Relationship between pharyngeal airway depth and ventilation condition in mandibular setback surgery: A computational fluid dynamics study
Relationship between pharyngeal airway depth and ventilation condition in mandibular setback surgery: A computational fluid dynamics study
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DOI：
10.1111/ocr.12371
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发表时间：
2020-08-01
影响因子：
3.1
通讯作者：
Yamasaki, Youichi
中科院分区：
文献类型：
--
作者：
Shirazawa, Yoshito;Iwasaki, Tomonori;Yamasaki, Youichi
目的应用计算机流体动力学（CFD）技术预测术后咽部气道（PA）阻塞的前后深度（APD），以预防下颌骨后移术后阻塞性睡眠呼吸暂停。背景和样本人群19名需要下颌后移手术的骨骼III类患者（8名男性;平均年龄，26.7岁）在手术前和手术后6个月拍摄了计算机断层扫描图像。方法测量腭后气道（RA）、第二颈椎气道、口咽气道和第三颈椎气道4个横断面上各部位的APD。基于三维PA模型，使用CFD在吸气时测量PA的最大负压（Pmax）。使用方差分析和Bonferroni校正的Friedman检验确定站点间差异。采用斯皮尔曼相关系数和非线性回归分析方法评价APD与Pmax的关系。结果最小PA部位为RA。Pmax与RA的APD显著相关（r（s）=.628，P < .001）。Pmax与APD-RA之间的关系拟合成曲线，其显示Pmax与APD-RA的平方成反比关系。Pmax显著增加，即使APD-RA略有减少。特别是当APD-RA为7 mm或更小时，Pmax显著增加，提示PA阻塞更可能发生。结论本研究的结果表明，APD-RA是手术后PA通气良好的有用预测因素。
Objectives This study aimed to determine the anteroposterior depth (APD) of the pharyngeal airway (PA) where post-operative PA obstruction was predicted, using computer fluid dynamics (CFD), in order to prevent obstructive sleep apnoea after mandibular setback surgery. Settings and sample population Nineteen skeletal Class III patients (8 men; mean age, 26.7 years) who required mandibular setback surgery had computed tomography images taken before and 6 months after surgery. Methods The APD of each site of the four cross-sectional reference planes (retropalatal airway [RA], second cervical vertebral airway, oropharyngeal airway and third cervical vertebral airway) were measured. The Maximum negative pressure (Pmax) of the PA was measured at inspiration using CFD, based on a three-dimensional PA model. Intersite differences were determined using analysis of variance and the Friedman test with Bonferroni correction. The relationship between APD and Pmax was evaluated by Spearman correlation coefficients and non-linear regression analysis. Results The smallest PA site was the RA. Pmax was significantly correlated with the APD of the RA (r(s) = .628,P < .001). The relationship between Pmax and the APD-RA was fitted to a curve, which showed an inversely proportional relationship of Pmax to the square of the APD-RA. Pmax substantially increased even with a slight reduction of the APD-RA. In particular, when the APD-RA was 7 mm or less, Pmax increased greatly, suggesting that PA obstruction was more likely to occur. Conclusions The results of this study suggest that APD-RA is a useful predictor of good PA ventilation after surgery.