口腔医学研究

口腔医学研究 ›› 2021, Vol. 37 ›› Issue (11): 1048-1053.DOI: 10.13701/j.cnki.kqyxyj.2021.11.018

• 口腔正畸学研究 • 上一篇    下一篇

三维重建技术评价双颌手术影响骨性Ⅱ类错牙合畸形患者上气道的初步研究

张昆1, 邹维娜2, 蒲玉梅2, 胡小蓓1, 王育新2   

  1. 1.南京大学医学院附属口腔医院 南京市口腔医院口腔正畸科 江苏 南京 210008;
    2.南京大学医学院附属口腔医院 南京市口腔医院口腔颌面外科 江苏 南京 210008
  • 收稿日期:2021-03-03 出版日期:2021-11-28 发布日期:2021-11-22
  • 通讯作者: *王育新,E-mail :wangyuxin0212@126.com
  • 作者简介:张昆(1985~ ),男,辽宁锦州人,硕士,主要从事口腔正畸相关的研究工作。
  • 基金资助:
    南京市医学科技发展课题(编号:YKK18120)南京市卫生青年人才(编号:QRX17174)南京市口腔疾病临床医学研究中心(编号:2019060009)

Preliminary Evaluation of Upper Airway Alteration after Bimaxillary Orthognathic Surgery in Patients with Skeletal Class Ⅱ Malocclusion via Three Dimensional Reconstruction Techniques

ZHANG Kun1, ZOU Weina2, PU Yumei2, HU Xiaobei1, WANG Yuxin2   

  1. 1. Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China;
    2. Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
  • Received:2021-03-03 Online:2021-11-28 Published:2021-11-22

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摘要： 目的: 采用螺旋CT分析双颌手术对骨性Ⅱ类错牙合畸形患者上气道的影响。方法: 选取12例(男4例,女8例)行上颌骨Le fort Ⅰ型截骨术+双侧下颌骨矢状劈开术的骨性Ⅱ类错牙合畸形患者,收集患者术前1周(T0)、术后3天(T1)、术后6~12个月(T2)的螺旋CT数据,测量T0、T1、T2上气道各平面矢状径、横径、截面积、上气道各段长度、容积等指标,分析患者T0、T1、T2的上气道三维变化。结果: 鼻咽前界平面垂直径、鼻咽段、舌咽段气道长度及上气道总长度在术后3 d及术后6~12个月显著减小,术后6~12个月较术前分别减小(3.42±3.68) mm、(3.42±3.68) mm、(2.83±3.89) mm、(6.02±8.23) mm。鼻咽前界平面截面积、鼻咽下界平面矢状径及截面积、腭咽下界平面横径、腭咽段气道容积在术后3 d时显著减小,但在术后6~12个月恢复到手术前水平。舌咽上界平面矢状径及截面积、舌咽下界平面矢状径及截面积、舌咽段气道容积在术后3 d无显著变化,在术后6~12个月显著增大,术后6~12个月较术前分别增大(3.90±3.83) mm、(25.16±68.21) mm2、(3.26±3.74) mm、(34.55±89.41) mm2、(1091.63±1382.39) mm3。术后6~12个月舌咽段气道容积的变化量与B点的矢状向移动距离呈正相关。结论: 双颌手术治疗骨性Ⅱ类错牙合畸形会造成舌咽段气道增大,增大量与下颌骨矢状向移动距离呈正相关;腭咽段气道在术后出现暂时性缩窄,但在术后6~12个月恢复到手术前水平;鼻咽段气道、喉咽段气道及上气道总容积无显著改变。

关键词: 骨性Ⅱ类错牙合畸形, 双颌手术, 上气道, 螺旋CT

Abstract: Objective: To evaluate the upper airway dimension changes in skeletal Class Ⅱ patients treated with bimaxillary orthognathic surgery through spiral computed tomography. Methods: Twelve patients (4 males and 8 females) with skeletal Class Ⅱ malocclusion underwent LeFort I osteotomy and bilateral sagittal split mandibular advancement was selected. Spiral CT data were collected 1 week before operation (T0), 3 days after operation (T1), and 6-12 months after operation (T2). The cross-sectional diameter, length and volumes of the airway in T0, T1 and T2 were measured. The data in T0, T1 and T2 were compared. Results: The vertical diameter of Anp plane, the airway length of the nasopharynx, the glossopharynx and the total upper airway decreased significantly 3 days and 6-12 months [(3.42±3.68) mm, (3.42±3.68) mm, (2.83±3.89) mm, and (6.02±8.23) mm] after surgery. The cross-section area of Anp plane, the sagittal diameter and cross-section area of Lnp plane, the glossopharynx airway volume, the transverse diameter of Lvp plane, the velopharynx airway volume decreased significantly 3 days after surgery, and returned to preoperative level 6-12 months after surgery. The sagittal diameter and cross-section area of Lvp plane and Lgp plane, the glossopharynx airway volume increased significantly 6-12 months [(3.90±3.83) mm, (25.16±68.21) mm2, (3.26±3.74) mm, (34.55±89.41) mm2, and (1091.63±1382.39) mm3] after surgery. The change degree of the glossopharynx airway volume 6-12 months after surgery was positively correlated with the sagittal movement distance of point B. Conclusion: The glossopharynx airway volume increased in skeletal Class Ⅱ patients after bimaxillary orthognathic surgery, the increase degree was positively correlated with the sagittal movement distance of the mandible. The velopharynx airway decreased significantly 3 days after surgery, and returned to preoperative level 6-12 months after surgery. There was no significant difference in the nasopharynx, the hypopharynx, and the total upper airway volume.

Key words: skeletal Class Ⅱ malocclusion, bimaxillary orthognathic surgery, upper airway, spiral computed tomography