骨性Ⅲ类患者双颌正颌手术后上气道形态变化与颌骨移动量的相关性研究

doi:10.13591/j.cnki.kqyx.2024.07.006

Abstract

Abstract:

Objective To investigate the morphological changes in the upper airway after bimaxillary surgery in patients with skeletal Class Ⅲ malocclusion and the relationship between jaw movement and airway changes using CBCT. Methods This study involved 44 individuals(21 males and 23 females)receiving Class Ⅲ bimaxillary surgery. Preoperative and 3-6-month postoperative CBCT data were examined using Dophin3D 11.95 software. The alterations before and after upper airway surgery were analysed using paired t-test and non-parametric Wilcoxon rank sum test. The association between airway alterations and jaw movement was examined using Pearson’s correlation coefficient. Results Patients who underwent Class Ⅲ bimaxillary surgery had significantly reduced upper airway volume, sagittal cross-sectional area, and minimum cross-sectional area(P<0.01). A correlation exists between oropharyngeal volume change and point B change(P<0.05). When B point recession was >7 mm, the decrease in upper airway volume increased significantly(P<0.01), as did the risk of minimum cross-sectional area of the patient’s airway(P<0.01). Conclusion Class Ⅲ bimaxillary surgery reduces upper airway capacity. Postoperative reduction in upper airway capacity coincides with mandibular recession. Mandibular recession(>7 mm)may reduce postoperative upper airway capacity and increase the risk of OSAHS. Patients at risk of upper airway stenosis should have their protocol modified to reduce airway risk.

Key words: skeletal Class Ⅲ malocclusion, bimaxillary orthognathic surgery, pharyngeal airway, cone-beam computed tomography

CLC Number:

R782.23

LI Gen, GUO Songsong, CAI Guanhui, SUN Lian, SUN Wen, WANG Hua. Correlation between upper airway morphological changes and jaw movement after bimaxillary orthognathic surgery in patients with skeletal Class Ⅲ malocclusion[J]. Stomatology, 2024, 44(7): 515-521.

Figures/Tables 8

Fig.1

Fig.2

Fig.3

Tab.1

Tab.2

Tab.3

Analysis of correlation between airway and jaw movement change"

测量项目	统计值	A点矢状向变化量	A点垂直向变化量	B点矢状向变化量	B点垂直向变化量	PNS点矢状向变化量	PNS点垂直向变化量	H0点矢状向变化量	H0点垂直向变化量
总气道体积	r_s	0.099	-0.061	0.461	0.163	-0.067	0.120	-0.187	-0.041
	P	0.524	0.693	0.002^*	0.290	0.667	0.437	0.225	0.792
口咽体积	r_s	0.111	-0.043	0.431	0.231	-0.066	0.128	-0.221	-0.050
	P	0.474	0.783	0.004^*	0.132	0.670	0.407	0.150	0.747
上口咽体积	r_s	0.229	0.005	0.303	0.171	0.072	0.246	-0.135	-0.098
	P	0.135	0.973	0.046^*	0.268	0.641	0.107	0.382	0.525
下口咽体积	r_s	-0.027	-0.203	0.356	0.103	-0.108	0.058	-0.221	0.048
	P	0.861	0.187	0.018^*	0.505	0.487	0.709	0.149	0.758
咽下体积	r_s	-0.180	-0.004	0.283	0.066	-0.240	0.107	-0.066	-0.197
	P	0.241	0.979	0.063	0.668	0.116	0.488	0.669	0.200
总气道纵截面积	r_s	0.148	-0.083	0.379	0.105	0.047	0.153	-0.054	-0.087
	P	0.336	0.593	0.011^*	0.499	0.763	0.321	0.727	0.576
口咽纵截面积	r_s	0.241	-0.071	0.392	0.159	0.062	0.158	-0.131	0.03
	P	0.115	0.646	0.009^*	0.302	0.690	0.306	0.396	0.848
上口咽纵截面积	r_s	0.249	0.051	0.201	0.095	0.213	0.305	-0.144	-0.085
	P	0.103	0.744	0.191	0.540	0.165	0.044^*	0.351	0.583
下口咽纵截面积	r_s	0.022	-0.102	0.313	0.136	-0.145	0.028	-0.231	-0.013
	P	0.887	0.509	0.039	0.380	0.348	0.856	0.131	0.932
咽下纵截面积	r_s	-0.049	-0.216	0.068	-0.142	-0.102	0.057	-0.023	-0.086
	P	0.751	0.158	0.661	0.356	0.512	0.713	0.882	0.579
总气道横截面积	r_s	0.193	0.040	0.413	0.093	0.165	0.132	-0.082	0.080
	P	0.209	0.797	0.005^*	0.547	0.284	0.393	0.598	0.607
口咽横截面积	r_s	0.091	0.066	0.399	0.200	0.079	0.043	-0.190	0.061
	P	0.558	0.672	0.007^*	0.194	0.610	0.781	0.216	0.696
上口咽横截面积	r_s	0.199	0.000	0.434	0.219	0.112	0.157	-0.102	0.023
	P	0.194	0.998	0.003^*	0.153	0.468	0.308	0.509	0.882
下口咽横截面积	r_s	0.003	-0.189	0.279	0.131	-0.159	0.034	-0.212	0.072
	P	0.983	0.220	0.067	0.395	0.304	0.826	0.167	0.641
咽下横截面积	r_s	-0.057	-0.026	0.319	-0.026	-0.080	-0.011	-0.205	-0.092
	P	0.713	0.866	0.035^*	0.866	0.606	0.943	0.181	0.552

Tab.3

Tab.4

Tab.5

References 26

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测量项目	术前		术后		术后-术前		P
测量项目	平均值	标准差	平均值	标准差	平均值	标准差	P
ANB/(°)	-4.03	2.64	0.77	1.96	4.80	2.12	0.000^*
wits值/mm	-12.13	3.65	-3.98	2.97	8.16	2.82	0.000^*
A-Y轴/mm	1.59	3.23	3.16	3.70	1.57	1.65	0.000^*
A-X轴/mm	-61.64	4.27	-62.38	5.05	-0.74	2.23	0.033^*
B-Y轴/mm	8.88	5.68	3.39	5.29	-5.49	3.24	0.000^*
B-X轴/mm	-101.14	8.02	-99.98	6.99	1.17	3.02	0.014^*
PNS-Y轴/mm	-42.72	4.05	-39.93	3.99	2.79	1.67	0.000^*
PNS-X轴/mm	-53.41	4.06	-53.42	4.41	-0.01	1.52	0.953
H0-Y轴/mm	-37.28	7.63	-38.6	7.60	-1.33	3.68	0.021^*
H0-X轴/mm	-113.35	8.51	-115.73	9.57	2.38	4.69	0.002^*

测量项目	术前		术后		术后-术前		变化率	P
测量项目	平均值	标准差	平均值	标准差	平均值	标准差	变化率	P
气道体积/mm³
总气道	2 1381.1	8 275.5	17 442.3	6 002.7	-3 938.9	4 732.6	-16.39%	0.000^*
口咽区	15 745.0	6 576.9	12 525.2	4 745.4	-3 219.8	3 845.9	-17.88%	0.000^*
上口咽区	8 307.7	4 039.5	6 585.0	2 902.3	-1 722.8	2 475.0	-17.24%	0.000^*
下口咽区	7 539.2	3 274.5	5 837.0	2 509.8	-1 702.2	2 240.4	-19.15%	0.000^*
咽下区	5 629.3	2 168.8	4 914.7	1 891.1	-714.6	1 274.2	-10.61%	0.001^*
正中矢状面纵截面积/mm²
总气道	943.6	208.2	842.7	180.4	-100.9	130.8	-9.87%	0.000^*
口咽区	705.4	160.8	627.9	137.7	-77.5	95.0	-10.13%	0.000^*
上口咽区	385.3	93.6	345.1	68.5	-40.3	64.1	-8.78%	0.000^*
下口咽区	326.6	100.2	286.1	93.1	-40.5	64.9	-10.89%	0.000^*
咽下区	236.5	71.3	218.4	61.5	-18.0	53.9	-3.53%	0.032^*
最小横截面积/mm²
总气道	171.6	79.1	121.5	59.1	-50.1	57.5	-23.32%	0.000^*
口咽区	181.1	89.6	126.5	63.1	-54.6	63.4	-26.95%	0.000^*
上口咽区	191.9	102.8	146.0	81.3	-45.9	58.4	-20.99%	0.000^*
下口咽区	221.1	94.8	156.9	67.8	-64.3	78.0	-25.07%	0.000^*
咽下区	229.3	113.6	202.3	95.7	-27.1	92.9	-0.65%	0.060

测量项目	B点后退量<4 mm(15例)				B点后退量4~7 mm(15例)				B点后退量>7 mm(14例)
测量项目	平均值	标准差	变化率	P	平均值	标准差	变化率	P	平均值	标准差	变化率	P
气道体积/mm³
总气道	-1 626.5	2 780.6	-8.28%	0.040^*	-2 371.8	3 482.3	-11.37%	0.008^*	-7 489.5	5 879.2	-26.93%	0.002^*
口咽区	-1 446.2	2 017.8	-10.19%	0.015^*	-1 782.4	3 200.1	-10.47%	0.012^*	-6 166.4	4 648.7	-29.86%	0.002^*
上口咽区	-1 356.0	1 773.7	-16.20%	0.010^*	-467.2	1 709.2	-4.73%	0.173	-3 150.1	3 285.8	-27.37%	0.004^*
下口咽区	-724.9	1 994.9	-7.88%	0.181	-1 261.9	1 825.1	-16.61%	0.017^*	-3 055.6	2 411.3	-30.93%	0.002^*
咽下区	-248.3	1 123.1	-3.13%	0.406	-483.7	778.1	-9.32%	0.023^*	-1301.4	1 662.4	-17.97%	0.012^*
正中矢状面纵截面积/mm²
总气道	-39.5	90.3	-4.58%	0.112	-60.8	100.9	-6.53%	0.010^*	-187.3	152.7	-16.55%	0.002^*
口咽区	-33.1	70.9	-5.58%	0.092	-39.1	77.0	-5.29%	0.011^*	-147.9	98.6	-17.55%	0.001^*
上口咽区	-36.2	52.0	-8.70%	0.017^*	-5.1	50.5	-0.57%	0.222	-70.1	81.2	-14.47%	0.005^*
下口咽区	-10.7	63.4	-3.49%	0.525	-31.4	51.5	-9.50%	0.030^*	-76.9	61.4	-19.03%	0.000^*
咽下区	-9.5	44.1	-1.28%	0.416	-17.7	44.9	-4.51%	0.114	-24.9	71.0	-3.54%	0.001^*
最小横截面积/mm²
总气道	-29.5	35.6	-16.93%	0.006^*	-23.1	50.2	-8.49%	0.031^*	-89.8	64.0	-39.97%	0.001^*
口咽区	-26.7	41.5	-14.37%	0.026^*	-32.4	40.8	-20.50%	0.001^*	-98.1	81.3	-40.78%	0.001^*
上口咽区	-22.6	42.8	-10.51%	0.060	-27.2	60.6	-13.25%	0.028^*	-89.9	65.4	-36.21%	0.002^*
下口咽区	-34.7	68.7	-11.47%	0.070	-42.4	51.4	-21.92%	0.001^*	-107.1	97.1	-36.06%	0.002^*
咽下区	5.5	104.4	12.14%	0.842	-13.9	68.7	10.39%	0.177	-62.2	91.7	-19.49%	0.025^*

B点后退量	术前最小横截面积危险度秩平均值	术后最小横截面积危险度秩平均值	Z	P
<4 mm	13.43	16.68	-1.383	0.167
4~7 mm	13.79	17.03	-1.119	0.263
>7 mm	11.00	18.00	-2.985	0.003^*

Correlation between upper airway morphological changes and jaw movement after bimaxillary orthognathic surgery in patients with skeletal Class Ⅲ malocclusion

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