矢状骨面型与上气道形态和舌骨位置关系的研究

目的 研究不同矢状骨面型上气道形态和舌骨位置的差异。方法 对182名恒牙早期青少年按ANB角大小分为I类、Ⅱ类和Ⅲ类三种不同矢状骨面型组，三组的年龄、性别相匹配，垂直骨面型以及腺样体情况三组间分布一致。对上气道矢状径和舌骨位置进行X线头影测量分析，并比较三组间的差异。结果三组间鼻咽段和腭咽段矢状径无显著差异；从悬雍垂尖向下，随ANB角的增大咽腔矢状径有减小趋势，Ⅱ类患者的舌咽矢状径显著小于Ⅲ类。舌骨的垂直向位置三组间无显著差异；水平方向上，Ⅲ类、Ⅰ类、Ⅱ类舌骨位置逐渐后移，Ⅱ类和Ⅰ类比Ⅲ类显著后位。结论 以ANB角为代表与面部矢状发育与上气道鼻咽、腭咽和舌骨垂直向位置无明显关系，而对上气道下段的舌咽和舌骨的矢状位置有显著影响，这可能与不同矢状骨面型下颌大小位置发育差异有关。     

正颌手术前后舌骨位置和咽下气道变化及相关性研究

目的　通过X线头影测量分析了解颌骨后退与前徙对舌骨位置及咽下气道变化的影响情况,为临床治疗提供参数。方法　下颌前突患者23例与小颌畸形患者9例,分别行双侧矢状劈开后退或前徙下颌,手术前后拍摄X线头颅定位侧位片,进行头影测量,测量项目13项,测量数值配对t检验,并将下颌后退距离与各测量项目变化值作相关分析。结果　各测量项目显著差异的有:(1)下颌前突组,下咽腔矢状面积(PSA),舌骨垂直向变化,舌根后缘至咽后壁距离(TBPW),舌背高点至FH平面距离(DTFH),会厌谷至咽后壁距离(VPW),悬雍垂尖点至后咽壁距离(UPW),下颌颏部水平、垂直向变化(PogPTV,MeFH)。舌骨垂直向变化与下颌颏部垂直向变化显著相关。(2)小颌畸形组,舌骨垂直向变化显著。结论　下颌前突组,(1)舌骨向下移位,舌背上抬,舌根向后移动。(2)咽腔气道空间缩小可表现为永久性,但后气道间隙接近正常人,不会发生通气阻塞,更未出现OSAS。舌骨与下颌前部垂直向变化呈负相关。(3)小颌畸形组,舌骨垂直向显著变化,舌骨因颏舌骨肌牵拉而上移。舌骨水平向无显著移位。除会厌谷前移外,舌体无显著移位,说明颌骨前徙对舌体形态没有大的影响。颌骨前徙对后气道无明显影响。从临床病例来看,小颌畸形愈重,前徙颌骨手术对周围组织结构的影响愈大。     

恒牙早期青少年上气道宽度及舌骨位置的X线头影测量研究

目的：研究恒牙早期青少年不同矢状骨面型上气道宽度及舌骨位置,从而探讨阻塞性睡眠呼吸暂停综合症发病与矢状骨面型的关系。方法：对110名青少年分成3组,分别为Ⅰ、Ⅱ、Ⅲ类骨面型,无鼾症,无腺样体,扁桃体肥大等咽部疾患,进行X线头影测量分析,研究不同矢状骨面型的气道宽度,舌骨位置。结果：通过ANB角进行分组,得出3种矢状骨面型青少年的气道宽度值,舌骨位置值和变异范围,并比较3组间的差异。结论：3组矢状骨面型间腭咽宽度无显著性差异,但舌咽宽度Ⅱ、Ⅰ、Ⅲ类有渐增大趋势,并且Ⅱ类与Ⅲ类比较舌咽宽度有显著性差异,舌骨垂直向位置无明显关系,而矢状位置有显著差异。     

不同矢状骨面型无鼾症青年上气道形态的锥形束CT分析

目的研究不同矢状骨面型的无鼾症青年错牙合畸形患者上气道形态和舌骨位置的差异。方法在自然头位下,对Ⅰ类、Ⅱ类和Ⅲ类矢状骨面型无鼾症青年错牙合畸形患者各30例进行锥形束CT扫描,借助Dolphin imaging 11.0图像分析软件进行三维重建,并分别测量上气道腭后区、舌后区的矢状径、横径、轴面面积以及上气道容积,最小轴面面积和上气道长度。使用Winceph 7.0软件对侧位片进行头影测量以及舌骨位置的测量,并对测量结果进行统计学分析。结果Ⅰ类、Ⅱ类矢状骨面型组舌后区及腭后区轴面面积均小于Ⅲ类矢状骨面型组。Ⅱ类矢状骨面型组与Ⅲ类矢状骨面型组间的舌后区矢状径,横径,上气道容积,舌骨位置有显著差异性。结论不同矢状骨面型无鼾症青年错牙合畸形患者上气道形态和舌骨位置存在一定的差异,差异有统计学意义。矢状向颌骨关系对上气道形态和舌骨位置有一定影响。     

OSAS患者直立位和仰卧位X线头影测量研究

ＯＳＡＳ患者睡眠期间体位变化能影响软组织姿势位，并通过重力影响上气道，本研究通过对ＯＳＡＳ患者直立位和仰卧的Ｘ线头影测量结果的分析比较表明：仰卧位趋于使上气道变窄，尤其是软腭后气道间隙减小；舌骨及会厌谷位置明显前移；舌背位置升高，舌背与硬软腭之间空隙减小；舌面积占上下颌间隙的比例增大，即舌和／或软腭与气道之间的大小比例异常在仰卧位更趋严重。此与临床现象相吻合，即多数鼾症或ＯＳＡＳ患者其症状在仰卧位较侧卧位明显。不同个体间上气道及周围结构受体位影响的部位和程度不同     

阻塞性睡眠呼吸暂停综合征患者舌后区上呼吸道CT测量

目的 对阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS)患者和健康人的舌体及舌后区上呼吸道的CT测量资料进行对比研究。方法 OSAS患者共59例，年龄与性别相近的健康成年人57名，采用螺旋CT对上呼吸道进行连续扫描，观察2组舌后区上呼吸道形态学的差异，测量并比较舌后区气道和舌体各测量参数的差别。结果 患者多表现为气道前后径大于左右径、颏舌肌分离、舌根与软腭接触和舌正中切迹。患者组舌后区上呼吸道的横截面积、左右径明显小于对照组；咽侧壁软组织厚度、舌体宽度、颏舌肌宽度、舌骨舌肌宽度和舌体横截面积均明显大于对照组；呼吸道前后径、咽后壁软组织厚度和舌体长度与对照组相比无明显变化。结论 OSAS患者舌后区上呼吸道较健康对照组狭窄，除咽侧壁软组织增厚外，颏舌肌、舌骨舌肌和舌体宽度的增加也是造成舌后区上呼吸道狭窄的主要原因。     

矢状Ⅱ类不同垂直骨面型成人舌骨位置的测量分析

目的研究矢状Ⅱ类不同垂直骨面型成人舌骨位置的特点及差异。方法选取成人矢状Ⅱ类不同垂直骨面型者135例的头颅侧位定位片,男性60例,女性75例。对每张头颅侧位定位片进行舌骨位置的测量并分别比较不同性别、不同垂直骨面型者舌骨位置的差异及舌骨位置与下颌平面角的相关关系。结果舌骨水平向测量指标AH-CVP和AH-C3在各垂直骨面型组均为男性大于女性,舌骨垂直向各测量指标在各垂直骨面型组几乎均为男性大于女性。AH-Or与下颌平面角正相关。结论矢状Ⅱ类不同垂直骨面型者舌骨位置存在某些差异,主要表现为男性舌骨位置较女性偏向前下方。舌骨位置与下颌平面角的大小存在一定相关关系。     

替牙期不同垂直骨面型儿童上气道形态和舌骨位置差异的研究

目的:比较替牙期不同垂直骨面型儿童上气道形态和舌骨位置的差异,为临床诊疗和颅面部生长发育的研究提供一定的参考依据。方法:采用计算机辅助X线头影测量技术,对120名替牙期不同垂直骨面型儿童的X线头颅定位侧位片进行测量研究,比较不同性别,不同垂直骨面型组间上气道矢状径和舌骨位置的差异。结果:上气道矢状径:女性大于男性,但除低角组PNS-Ad2、PNS-UPW、SPP-SPPW、U-MPW外无统计学差异;不同垂直骨面型组间存在统计学差异,高角组<均角组<低角组。舌骨位置:男性比女性偏前下;高、均、低角组间舌骨垂直向位置无显著差异,水平方向上高角、均角、低角组舌骨位置逐渐前移。结论:替牙期不同垂直骨面型儿童上气道形态,舌骨位置存在差异。     

无鼾老年人上气道及周围结构矢状面测量分析

目的建立无鼾正常老年男女性上气道及周围结构矢状面52项测量项目的正常值范围并作比较。方法摄取无鼾正常老年男性38名、女性18名的X线头颅定位侧位片,测量分析上气道及周围结构52项测量项目,行统计学t检验。结果建立两组人群上气道及周围结构矢状面52项测量项目的正常值范围,老年男性上气道矢状面较宽,软腭、舌体较大,但软腭、舌体占口咽腔比例、上下颌骨关系、下颌平面角、软腭及舌的倾斜度、下气道咽后壁厚度两组差异无显著性。结论老年男女人群上气道及周围结构矢状面不尽相同,老年女性上气道矢状面宽度较男性窄。     

正常男性青、老年人上气道结构的矢状面测量分析

目的　探讨无鼾正常男性青年及老年人群上气道及周围组织 5 2项测量项目的正常值范围 ,比较两组间差异。方法　摄取无鼾正常男性青年 47名、老年 3 8名的X线头颅定位侧位片并使用开发软件测量上气道及周围结构 5 2个测量项目 ,对测量值进行统计学T检验。结果　两组人群多为低角面型。老年组下颌骨颏部靠后 ,会厌及舌骨靠前下方 ,上气道鼻咽径及会厌至咽后壁距较宽 ,悬雍垂尖至咽后壁距较窄 ,软腭长而肥厚 ,舌体厚而较直立 ,与软腭接触长度大 ,舌及软腭占口腔及上气道面积较大。结论　二组上气道结构有差异 ,应分年龄段建立上气道及周围结构的正常值范围     

Uvulo-glosso-pharyngeal dimensions in subjects with beta-thalassaemia major

The purpose of this study was to investigate cephalometrically the uvulo-glosso-pharyngeal dimensions in subjects with beta-thalassaemia major. The subjects were 15 thalassaemic patients (eight males, seven females) with a mean age of 14.13 +/- 1.06 years. The variables measured on the lateral cephalograms were tongue height and length, soft palate length and thickness, superior, middle and inferior pharyngeal airway space, and hyoid bone position. The thalassaemic group was compared with a normal control group matched for sex and age using a t-test. The results showed that thalassaemic patients had a smaller tongue size (length P < 0.05, height P < 0.001), shorter soft palate (P < 0.001), smaller upper (P < 0.001) and middle (P < 0.05) pharyngeal airway spaces, and a shorter vertical pharyngeal length (P < 0.05). The hyoid bone in thalassaemic patients was closer to the mandibular plane (P < 0.001).     

肥胖伴OSAHS患者X线头影测量研究

目的 分析肥胖伴OSAHS患者头影软硬组织的测量特征。方法 采用本科开发的OSAHS患者计算机头影测量分析系统，对67例年龄在40～60岁、BMI≥30以上的OSAHS患者(诊断经nPSG监测确立，患者AHI≥51和12例同年龄组的正常人头影软硬组织进行测量对照分析。结果 本组肥胖伴OSAHS患者头影硬组织测量特征表现为下颌骨后缩，舌骨向后下移位；软组织测量特征上表现为舌、软腭矢状面积显著增加，舌、软腭占口咽腔比明显增加，软腭后和舌后咽径明显减小。口咽部狭窄(软腭和舌后区)最多见(54．02％)，软腭水平咽腔阻塞占29．89％，上、中、下咽腔同时阻塞为1．15％，87．35％肥胖伴OSAHS患者存在上气道狭窄，72．41％患者为多部位阻塞。结论 大部分肥胖伴OSAHS患者头影硬组织测量存在异常，此类患者睡眠时上气道通气不畅多发生于口咽区，大部分患者为多部位狭窄或阻塞。     

Reliability of Lateral Cephalometric Radiographs in the Assessment of the Upper Airway in Children: A Retrospective study

ObjectivesTo test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue.Materials and MethodsThe records of 57 healthy Chinese children from a nonhospital population (mean age = 12.6 years, SD = 0.5, 28 males and 29 females) who received two consecutive LCRs in the natural head posture were retrospectively analyzed. Fifteen linear, angular, and area measurements were used to describe the airway, hyoid bone, soft palate, and tongue. The reliability between the two LCRs was assessed with the intraclass correlation coefficient (ICC) and F-test. Errors were estimated with the Dahlberg and Bland-Altman method, and intra- and inter-assessor agreements were determined.ResultsMeasurements of upper airway and hyoid bone had excellent method reliability, intra-assessor reliability, and inter-assessor reliability (ICC > 0.8). However, the method reliability and the inter-assessor reliability for soft palate and tongue was less favorable (ICC from 0.60 to 0.96). Soft palate area and thickness were the most critical parameters. Intra-assessor reliability was greater than both method reliability and inter-assessor reliability (which were similar).ConclusionsThe measurement of upper airway morphology, defined as the intramural space, and of the hyoid bone position were highly reliable on LCRs of children. However, the limited reliability in the assessment of tongue and soft palate area may compromise the diagnostic application of LCRs to these structures.     

A cephalometric study of the cervical and palatal movements during growth

The sagittal and anterior position of the hyoid bone is at the origin of the changes in orientation of the palatine laminae. A posterior-anterior movement of this bone allows the tongue to liberate the posterior part of the oral cavity; the palatine laminae rotate forwards and downwards. The opposite case is verified in the same way; the naso-palatine canal is a very malleable area, allowing a lowering of the anterior part of the palatine laminae. The vertical variations of the hyoid bone have little effect on the palate.     

Surgical mandibular advancement and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males

The aim of the present study was to investigate, by means of an extensive cephalometric examination, the alterations which took place in hyoid bone position, head posture, position and morphology of the soft palate, and tongue and sagittal dimensions of the pharyngeal airway after mandibular advancement osteotomy for the correction of mandibular retrognathism. The sample consisted only of adult males who underwent mandibular advancement by bilateral sagittal ramus split osteotomy (BSRO) with rigid fixation. Profile cephalograms were obtained 1-3 days before surgery (20 subjects), and 6 months (20 subjects) and 3 years (19 subjects) after the surgery. Statistical evaluation was performed by paired Student's t-test and Pearson product moment correlation analysis. At the short-term follow-up, hyoid bone and vallecula assumed a more superior (AH perpendicular FH, AH perpendicular ML, AH perpendicular S, V perpendicular FH) and anterior position (AH-C3 Hor, V-C3), which was maintained at the long-term follow-up. The soft palate (NL/PM-U) became more upright at the short-term follow-up. The tongue demonstrated a transient increase in height (H perpendicular VT) and a less upright position (VT/FH) at the long-term observation. In addition, a more upright cervical spine (OPT/HOR, CVT/HOR) was recorded at the long-term follow-up. The pharyngeal airway space at the level of the oropharynx (U-MPW) and the retroglossal space at the base of the tongue (PASmin) showed an increase in the sagittal dimension at the short-term follow-up. Significant widening at the PASmin level was sustained at the long-term follow-up, indicating that mandibular advancement osteotomy could increase airway patency and be a treatment approach for sleep apnoea in selected patients.     

Relationship of the hyoid bone and posterior surface of the tongue in prognathism and micrognathia

In order to study relationship of the hyoid bone and posterior surface of the tongue in prognathism and micrognathia, we focused on the effect of the tongue on the upper airway lumen in 16 patients with Angle's Class II and 51 patients with Angle's Class III, and assessed the position of the hyoid, the depth from the posterior surface of the tongue, from the bottom of the vallecula and from hyoid bone to the posterior pharyngeal wall using lateral cephalograms. We were able to assess significant correlations between the posterior surface of the tongue and hyoid position in Angle's Class III. However, we found no association between them in Angle's Class II. This could be an adaptive feature of the genioglossus in response to hyoid localization to serve a compensatory role to prevent respiratory impairment in micrognathia at risk of apnoea.     

Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males

A detailed cephalometric analysis was conducted on a sample of 31 adult males who underwent correction of mandibular prognathism by mandibular setback osteotomy (BSRO) with rigid fixation to evaluate the changes in uvuloglossopharyngeal morphology, hyoid bone position and head posture. Lateral cephalograms were obtained 1-3 days prior to the operation and at standardized 6 months and 3 years post-operative follow-up. Statistical evaluation was performed by paired Student's t-test and Pearson product moment correlation analysis. Inferior position of the hyoid bone (AH perpendicular FH, AH perpendicular ML, AH perpendicular S) and valeculla (V perpendicular FH) was recorded at the 6-month follow-up, a transient finding as at 3 years almost complete recovery to their pre-surgical position was noted. No posterior displacement of the above structures (AH-C3 Hor, V-C3) was recorded. Soft palate length (pm-U) was increased and maintained at the long-term follow-up while its posture (NL/pm-U) became less upright. The tongue showed increased length (V-T) and sagittal area (TA) and a more upright posture (VT/FH) at the late follow-up. Increased contact length between tongue and the soft palate (CL) and less residual oropharyngeal area [area not occupied by soft tissues, (TA + SPA)/OPA] was found at the long-term follow-up. Craniocervical agulation (NSL/OPT, NSL/CVT) was increased indicating cervical hyperflexion at the 3-year follow-up. Reduction of the sagittal dimension of the oropharyngeal airway space (U-MPW) appeared at the first follow-up and was sustained at the longest follow-up which, in conjunction with the decrease in residual oropharyngeal area, could raise questions regarding airway patency after mandibular setback osteotomy.     

Morphological changes in the pharyngeal airway of female skeletal class III patients following bimaxillary surgery: A cone beam computed tomography evaluation

Using cone beam computed tomography (CBCT), the present study compared three-dimensional (3D) changes in the pharyngeal airway and surrounding tissues in female skeletal class III patients treated with bimaxillary surgery. Twenty-nine female skeletal class III patients with both maxillary hypoplasia and a mandibular excess underwent bilateral sagittal split ramus osteotomy for mandibular setback combined with Le Fort I osteotomy for maxillary advancement. Volumetric measurements were performed using CBCT scans taken at 1 week presurgery and 6 months post-surgery. The oropharynx volumes and the cross-sectional area behind the soft palate decreased significantly. There was an insignificant change in the volume of the nasopharynx (P > 0.05). The hyoid bone moved downward and posteriorly after surgery. The morphology of the soft palate also changed dramatically, with an increase in the length and thickness. Negative correlations were found between the pharyngeal airway space and the position of the hyoid bone. The change in morphology of the soft palate was significantly correlated with the changes in hyoid bone position. These 3D results suggest that bimaxillary orthognathic surgery significantly changes the position of the hyoid bone and the soft palate together with a significant decrease in the pharyngeal airway space in the correction of skeletal class III malocclusion.     

基于锥形束CT分析骨性Ⅱ类错牙合畸形患者舌体舌骨位置及形态特征的研究

目的　应用锥形束CT（cone-beam CT,CBCT）研究骨性Ⅱ类错牙合畸形患者的舌体、舌骨位置及形态特征。方法　选取2016年1月至2018年12月于上海交通大学附属第九人民医院口腔正畸科就诊的骨性Ⅱ类错牙合畸形患者35例（Ⅱ组）、骨性Ⅰ类错牙合畸形患者35例（Ⅰ组）。各组患者根据垂直骨面型又分为高角型、均角型和低角型。所有患者拍摄CBCT,比较各组及各型患者舌体、舌骨位置及形态差异。结果　（1）两组患者舌体位置各项指标测量结果比较,差异均有统计学意义（均P < 0.05）,且Ⅱ组的测量值均大于Ⅰ组;两组患者舌体长度比较,差异无统计学意义（P > 0.05）,而Ⅰ组患者舌体矢状截面面积大于Ⅱ组,差异有统计学意义（均P < 0.05）。（2）两组患者舌骨位置测量结果比较发现,Ⅱ组患者的H-H′ （舌骨顶点到颈椎点和颏下点连线的垂直距离）和H-Y（舌骨顶点到PS平面的垂直距离）均大于Ⅰ组,差异有统计学意义（均P < 0.05）;而两组患者舌骨形态测量结果比较,差异均无统计学意义（均P > 0.05）。（3）Ⅰ组低角型患者舌体长度与H-Me（舌骨顶点至颏下点的距离）的测量结果较均角型和高角型患者的大,差异均有统计学意义（均P < 0.05）;而Ⅱ组不同垂直骨面型患者舌体、舌骨位置及形态的各项指标测量结果比较,差异均无统计学意义（均P > 0.05）。结论　与骨性Ⅰ类错牙合畸形患者相比,骨性Ⅱ类错牙合畸形患者具有较低的舌体姿势位,舌体也相对较小,舌骨位置较低并位于后下方。骨性Ⅰ类错牙合畸形患者中,与均角型和高角型患者比较,低角型患者舌体和下颌骨体部较长。     

基于锥形束CT分析骨性Ⅱ类错牙合畸形患者舌体舌骨位置及形态特征的研究

 目的　应用锥形束CT（cone-beam CT，CBCT）研究骨性Ⅱ类错牙合畸形患者的舌体、舌骨位置及形态特征。方法　选取2016年1月至2018年12月于上海交通大学附属第九人民医院口腔正畸科就诊的骨性Ⅱ类错牙合畸形患者35例（Ⅱ组）、骨性Ⅰ类错牙合畸形患者35例（Ⅰ组）。各组患者根据垂直骨面型又分为高角型、均角型和低角型。所有患者拍摄CBCT，比较各组及各型患者舌体、舌骨位置及形态差异。结果　（1）两组患者舌体位置各项指标测量结果比较，差异均有统计学意义（均P < 0.05），且Ⅱ组的测量值均大于Ⅰ组；两组患者舌体长度比较，差异无统计学意义（P > 0.05），而Ⅰ组患者舌体矢状截面面积大于Ⅱ组，差异有统计学意义（均P < 0.05）。（2）两组患者舌骨位置测量结果比较发现，Ⅱ组患者的H-H′ （舌骨顶点到颈椎点和颏下点连线的垂直距离）和H-Y（舌骨顶点到PS平面的垂直距离）均大于Ⅰ组，差异有统计学意义（均P < 0.05）；而两组患者舌骨形态测量结果比较，差异均无统计学意义（均P > 0.05）。（3）Ⅰ组低角型患者舌体长度与H-Me（舌骨顶点至颏下点的距离）的测量结果较均角型和高角型患者的大，差异均有统计学意义（均P < 0.05）；而Ⅱ组不同垂直骨面型患者舌体、舌骨位置及形态的各项指标测量结果比较，差异均无统计学意义（均P > 0.05）。结论　与骨性Ⅰ类错牙合畸形患者相比，骨性Ⅱ类错牙合畸形患者具有较低的舌体姿势位，舌体也相对较小，舌骨位置较低并位于后下方。骨性Ⅰ类错牙合畸形患者中，与均角型和高角型患者比较，低角型患者舌体和下颌骨体部较长。