Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment
Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment
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DOI：
10.1016/j.ajodo.2014.01.026
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发表时间：
2014-09-01
影响因子：
3
通讯作者：
Jacobson, Richard L.
中科院分区：
文献类型：
--
作者：
Schendel, Stephen A.;Broujerdi, Joseph A.;Jacobson, Richard L.
简介：气道尺寸的增加与上颌前移 (MMA) 手术以及阻塞性睡眠呼吸暂停 (OSA) 的改善或消除有关。然而，MMA 后 OSA 患者上气道的 3 维形态、体积、高度、横截面积和直径变化尚不清楚。方法：通过术前和术后锥形束计算机断层扫描和多导睡眠图对接受 MMA 手术的中度或重度 OSA 患者进行评估。上气道空间也分为腭后空间和舌后空间，并分析体积、高度、横截面积、横向和前后直径的变化。结果：本研究纳入了连续 10 名术前平均呼吸暂停/呼吸不足指数为 46 并接受 MMA 手术治疗的 OSA 患者。其中男8例，女2例，平均年龄46岁，平均体重指数28。上呼吸道空间总容积平均增加2.5倍。腭后空间增加了 3.5 倍。舌后空间增加了1.5倍。横截面积的最大变化发生在舌后和腭后空间的横轴上。术后平均呼吸暂停/呼吸不足指数为4。结论：MMA 手术导致 OSA 患者上气道空间体积显着增加，气道形态从圆形变为椭圆形 f 形。这些作用的结合减少了上呼吸道空间的塌陷，从而改善或解决 OSA。
Introduction: Airway size increases are associated with maxillomandibular advancement (MMA) surgery and improvement or elimination of obstructive sleep apnea (OSA). The 3-dimensional morphologic, volumetric, height, cross-sectional surface area, and diameter changes of the upper airway in patients with OSA after MMA, however, are not well understood. Methods: Patients with moderate or severe OSA who underwent MMA surgery were evaluated by preoperative and postoperative cone-beam computed tomography scans and polysomnograms. The upper airway space was also divided into retropalatal and retroglossal spaces and was analyzed for volumetric, height, cross-sectional surface area, transverse, and anteroposterior diameter changes. Results: Ten consecutive OSA patients with an average preoperative apnea/hypopnea index of 46 and treated with MMA surgery were included in this study. There were 8 men and 2 women, with an average age of 46 years and an average body mass index of 28. There was an average of a 2.5-fold increase in the total volume of the upper airway space. The retropalatal space increased by 3.5-fold. The retroglossal space increased by 1.5-fold. The greatest change in a cross-sectional area occurred in the transverse axis in both the retroglossal and retropalatal spaces. The average apnea/hypopnea index was 4 postoperatively. Conclusion: MMA surgery results in a significant increase in the volume and a morphologic airway change from a round to an elliptical f shape in the upper airway space in patients with OSA. The combination of these actions reduces the collapsibility of the upper airway space, hence improving or resolving the OSA.