骨性Ⅲ类患者正颌手术后上气道变化预测方法的研究现状

doi:10.13591/j.cnki.kqyx.2023.10.018

摘要/Abstract

摘要：

骨性Ⅲ类患者在进行正畸-正颌联合治疗的过程中,需要注意正颌手术时后退下颌骨对气道造成的影响,从而减小医源性阻塞性睡眠呼吸暂停综合征发生的概率。术前有效预测气道的变化,选择正确的术式,在整个治疗计划中至关重要。本文主要对骨性Ⅲ类患者上气道结构特点、上气道常用测量方法的优缺点、正颌术后气道的变化和现有的气道预测方法进行综述。

关键词: 骨性Ⅲ类, 上气道, 正颌手术

Abstract:

During the combined orthodontic-orthognathic treatment of orthopaedic Class Ⅲ patients, attention needs to be paid to the impact of receding mandible on the airway during orthognathic surgery, thus reducing the probability of medically induced obstructive sleep apnoea syndrome. Effective preoperative prediction of airway changes and selection of the correct procedure are essential in the overall treatment plan. This article reviews structural characteristics of the upper airway in patients with skeletal Class Ⅲ malocclusion, advantages and disadvantages of commonly used methods for measuring the upper airway, changes in the airway after orthognathic surgery and available methods for airway prediction.

Key words: skeletal class Ⅲ malocclusion, upper airway, orthognathic surgery

中图分类号:

R782.23

龚依玲, 樊蓉, 常新. 骨性Ⅲ类患者正颌手术后上气道变化预测方法的研究现状[J]. 口腔医学, 2023, 43(10): 955-960.

GONG Yiling, FAN Rong, CHANG Xin. Current research on predictive methods for upper airway changes after orthognathic surgery in orthopaedic Class Ⅲ patients[J]. Stomatology, 2023, 43(10): 955-960.

参考文献 45

[1]	Azevêdo MS, Machado AW, Barbosa I, et al. Evaluation of upper airways after bimaxillaryorthognathic surgery in patients with skeletal Class Ⅲ pattern using cone-beam computed tomography[J]. Dental Press J Orthod, 2016, 21(1):34-41.
[2]	Joy A, Park J, Chambers DW, et al. Airway and cephalometric changes in adult orthodontic patients after premolar extractions[J]. Angle Orthod, 2020, 90(1):39-46. doi: 10.2319/021019-92.1 pmid: 31403835
[3]	陈贵海, 张立强, 高雪梅, 等. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24):1902-1914.
[4]	Kang NE, Lee DH, In Seo J, et al. Postoperative changes in the pharyngeal airway space through computed tomography evaluation after mandibular setback surgery in skeletal Class Ⅲ patients: 1-year follow-up[J]. Maxillofac Plast Reconstr Surg, 2021, 43(1):31. doi: 10.1186/s40902-021-00319-1 pmid: 34448114
[5]	Iwasaki T, Hayasaki H, Takemoto Y, et al. Oropharyngeal airway in children with Class Ⅲ malocclusion evaluated by cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2009, 136(3):318-319. doi: 10.1016/j.ajodo.2009.04.010
[6]	Martin O, Muelas L, Viñas MJ. Comparative study of nasopharyngeal soft-tissue characteristics in patients with Class Ⅲ malocclu-sion[J]. Am J Orthod Dentofac Orthop, 2011, 139(2):242-251. doi: 10.1016/j.ajodo.2009.07.016
[7]	Hong JS, Oh KM, Kim BR, et al. Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible[J]. Am J Orthod Dentofacial Orthop, 2011, 140(4):e161-e169. doi: 10.1016/j.ajodo.2011.04.020
[8]	Bozzini MFR, Valladares-Neto J, Paiva JB, et al. Sex differences in pharyngeal airway morphology in adults with skeletal Class Ⅲ malocclusion[J]. Cranio, 2018, 36(2):98-105. doi: 10.1080/08869634.2017.1300995
[9]	Chokotiya H, Banthia A, Srinivasa RK, et al. A study on the evaluation of pharyngeal size in different skeletal patterns: A radiographic study[J]. J Contemp Dent Pract, 2018, 19(10):1278-1283. pmid: 30498186
[10]	吴剑豪, 王晓怡. 骨性Ⅲ类高角错牙合患者上气道长度、横截面积及体积的CBCT测量分析[J]. 口腔颌面修复学杂志, 2021, 22(6):441-444.
[11]	Pinheiro M, Ma XH, Fagan MJ, et al. A 3D cephalometric protocol for the accurate quantification of the craniofacial symmetry and facial growth[J]. J Biol Eng, 2019, 13: 42. doi: 10.1186/s13036-019-0171-6 pmid: 31131023
[12]	Neelapu BC, Kharbanda OP, Sardana HK, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies[J]. Sleep Med Rev, 2017, 31: 79-90. doi: S1087-0792(16)00016-2 pmid: 27039222
[13]	Uzuner FD, Aslan BI, Dinçer M. Dentoskeletal morphology in adults with Class Ⅰ, Class Ⅱ Division 1, or Class Ⅱ Division 2 malocclusion with increased overbite[J]. Am J Orthod Dentofacial Orthop, 2019, 156(2):248-256.e2. doi: 10.1016/j.ajodo.2019.03.006
[14]	Silva NNE, Lacerda RHW, Silva AWC, et al. Assessment of upper airways measurements in patients with mandibular skeletal Class Ⅱ malocclusion[J]. Dental Press J Orthod, 2015, 20(5):86-93. doi: 10.1590/2177-6709.20.5.086-093.oar
[15]	Kochel J, Meyer-Marcotty P, Sickel F, et al. Short-term pharyngeal airway changes after mandibular advancement surgery in adult Class Ⅱ-Patients: A three-dimensional retrospective study[J]. J Orofac Orthop, 2013, 74(2):137-152. doi: 10.1007/s00056-012-0132-x pmid: 23467732
[16]	Ravelo V, Olate G, Muñoz G, et al. The airway volume related to the maxillo-mandibular position using 3D analysis[J]. Biomed Res Int, 2021, 2021: 6670191.
[17]	Savoldi F, Gou XY, McGrath CP, et al. Reliability of lateral cephalometric radiographs in the assessment of the upper airway in children: A retrospective study[J]. Angle Orthod, 2020, 90(1):47-55. doi: 10.2319/022119-131.1 pmid: 31403838
[18]	Aboudara C, Nielsen I, Huang JC, et al. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2009, 135(4):468-479. doi: 10.1016/j.ajodo.2007.04.043
[19]	Larheim TA, Abrahamsson AK, Kristensen M, et al. Temporomandibular joint diagnostics using CBCT[J]. Dentomaxillofac Radiol, 2015, 44(1):20140235.
[20]	Ganugapanta VR, Ponnada SR, Gaddam KPR, et al. Computed tomographic evaluation of condylar symmetry and condyle-Fossa relationship of the temporomandibular joint in subjects with normal occlusion and malocclusion: A comparative study[J]. J Clin Diagn Res, 2017, 11(2):ZC29-ZC33.
[21]	Alwadei AH, Galang-Boquiren MTS, Kusnoto B, et al. Computerized measurement of the location and value of the minimum sagittal linear dimension of the upper airway on reconstructed lateral cephalograms compared with 3-dimensional values[J]. Am J Orthod Dentofacial Orthop, 2018, 154(6):780-787. doi: 10.1016/j.ajodo.2018.01.022
[22]	Alcalde LFA, Faria PEP, Nogueira RLM, et al. Computed tomography visualizing alterations in the upper airway after orthognathic surgery[J]. J Craniomaxillofac Surg, 2019, 47(7):1041-1045. doi: S1010-5182(18)30958-2 pmid: 31130356
[23]	Faur CI, Roman RA, Bran S, et al. The changes in upper airway volume after orthognathic surgery evaluated by individual segmentation on CBCT images[J]. Maedica, 2019, 14(3):213-219. doi: 10.26574/maedica.2019.14.3.213 pmid: 31798735
[24]	On SW, Kim HJ, Cho DH, et al. Silent changes in sleep quality following mandibular setback surgery in patients with skeletal Class Ⅲ malocclusion: A prospective study[J]. Sci Rep, 2019, 9(1):9737. doi: 10.1038/s41598-019-46166-z
[25]	Yang HJ, Jung YE, Kwon IJ, et al. Airway changes and prevale-nce of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback[J]. Int J Oral Maxillofac Surg, 2020, 49(3):342-349. doi: 10.1016/j.ijom.2019.07.012
[26]	Karan NB, Kahraman S. Evaluation of posterior airway space after setback surgery by simulation[J]. Med Biol Eng Comput, 2019, 57(5):1145-1150. doi: 10.1007/s11517-018-1943-8 pmid: 30673976
[27]	Irani SK, Oliver DR, Movahed R, et al. Pharyngeal airway evaluation after isolated mandibular setback surgery using cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2018, 153(1):46-53. doi: 10.1016/j.ajodo.2017.05.031
[28]	聂萍, 陶丽, 朱妍菲, 等. 2种不同正颌术式对骨性Ⅲ类错牙合畸形患者上气道形态的影响[J]. 上海口腔医学, 2018, 27(3):280-284.
[29]	Havron AG, Aronovich S, Shelgikar AV, et al. 3D Airway changes using CBCT in patients following mandibular setback surgery ± maxillary advancement[J]. Orthod Craniofac Res, 2019, 22(Suppl 1):30-35. doi: 10.1111/ocr.2019.22.issue-S1
[30]	Yang YX, Yang K, Zhao Y. Three-dimensional changes in the upper airway of skeletal Class Ⅲ patients after different orthognathic surgical procedures[J]. J Oral Maxillofac Surg, 2018, 76(1):155-164. doi: 10.1016/j.joms.2017.06.025
[31]	AlQahtani F, George JM, Bishawi K, et al. Comparison of oropharyngeal airway dimensional changes in patients with skeletal Class Ⅱ and Class Ⅲ malocclusions after orthognathic surgery and functional appliance treatment: A systematic review[J]. Saudi Dent J, 2021, 33(8):860-868. doi: 10.1016/j.sdentj.2021.09.013
[32]	Rizk MZ, Torgersbråten N, Mohammed H, et al. Stability of single-jaw vs two-jaw surgery following the correction of skeletal Class Ⅲ malocclusion: A systematic review and meta-analysis[J]. Orthod Craniofac Res, 2021, 24(3):314-327. doi: 10.1111/ocr.v24.3
[33]	He J, Wang Y, Hu H, et al. Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal Class Ⅲ malocclusion: A systematic review and meta-analysis[J]. Int J Surg, 2017, 38: 31-40. doi: 10.1016/j.ijsu.2016.12.033
[34]	Park JH, Kim HS, Choi SH, et al. Changes in position of the hyoid bone and volume of the pharyngeal airway after mandibular setback: Three-dimensional analysis[J]. Br J Oral Maxillofac Surg, 2019, 57(1):29-35. doi: S0266-4356(18)30674-0 pmid: 30598316
[35]	王雷, 韩培辉, 李永明, 等. 骨性Ⅲ类错牙合患者双颌手术后鼻咽及口咽部气道及其周围软硬组织的变化[J]. 实用口腔医学杂志, 2012, 28(3):333-337.
[36]	Aboul-HosnCentenero S, Hernández-Alfaro F. 3D planning in orthognathic surgery: CAD/CAM surgical splints and prediction of the soft and hard tissues results—our experience in 16 cases[J]. J Craniomaxillofac Surg, 2012, 40(2):162-168. doi: 10.1016/j.jcms.2011.03.014 pmid: 21458285
[37]	Alkhayer A, Piffkó J, Lippold C, et al. Accuracy of virtual planning in orthognathic surgery: A systematic review[J]. Head Face Med, 2020, 16(1):34. doi: 10.1186/s13005-020-00250-2 pmid: 33272289
[38]	Xia JJ, Shevchenko L, Gateno J, et al. Outcome study of computer-aided surgical simulation in the treatment of patients with craniomaxillofacial deformities[J]. J Oral Maxillofac Surg, 2011, 69(7):2014-2024. doi: 10.1016/j.joms.2011.02.018
[39]	Chen FS, Terada K, Hanada K, et al. Predicting the pharyngeal airway space after mandibular setback surgery[J]. J Oral Maxillofac Surg, 2005, 63(10):1509-1514. doi: 10.1016/j.joms.2005.06.007
[40]	Resnick CM, Inverso G, Wrzosek M, et al. Is there a difference in cost between standard and virtual surgical planning for orthognathic surgery?[J]. J Oral Maxillofac Surg, 2016, 74(9):1827-1833. doi: 10.1016/j.joms.2016.03.035
[41]	Lee HJ, Suh HY, Lee YS, et al. A better statistical method of predicting postsurgery soft tissue response in Class Ⅱ patients[J]. Angle Orthod, 2014, 84(2):322-328. doi: 10.2319/050313-338.1
[42]	Muto T, Yamazaki A, Takeda S, et al. Accuracy of predicting the pharyngeal airway space on the cephalogram after mandibular setback surgery[J]. J Oral Maxillofac Surg, 2008, 66(6):1099-1103. doi: 10.1016/j.joms.2008.01.003
[43]	Uribe F, Janakiraman N, Shafer D, et al. Three-dimensional cone-beam computed tomography-based virtual treatment planning and fabrication of a surgical splint for asymmetric patients: Surgery first approach[J]. Am J Orthod Dentofacial Orthop, 2013, 144(5):748-758. doi: 10.1016/j.ajodo.2012.10.029
[44]	Yamashita AL, Iwaki LCV, Pinto G, et al. Accuracy of two-dimensional pharyngeal airway space prediction for bimaxillary orthognathic surgery[J]. Oral Maxillofac Surg, 2018, 22(2):197-202. doi: 10.1007/s10006-018-0693-y pmid: 29623598
[45]	刘燕菲, 李运峰, 祝颂松. 虚拟手术设计在双颌正颌手术中的精准性研究[J]. 口腔疾病防治, 2020, 28(1):30-35. doi: 10.12016/j.issn.2096-1456.2020.01.005