双颌手术后骨性Ⅲ类患者上气道、自然头位和舌骨位置变化的三维评估

doi:10.13591/j.cnki.kqyx.2024.08.007

摘要/Abstract

摘要：

目的本研究旨在评估双颌手术后骨性Ⅲ类患者上气道、自然头位和舌骨位置的短期和长期变化。方法在这项回顾性研究中,对骨性Ⅲ类患者分别在手术前(T0)、手术后3个月(T1)和手术后2年(T2)拍摄锥形束CT(cone-beam computed tomography,CBCT)。创建三维图像以评估术后变化,并分析上气道、自然头位和舌骨之间的相关性。结果对30例接受双颌手术的骨性Ⅲ类患者(男13例和女17例)进行了评估,他们的平均年龄为21岁(17~30岁)。T1和T2后,腭咽段、舌咽段和总上气道的体积明显缩小。下颌骨位置的变化与上气道体积的变化之间存在明显的相关性(P<0.05)。NSL/OPT和NSL/CVT在T1和T2后增大。NSL/CVT的变化与腭咽段和舌咽段体积的变化呈正相关(P<0.05)。结论双颌手术可能导致上气道体积减小、颅颈角增大、舌骨向下和向后移动。颅颈角的变化可能会引起上气道的改变。

关键词: 上气道, 骨性Ⅲ类, 双颌手术, 锥形束CT

Abstract:

Objective To assess short- and long-term changes in the upper airway, natural head position and hyoid bone position in skeletal Class Ⅲ patients after bimaxillary surgery. Methods In this retrospective study, the cone-beam computed tomography(CBCT) of skeletal Class Ⅲ patients was taken before surgery(T0), 3 months after surgery(T1) and 2 years after surgery(T2). Three-dimensional images were created to assess postoperative changes and the correlation between the upper airway, natural head position and hyoid bone was analyzed. Results Thirty skeletal Class Ⅲ patients(13 men and 17 women) who underwent bimaxillary surgery with a mean(SD)age of 21 years(a range of 17-30 years)were evaluated. A significant decrease was observed in the volume of palatopharynx, glossopharynx and total airway after T1 and T2. There was a significant correlation between changes in the position of the mandible and changes in the volume of the upper airway(P<0.05). The NSL/OPT angle and the NSL/CVT angle were greater after T1 and T2. The change in the NSL/CVT angle was positively correlated with the change in palatopharyngeal and glossopharyngeal volume(P<0.05). Conclusion Bimaxillary surgery may cause a decrease in upper airway volume, an increase in the cranio-cervical angle, and a downward and backward movement of the hyoid bone. Changes in the cranio-cervical angle may cause changes in the upper airway.

Key words: upper airway, skeletal Class Ⅲ, bimaxillary surgery, cone-beam computed tomography

中图分类号:

R783.5

郑瑶, 于少洋, 黄文莉, 董丽蓉, 张强, 袁晓. 双颌手术后骨性Ⅲ类患者上气道、自然头位和舌骨位置变化的三维评估[J]. 口腔医学, 2024, 44(8): 590-595.

ZHENG Yao, YU Shaoyang, HUANG Wenli, DONG Lirong, ZHANG Qiang, YUAN Xiao. Three-dimensional evaluation of changes in the upper airway, natural head position and hyoid bone position in skeletal Class Ⅲ patients after bimaxillary surgery[J]. Stomatology, 2024, 44(8): 590-595.

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参考文献 25

[1]	Kang NE, Lee DH, Seo JI, 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.
[2]	郭蕾, 康非吾, 陈袁伟. 正颌手术患者报告结局量表的研究现状[J]. 口腔颌面外科杂志, 2022, 32(5): 315-318. doi: 10.3969/j.issn.1005-4979.2022.05.009
[3]	Tseng YC, Hsiao SY, Cheng JH, et al. Postoperative skeletal stability and pharyngeal airway: Counterclockwise versus clockwise rotation during mandibular setback surgery[J]. Biomed Res Int, 2020: 3283080.
[4]	Kim SH, Choi SK. Changes in the hyoid bone, tongue, and oropharyngeal airway space after mandibular setback surgery evaluated by cone-beam computed tomography[J]. Maxillofac Plast Reconstr Surg, 2020, 42(1): 27.
[5]	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.
[6]	Yang HJ, Jung YE, Kwon IJ, et al. Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback[J]. Int J Oral Maxillofac Surg, 2020, 49(3): 342-349.
[7]	Kim MA, Kim BR, Youn JK, et al. Head posture and pharyngeal airway volume changes after bimaxillary surgery for mandibular prognathism[J]. J Craniomaxillofac Surg, 2014, 42(5): 531-535.
[8]	Lin XZ. Correlation study of increase of pharyngeal airway space after mandibular advancement, taking natural head position into consideration[J]. Br J Oral Maxillofac Surg, 2019, 57(8): 760-764. doi: S0266-4356(19)30268-2 pmid: 31345578
[9]	余紫嘉, 郑之峻. 自然头位在正畸领域的应用[J]. 实用临床医药杂志, 2021, 25(12): 113-118.
[10]	Achilleos S, Krogstad O, Lyberg T. Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: A short- and long-term cephalometric study in males[J]. Eur J Orthod, 2000, 22(4): 383-394.
[11]	Zheng LY, Jahn J, Vasavada AN. Sagittal plane kinematics of the adult hyoid bone[J]. J Biomech, 2012, 45(3): 531-536. doi: 10.1016/j.jbiomech.2011.11.040 pmid: 22176712
[12]	Samaha CJ, Tannous HJ, Salman D, et al. Role of surgical hyoid bone repositioning in modifying upper airway collapsibility[J]. Front Physiol, 2022, 13: 1089606.
[13]	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
[14]	Jiang YY. Correlation between hyoid bone position and airway dimensions in Chinese adolescents by cone beam computed tomography analysis[J]. Int J Oral Maxillofac Surg, 2016, 45(7): 914-921.
[15]	Jeong S, Sung J, Kim S, et al. Upper airway morphologic changes after mandibular setback surgery in skeletal Class Ⅲ malocclusion patients measured using cone beam computed tomography superimposition[J]. Int J Oral Maxillofac Surg, 2018, 47(11): 1405-1410.
[16]	Kang Y, Lee S, Gong Y, et al. Three-dimensional morphologic evaluation of the changes in the pharyngeal airway and hyoid bone after bimaxillary surgery in patients with skeletal Class Ⅲ malocclusion with facial asymmetry: A preliminary study[J]. Am J Orthod Dentofacial Orthop, 2022, 162(1): 42-50.
[17]	Tan SK, Tang ATH, Leung WK, et al. Three-dimensional pharyngeal airway changes after 2-jaw orthognathic surgery with segmentation in dento-skeletal Class Ⅲ patients[J]. J Craniofac Surg, 2019, 30(5): 1533-1538.
[18]	An JH, Park SB, Choi YK, et al. Cone-beam computed tomography evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery in patients with Class Ⅲ skeletal deformities: A 6-year follow-up study[J]. J Oral Maxillofac Surg, 2019, 77(12): 2534-2544.
[19]	Jakobsone G, Stenvik A, Espeland L. The effect of maxillary advancement and impaction on the upper airway after bimaxillary surgery to correct Class Ⅲ malocclusion[J]. Am J Orthod Dentofacial Orthop, 2011, 139(4 Suppl): e369-e376.
[20]	Giap HV, Shin JW, Chae HS, et al. Pharyngeal airway morphology in skeletal Class Ⅲ with mandibular asymmetry is improved after bimaxillary orthognathic surgery[J]. J Oral Maxillofac Surg, 2021, 79(5): 1107-1121.
[21]	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.
[22]	Souza Pinto GN, Iwaki Filho L, Previdelli ITDS, et al. Three-dimensional alterations in pharyngeal airspace, soft palate, and hyoid bone of Class Ⅱ and Class Ⅲ patients submitted to bimaxillary orthognathic surgery: A retrospective study[J]. J Craniomaxillofac Surg, 2019, 47(6): 883-894.
[23]	Khaghaninejad MS, Khojastehpour L, Danesteh H, et al. Changes in the pharyngeal airway after different orthognathic procedures for correction of Class Ⅲ dysplasia[J]. Maxillofac Plast Reconstr Surg, 2022, 44(1): 23.
[24]	Eggensperger N, Smolka W, Iizuka T. Long-term changes of hyoid bone position and pharyngeal airway size following mandibular setback by sagittal split ramus osteotomy[J]. J Craniomaxillofac Surg, 2005, 33(2): 111-117. pmid: 15804590
[25]	Bibby RE, Preston CB. The hyoid triangle[J]. Am J Orthod, 1981, 80(1): 92-97. doi: 10.1016/0002-9416(81)90199-8 pmid: 6942659

参考点	定义
Na	鼻额缝的最前点
Ba	枕骨大孔前缘中点
Se	蝶鞍中心点
OrR	右侧眶下缘中点
PoL	左侧外耳道最上点
PoR	右侧外耳道最上点
Roof	鼻咽顶部
PNS	硬腭的最后点
A	前鼻棘与上牙槽缘点之间的骨部最凹点
B	下牙槽突缘点与颏前点之间的骨部最凹点
H	舌骨最上最前点
C2s	第二颈椎上后极切点
C2i	第二颈椎下后点
C4i	第四颈椎下后点
CV2	第二颈椎下前点
CV3	第三颈椎下前点
CV4	第四颈椎下前点

变量		T0	T1	T2	T1-T0	P	T2-T0	P	T2-T1	P
骨骼位置
PNS/mm	Y轴	18.20±2.67	20.58±3.42	20.26±3.41	2.38±2.30	0.003^**	2.06±2.21	0.003^**	-0.32±0.38	0.064
	Z轴	44.05±3.34	44.15±3.36	44.22±3.15	0.10±1.05	0.694	0.17±0.70	0.272	0.07±0.55	0.813
A/mm	Y轴	63.51±3.62	65.43±3.87	65.16±3.96	1.92±2.16	0.015^*	1.66±2.04	0.041^*	-0.26±0.46	0.075
	Z轴	51.89±5.62	51.77±5.31	51.74±5.40	-0.13±2.54	0.875	-0.14±2.34	0.753	-0.02±0.72	0.637
B/mm	Y轴	69.06±5.75	64.04±6.58	64.35±6.74	-5.03±4.25	0.005^**	-4.71±4.05	0.005^**	0.31±0.95	0.308
	Z轴	95.25±8.43	93.83±6.84	93.56±7.26	-1.41±4.22	0.239	-1.68±3.01	0.099	-0.27±1.50	0.480
H/mm	Y轴	19.35±6.80	14.95±6.27	15.85±6.32	-4.39±3.80	0.006^**	-3.50±2.51	0.005^**	0.90±1.50	0.099
	Z轴	98.44±10.14	105.15±11.08	103.89±11.34	6.71±4.00	0.003^**	5.46±3.93	0.003^**	-1.26±0.73	0.003^**
颅颈角
NSL/OPT/(°)		99.06±6.02	101.44±6.15	102.80±5.59	2.38±2.73	0.015^*	3.64±2.67	0.005^**	1.25±1.80	0.031^*
NSL/CVT/(°)		101.92±4.43	104.35±4.83	104.70±4.72	2.43±2.06	0.005	2.79±1.91	0.003	0.36±1.74	0.197

变量	T0	T1	T2	T1-T0	P	T2-T0	P	T2-T1	P
NP/mm³	8 226.89± 2 707.39	7 710.40± 3 356.70	8 124.25± 3 051.18	-611.80± 1415.68	0.182	-197.94± 879.80	0.328	413.85± 695.61	0.062
PP/mm³	14 598.61± 5 386.37	11 217.05± 4 080.98	11 808.52± 4 032.12	-3 381.55± 2 807.76	0.003^**	-2 790.09± 2 358.70	0.003^**	591.46± 664.30	0.005^**
GP/mm³	6 417.16± 2 036.86	5 335.74± 1 162.28	5 571.05± 1 284.02	-1 081.41± 1 294.44	0.008^**	-846.11± 1029.61	0.008^**	235.30± 295.57	0.023^*
HP/mm³	6 262.70± 2 138.28	5 497.59± 1 600.29	5 697.34± 1 497.32	-765.10± 1913.80	0.239	-565.36± 1446.35	0.347	199.74± 514.00	0.209
TP/mm³	35 697.66± 11 382.63	29 550.84± 8 905.01	31 053.32± 9 013.40	-6 146.82± 5 991.69	0.002^**	-4 644.33± 4 960.28	0.003^**	1 502.48± 1 209.72	0.002^**

变量	ΔNP		ΔPP		ΔGP		ΔHP				ΔTP				H-ΔY				H-ΔZ
变量	T1-T0	T2-T0	T1-T0	T2-T0	T1-T0	T2-T0	T1-T0		T2-T0		T1-T0		T2-T0		T1-T0		T2-T0		T1-T0		T2-T0
上下颌骨位置变化
PNS-ΔY	-0.015	0.109	-0.019	0.110	0.152	0.260	0.118	0.218		0.087		0.251		0.165		0.136		-0.169		0.137
PNS-ΔZ	0.338	0.109	0.025	0.007	-0.141	-0.044	0.004	0.083		0.031		0.056		0.012		-0.018		0.222		-0.019
A-ΔY	-0.033	-0.047	0.490	0.453	0.529	0.440	0.480	0.436		0.552		0.577		-0.401		-0.553		-0.421		-0.553
A-ΔZ	-0.262	-0.242	0.542	0.311	0.451	0.231	0.158	0.060		0.325		0.051		-0.048		0.149		0.222		0.149
B-ΔY	-0.150	-0.189	0.402	0.434	0.462	0.509	0.466	0.497		0.586^*		0.621^*		-0.496		-0.455		-0.577		-0.455
B-ΔZ	-0.243	-0.299	0.546	0.507	0.421	0.447	0.118	0.218		0.169		0.189		0.092		0.089		0.029		0.089
颅颈角变化
NSL/OPT	0.046	0.271	0.430	0.544	0.054	0.423	-0.226	0.323		0.176		0.468		-0.084		0.002		0.337		0.002
NSL/CVT	-0.565	-0.097	0.300	0.594^*	0.172	0.615^*	-0.000	0.547		0.001		0.431		0.037		-0.253		0.183		-0.254