Clinical study on changes and adaptations of physiological functions after orthognathic surgery

正颌手术后生理功能变化与适应的临床研究

• 批准号: 09470467
• 负责人: KATO Yoshiyuki
• 金额: $ 3.71万
• 依托单位: Tokyo Medical and Dental University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1997
• 资助国家: 日本
• 起止时间: 1997 至 1998
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09470467/
• 关键词: Tongue; Orthognathic surgery; Genioglossus muscle; Single motor unit; Respiration; Jaw deformity; Upper airway; Temporomandibular-joint disorder; 反射; Cervical Headgear; 上部気道; 睡眠呼吸障害

A) The genioglossus (GG) muscle shows a phasic inspiratory activity superimposed on tonic activity to maintain upper airway (UA) patency. However, discharge properties of single GG motor unit (MU) with respiratory-related activity remain to be determined. Single unit activities of 24 GG MUs with respiratory-related discharge were recorded during spontaneous nasal breathing in both the natural head position and 30ﾟ head-up position in 8 adult males. The inspiratory MU (IMU) showed the phasic activity during inspiration, whereas the inspiratory-expiratory MU (IEMU) showed the phasic inspiratory activity superimposed on the tonic activity. The firing duration and instantaneous firing frequency (1FF) of the IMU during inspiration significantly increased in the 30ﾟ head-up position. Although the 1FF of the IEMU also significantly increased in the 30ﾟ head-up position, there was no significant difference between inspiratory and expiratory phases. An interspike interval analysis demonstrated … More that the functional divergence of the IMU and IEMU.B) (1) To investigate morphologic changes in oropharyngeal structures in mandibular prognathic patients after or thognathic surgery, 25 patients with mandibular prognathism who had undergone surgical and or thognathic treatment were used. A set of 4 standardized lateral cephalograms were obtained from each subject preoperatively and at 3 months, 6 months, and I year postoperatively. Morphologic changes in UA structures were evaluated longitudinally by gender. Parameters of the anteroposterior width of the pharynx significantly decreased at 3 and 6 months in both genders, and these parameters tended to rebound to the preoperative values 1 year postoperatively in females, but not in males. The hyoid hone significantly descended inferiorly 1 year postoperatively in males, white there were no significant changes in females. The distance between the hyoid bone and the third vertebra gradually decreased in males postoperatively ; however, there were no significant changes in females. The cross-sectional area of the hypopharynx significantly decreased 1 year postoperatively in males, but not in females. These results indicate that the UA morphology changed differently in males and females following surgery. To compensate fro skeletal changes following surgery, it appears that males and females responded in differently ways to preserve a functional UA.(2) To extract characteristic three-dimensional dentofacial changes during retention and to clarify morphological factors affecting the stability of postoperative occlusion in mandibular prognathic patients with open bite and asymmetry, 7 adult patients were used. Changes in denture and skeletal components, and anterior occlusion during retention were analyzed three-dimensionally using the lateral and frontal cephalograms. Results indicated that it was important to maintain long-term stability of the anterior occlusion in the vertical dimension in patients with three-dimensional dentofacial deformity.C) (1) To investigate the relationship between the etiologic factors such as gender, age, and general joint mobility and temporomandibular joint (TMJ) disorders, 110 orthodontic patients were used. Fifty of 78 females and 17 of 32 males showed symptoms of TMJ disorders. No significant gender difference was observed in the prevalence of TMJ disorders. However, TMJ and muscular pain and difficulty in mouth opening were more frequently observed in female symptomatic patients than male patients. There was a significant relative risk of TMJ disorders associated with increasing age. Higher score of general joint mobility was also significantly associated with an increased risk of TMJ disorders. (2) The frequency of TMJ disorders in 174 patients with jaw deformities was surveyed by questionnaires and dental casts. The frequency of reported present or past TMJ disorders was 77.6%. No difference by gender was observed. When the frequency of TMJ disorders in different age groups was examined, the youngest being 15 years of age followed by others at increasing age intervals of 5 years, there was no significant difference between age groups. Among 135 symptomatic patients, 49 patients (36.3%) reported only one symptom of TM) disorders, while 86 patients (63.7%) reported two or more symptoms. As for potential etiologic factors and historical events, poor posture and experience of trauma were more frequently observed among symptomatic patients than asymptomatic patients. There was no significant difference in the frequency of TMJ disorders between different occlusomorphologic types. Less

A）颏舌肌（GG）显示叠加在强直活动上的阶段性吸气活动以维持上气道（UA）通畅。然而，放电性能的单一GG运动单位（MU）与癫痫相关的活动仍有待确定。本文记录了8名成年男性在自然头位和30 ° C头高位自主鼻呼吸时24个GG MU的单位活动。吸气MU（IMU）在吸气时表现出阶段性活动，而吸气-呼气MU（IEMU）表现出叠加在强直性活动上的阶段性吸气活动。在30 mm头高位时，IMU在吸气期间的放电持续时间和瞬时放电频率（1FF）显著增加。虽然在30 °头高位时IEMU的1FF也显著增加，但吸气和呼气相之间没有显著差异。峰间期分析表明， ...更多信息 B）（1）为探讨下颌骨无颌畸形患者手术前后口咽结构的形态学变化，选取25例下颌骨无颌畸形患者，均行手术或颌外科治疗。在术前和术后3个月、6个月和1年时，对每例受试者拍摄一组4张标准化头颅侧位片。UA结构的形态学变化按性别进行纵向评价。两种性别的咽前后宽度参数在3个月和6个月时均显著降低，女性术后1年这些参数趋于反弹至术前值，但男性未反弹。术后1年，男性舌骨明显向下，女性白色无明显变化。术后，雄性动物舌骨和第三椎骨之间的距离逐渐减小;然而，雌性动物无显著变化。术后1年，男性下咽部的横截面积显著减小，但女性没有。这些结果表明，UA的形态变化在男性和女性手术后不同。为了补偿手术后骨骼的变化，男性和女性似乎以不同的方式来保护功能性UA。(2)为了提取特征性的三维固位过程中的牙面变化，并澄清形态学因素影响术后咬合的稳定性，下颌开牙合和不对称的患者，7名成人患者。利用头颅侧位片和正侧位片，对义齿和骨骼部件以及前牙咬合在固位过程中的变化进行三维分析。结果表明，在三维牙面畸形患者中，保持前牙垂直向的长期稳定性是非常重要的。C）（1）研究110例正畸患者的性别、年龄、关节活动度等因素与颞下颌关节（TMJ）紊乱的关系。78名女性中有50名和32名男性中有17名表现出颞下颌关节紊乱症状。颞下颌关节紊乱病的患病率没有显著的性别差异。然而，颞下颌关节和肌肉疼痛和张口困难在女性症状患者中比男性患者更常见。颞下颌关节紊乱病的相对危险性与年龄的增加有关。一般关节活动度评分越高，颞下颌关节紊乱的风险也越高。(2)采用问卷调查和牙模法，对174例颌骨畸形患者的颞下颌关节紊乱病进行了调查。报告的现在或过去的颞下颌关节疾病的频率为77.6%。未观察到性别差异。当检查不同年龄组的颞下颌关节疾病的频率时，最年轻的是15岁，其次是以5年的年龄间隔增加的其他人，年龄组之间没有显著差异。在135名有症状的患者中，49名患者（36.3%）仅报告了一种TM障碍症状，而86名患者（63.7%）报告了两种或两种以上症状。至于潜在的病因因素和历史事件，有症状的患者比无症状患者更容易观察到不良姿势和创伤经历。颞下颌关节紊乱病的发生率在不同的咬合形态类型之间没有显著差异。少

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