Changes in nasal resistance and air way structure associated with orthognathic surgery.

本研究旨在探讨正颌外科手术(Obwegeser Dalpon‘t法)对鼻腔阻力和上咽呼吸道结构的影响。实验一观察了13例鼻腔内插管患者术后鼻腔阻力的变化，并于拔管后每天用面罩前置法测量鼻腔阻力。实验二以10例患者术前、术后头颅侧位片为材料，进行统计学分析和主观评价，得出以下结论：1.在插管侧，由于气管导管的机械压力，拔管后鼻腔阻力即刻降低并在第二天有所增加。术后第2天恢复至术前水平，无明显变化。非插管侧鼻腔阻力在拔管后即刻增加，第二天下降。围手术期的总阻力和纤维组织学检查结果无明显变化。盐酸曲马唑林鼻腔给药后，阻塞侧鼻腔阻力明显降低。咽部气道前后宽度略有减小，但远小于手术后下巴的退缩量。咽部呼吸道面积略有缩小，但不代表拔管后即刻有呼吸道阻塞。提示术后呼吸道安全，应注意术后2天的呼吸道管理。

The purpose of this study was to investigate the respiratory physiological and morphological effects of orthognathic surgery (Obwegeser Dalpon't method) on nasal resistance and upper pharyngeal air way structure.On experiment 1, the change of nasal resistance in postoperative period was investigated in thirteen patients who underwent nasal endtracheal intubation, and the nasal resistance was measured by the mask anterior method for every day after extubation.On experiment 2, materials were composed of pre and postoperative lateral cephalogram of ten individuals.The statistical results and subjective appraisal suggest the following conclusions :1. On the intubated side, the nasal resistance was decreased immediately after extubation due to mechanical pressure of the endotracheal tube, and increased on the next day. After 2nd post operative day, it returned to the preoperative value, and it did not change any more.2. On the not intubated side, the nasal resistance increased just after extubation, and decreased on next day.3. There was no significant change in total resistance and fiber scopic finding for the perioperative period.4. The nasal resistance of obstructed side was severly decreased after intra-nasal administration of tramazoline HCI.5. The width of pharyngeal air way was slightly decreased anteroposteriorly but this was much smaller than the amount of chin retraction associated with operation.6. The area of pharyngeal air way was slightly decreased but this was not indicate air way obstruction immediately after extubation.The findings in the present studies indicate the safty of air way in post-operative period and suggested the attention should be paid to the management of air way for two days after operation.