Oral Maxillofac Surg, 2017, 75(1):189.e1-189.e12.
[22] 喻幸娜,侯世达,黄弋欢,等.下颌骨牵张成骨术后1~3年稳定性的回顾性研究[J].中华口腔医学研究杂志(电子版),2019,13(2):90-96.
[23] 宗春琳,马秦,苏忠平,等.牵张成骨术治疗小下颌畸形伴重度OSAHS效果的回顾性研究[J].中国临床新医学,2018,11(11):1078-1081.
[24] 韦倩,周诺.正颌外科及牵张成骨技术在阻塞性睡眠呼吸暂停低通气综合征治疗中的应用进展[J].口腔医学研究,2019,35(11):1020-1022.
[25] Moore M, Netherway DJ, Abbott A, et al. Mandibular lengthening by distraction for airway obstruction in treacher-collins syndrome: the long-term results [J]. J Craniofac Surg,1994, 5(1):22-25.
[26] 唐友盛,高益鸣,沈国芳,等.牵引成骨技术治疗小下颌畸形伴OSAS效果的初步报告[J].中华口腔医学杂志,2000,35(1):9-11.
[27] 张武阳,贾骏麒,赵天一,等.牵张成骨序列治疗颞下颌关节强直及继发畸形[J].实用口腔医学杂志,2017,33(2):249-253.
[28] Van Strijen PJ, Breuning KH, Becking AG, et al. Stability after distraction osteogenesis to lengthen the mandible: results in 50 patients [J]. J Oral Maxillofac Surg, 2004, 62(3):304-307.