双颌前徙术治疗阻塞性睡眠呼吸暂停低通气综合征

阻塞性睡眠呼吸暂停低通气综合征是一种严重影响人们健康的常见病、多发病,是多种全身疾患的独立危险因素。双颌前徙术作为治疗OSAHS的一种新兴方法在近30年受到了越来越多的关注,并在临床上得到了较广泛应用。本该就近年来关于双颌前徙术治疗OSAHS的研究现状做一综述,希望为临床医生提供参考。     

双颌前徙手术治疗黄种人群阻塞性睡眠呼吸暂停低通气综合征的初步研究

目的 初步探讨应用双颌前徙手术治疗黄种人群阻塞性睡眠呼吸暂停低通气综合征患者的术后效果及相关并发症.方法 选择北京大学口腔医院正颌外科中心2005年9月到2007年10月诊治的4名阻塞性睡眠呼吸暂停低通气综合征患者,均为男性.所有患者均进行双颌前徙手术治疗.术前和术后3-6个月分别进行多导睡眠图仪检查和拍摄头颅定位侧位片,于术后3-6个月期间进行主观问询.结果 术后所有患者的睡眠呼吸暂停低通气指数及睡眠时最低血氧饱和度均得到明显改善,SNA、SNB都有明显增大,术后后气道间隙得到了明显的扩大,舌骨到下颌骨的距离也有所缩短.通过主观调查问卷调查,本研究中所有4名患者术后睡眠打鼾及日问嗜睡症状消失,并且对术后面型的改善比较满意.3名患者术后出现短暂的下唇麻木及颞下颌关节不适,术后短期存在的下唇麻木及颞下颌关节不适的症状基本消失.结论 双颌前徙手术是一种治疗黄种人群OSAHS有效的方法.     

悬雍垂腭咽成形术联合颏前徙术治疗阻塞性睡眠呼吸暂停低通气综合征

目的 探讨悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)和颏前徙手术对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的治疗效果。方法 对11例术前检查确定上气道狭窄或阻塞的OSAHS患者施行UPPP联合颏前徙手术,应用术前、后临床检查、多导睡眠呼吸监测(PSG)、头影测量等方法 评价治疗效果。结果 术后患者软腭长度、腭后气道和舌后气道宽度等较术前显著改变(P<0.05),上气道阻塞症状基本消失,呼吸暂停及低通气指数(AHI)>5,SaO2>90%。结论 UP-PP联合颏前徙手术可有效地治疗后气道狭小等上气道多水平阻塞的OSAHS。     

悬雍垂腭咽成形术与双颌前徙术联合治疗阻塞性睡眠呼吸暂停低通气综合征的初步报告

目的 在采用双颌前徙术（maxillomandibular advancement，MMA）的同时结合计算机辅助设计悬雍垂腭咽成形术（uvulopalatopharyngoplasty，UPPP），探索其治疗重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）的可行性和疗效。方法严重OSAHS肥胖患者9例，年龄（47．8±9．7）岁，体重指数（body mass index，BMI）为（35．3±2．5）kg／m^2，睡眠呼吸暂停低通气指数（apneaand hypopnea index，AHI）为（88．7±6．7）次／h。对所有患者行计算机辅助设计的UPPP和MMA联合手术治疗。患者术前、术后3、6、12个月行多道睡眠检测（polysomography，PSG）监测，同时进行上气道测量分析，以及腭咽闭合功能、语音评价。结果患者上颌骨LeFort-Ⅰ截骨前移（8．3±1．3）mm，双侧下颌矢状劈开和颏截骨前移合计（23．0±2．2）mm。随访时间7．7个月，所有患者OSAHS症状均消失，术后AHI（2．1±1．1）次／h，患者均无语音障碍和吞咽障碍，无明显颌面畸形，牙胎关系良好。结论UPPP和MMA联合手术治疗OSAHS肥胖患者的近期手术效果良好。采用MMA同期结合计算机辅助设计的UPPP不必然造成腭咽闭合功能障碍；UPPP与上颌LeFort-Ⅰ截骨联合手术不必然造成上颌骨缺血坏死或影响上颌创口愈合。     

阻塞性睡眠呼吸暂停低通气综合征的正颌外科手术治疗

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）是一类以睡眠中频发呼吸暂停或低通气，反复发生低氧血症和高碳酸血症，睡眠打鼾、憋气和日间极度困倦为特征的睡眠呼吸紊乱性疾患。低氧血症和高碳酸血症对全身各个系统均可能有不同程度的影响，OSAHS具有潜在的致死性。根据新近的流行病学调查，OSAHS在人群中并不属于罕见疾患。因此，医学界对OSAHS的重视程度越来越高。     

阻塞性睡眠呼吸暂停低通气综合征的正颌外科及牵引成骨治疗

睡眠呼吸障碍疾病(sleep-related breathing disorders,SRBD)是一类常见、多发疾病,其主要临床表现为：睡眠打鼾、憋气、晨起头痛和疲乏、白日嗜睡、记忆力减退、注意力难以集中以及性功能障碍等。睡眠呼吸障碍多由上呼吸道狭窄、阻塞所致,频繁出现的睡眠低氧是其病理生理基础,不及时治疗将造成严重的后果。阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,     

阻塞性睡眠呼吸暂停低通气综合征的诊断与治疗

阻塞性睡眠呼吸暂停低通气综合征OSAHS发病率高,并且是许多疾病的源头性疾病,是临床医学关注的一个热点问题,因其与口腔医学关系尤为密切,近年来口腔颌面外科广泛地介入了OSAHS研究。本文就口腔颌面外科在OSAHS的诊断和治疗中的现状和进展作一综述。     

正颌外科治疗阻塞性睡眠呼吸暂停综合征

为了总结使用正颌外科方法治疗严重的小颌或下颌后缩畸形伴阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ，ＯＳＡＳ）后，患者面型、关系以及口颌系统功能获得的改善，作者通过１０例患者的手术治疗对颌骨和舌骨的移动，同时改善面型、口颌系统功能并扩张舌根水平的上气道，从而治疗ＯＳＡＳ。讨论了治疗ＯＳＡＳ的正颌外科手术方法，并提出了正颌外科治疗ＯＳＡＳ的适应证和外科治愈指标。     

阻塞性睡眠呼吸暂停低通气综合征的诊断及外科治疗

介绍阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)相关概念、OSAHS患者的检查流程及外科治疗方式,探讨各种术式的适应证.     

Patient-reported outcome measures following maxillomandibular advancement surgery in patients with obstructive sleep apnoea syndrome

Maxillomandibular advancement (MMA) is an effective treatment for obstructive sleep apnoea syndrome (OSAS) that is refractory to conventional treatment. However, it is a highly invasive procedure with several recognised side effects, and we know of few data on its effect on important patient-reported outcome measures (PROMS). Here we describe a case series of patients selected for MMA through our joint respiratory/maxillofacial surgery clinic, detailing the effect of MMA on objective physiological measurements and important PROMS. Patients with confirmed moderate/severe symptomatic OSAS who could not tolerate continuous positive airway pressure (CPAP) or mandibular advancement devices (MAD) were assessed in the clinic for consideration of MMA. Preoperative and postoperative airway measurements, apnoea/hypopnoea index (AHI), Epworth sleepiness scale (ESS) score, and quality of life (10-point Likert scale), were recorded. A customised questionnaire was administered postoperatively to assess selected psychosocial and functional domains (sleep quality, energy levels, appearance, ability to perform daily activities, and mood) and patient satisfaction using five-point Likert scales. Over an 18 month period, 39 patients were referred for consideration of MMA. Ten patients (7 men and 3 women, mean age 49.9, mean BMI 27.5) underwent surgery, which resulted in significant improvements in ESS, quality of life, AHI, and airway diameters. All patients reported improvements in all psychosocial/functional domains except appearance, in which five reported no change or worsened appearance. All subjects felt that MMA provided better symptom control than CPAP. The most commonly reported side effects were facial/lip numbness (9/10) and affected bite (6/10). MMA resulted in significant improvements in ESS, quality of life, and a range of PROMS, with a high level of patient satisfaction.     

Central and mixed sleep apnea related to patients treated with maxillomandibular advancement for obstructive sleep apnea: A retrospective cohort study

The aim of this study was to evaluate the clinical efficacy of maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) patients with a percentage of central and mixed apnea index in the total apnea?hypopnea index (CMAI%) ≧25%.Patients treated with MMA for OSA were retrospectively evaluated for baseline and postoperative patient data and polysomnographic results. The pre- and postoperative obstructive, central and mixed apnea parameters were compared.Of the included 78 patients, 21 patients (27%) presented with CMAI% ≧25% (median CMAI%, 49.1%; 35.9–63.8) prior to MMA. In 67% of these cases, MMA resulted in CMAI% <25 (median CMAI%, 6.1%; 2.1–8.9) and significantly improved the apnea?hypopnea index (AHI) (p < 0.001), the lowest oxyhemoglobin saturation (p < 0.001), central and mixed apnea index (p < 0.001), percentage of central and mixed apneas of total AHI (p = 0.004), central apnea index (p < 0.001), and mixed apnea index (p < 0.001). CMAI% ≧25% emerged in 25% of patients after MMA (median CMAI%, 49.1%; 35.9–63.8).Within the undeniable limitations of the study, it seems that the presence of CMAI% ≧25% should not be regarded as a contraindication for MMA in OSA patients.     

下颌前移矫治器辅助腭咽成形术治疗睡眠呼吸暂停低通气综合征

目的:对经腭咽成形术(UPPP)后的睡眠呼吸暂停低通气综合征(OSAHS)患者辅以下颌前移器治疗,探讨UPPP手术后口腔矫治器前移下颌辅助治疗的作用机制。方法:10例OSAHS患者接受UPPP手术后,辅以下颌前移矫治器治疗。所有患者在戴用矫治器后1个月再次进行多导睡眠监测(PSG)。同时,按标准头颅定位片拍摄方法分别拍摄戴用口腔矫治器前、后的头颅定位侧位片,由作者应用正颌外科模拟预测系统(CASSOS 2001)进行头影测量分析。头影测量数据应用SPSS10.0软件包进行配对t检验,各个测量项目的差值分别与呼吸暂停低通气指数(AHI)的差值作相关分析。结果:戴用矫治器后,X线头影测量显示颅中窝和上颌骨后部的相对位置(MCF)有显著改变(P<0.05),而舌骨的上、下位置(∠C3-Rgn-H)以及前颌间高度(Ant In Mx.Ht)有非常显著的变化。各个测量项目的差值分别与AHI的差值作相关分析,结果显示AHI值的变化与前颌间高度(Ant In Mx.Ht)以及正中矢状面上舌面积和颌间面积的比例(T/In Mx.Area)的变化有显著相关性(P<0.05)。结论:经UPPP手术后戴用口腔矫治器的患者,其下颌前移的作用机制主要不是发生在口咽腔,而是由于下颌骨本身的位置改变而产生的一系列效应,从而导致AHI的改变。     

Changing practice: Trends in skeletal surgery for obstructive sleep apnea

Objectives/HypothesisThe objective of this study was to systematically review the English literature for articles that have described skeletal surgeries in the treatment of obstructive sleep apnea in both adults and children. From these articles trends and patterns in the treatment of OSA with skeletal procedures are described.Study designThree databases including MEDLINE, Google Scholar and the Cochrane Library were searched through May 1, 2018.MethodsThe systematic and independent literature reviews were performed and the determination of included studies was made by consensus. Relevant studies were examined based on six categories of skeletal surgery: 1) Hyoid Advancement 2) Genioplasty/Genioglossus Advancement 3) Maxillary Expansion 4) Maxillomandibular Advancement 5) Mandibular Distraction and 6) Maxillomandibular Expansion.Results1875 studies were analyzed for inclusion of which 414 were ultimately included in our analysis. A steady increase in the publication of articles pertaining to maxillary expansion and maxillomandibular advancement was identified. Research interest in hyoid advancement and genioplasty/genioglossus advancement has declined in the past decade.ConclusionsChanging trends in skeletal surgery for OSA offer exciting and efficacious therapeutic surgical modalities. MMA is the most widely studied and efficacious multi-level surgery for OSA today. Newer modalities such as adult maxillary expansion offer encouraging early results with minimal complication rates, and further study should be directed in this area.     

Long-term results of maxillomandibular advancement surgery in patients with obstructive sleep apnoea syndrome

This article describes the eight-year follow-up results of maxillomandibular advancement (MMA) in a cohort of patients with obstructive sleep apnea syndrome (OSAS). Results are promising by means of Apnoea Hypopnoea Index (AHI) and Epworth Sleepiness Scale (ESS).     

下颌前伸矫治器对阻塞性睡眠呼吸暂停低通气综合征作用的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床表现为夜间频发的上气道阻塞和呼吸障碍,伴发日间嗜睡、疲倦等。病因主要包括肥胖、神经肌肉、上气道结构的变化等因素。对于患者上气道阻塞程度和位点的研究方法有多种,如X线头影测量、多层螺旋CT成像等。通过多平面重建技术建立上气道的三维结构,可以精确显示上气道的细微变化。下颌前伸矫治器是治疗轻、中度OSAHS的有效方法,通过前移下颌而使上气道特别是口咽部间隙增宽。本文对阻塞性睡眠呼吸暂停综合征(OSAHS)患者使用下颌前伸矫治器时上气道形状变化特点及其研究方法作一综述。     

Maxillomandibular advancement is a safe procedure in patients with obstructive sleep apnoea. Results of a retrospective study

Obstructive sleep apnoea (OSA) is a syndrome with a high burden on public health. Maxillomandibular advancement (MMA) has proven to be a highly effective treatment option. This retrospective analysis evaluated the safety of maxillomandibular advancement with rotation in patients with OSA. A total of 63 patients with OSA were included in this study. Surgical treatment by maxillomandibular advancement was virtually planned based on preoperative cone beam computed tomography (CBCT). A 3D printed guide and a customised implant were used for surgical transfer. The safety of MMA was evaluated based on the necessity of postoperative intermediate care unit (IMCU) stay, duration of stay in hospital, and recording of medical complications. A total of 63.5% of the OSA patients treated by MMA (n = 40/63) were postoperatively transferred from the recovery room directly to the regular ward, while 36.5% of the patients (n = 23/63) stayed on IMCU for at least one night. On average, the length of hospitalisation was four days after surgery. One patient from the ward group and one patient from the IMCU group developed a major complication according to Clavian-Dindo classification grade IV. MMA is a safe surgical procedure. The necessity for postoperative monitoring in an IMCU setting should be based on an individual risk evaluation. However, since major complications can occur, MMA should be performed as an inpatient procedure in a hospital with available intensive medicine care. This study underlines the safety of MMA in OSA patients.     

下颌前伸矫治器治疗睡眠呼吸暂停综合征的三维影像学评估

目的:研究下颌前伸矫治器对阻塞性睡眠呼吸暂停综合征(OSAS)患者的疗效及机制.方法:采集80例OSAS患者应用下颌前伸矫治器治疗前、后的CT数据,利用三维影像重建技术测量上气道结构及容积变化,评价口腔矫治器(0A)的疗效及机制,采用SPSS17.0软件包对数据进行方差分析.结果:下颌前伸矫治器治疗OSAS多数患者主观症状缓解或消失,客观检测指标相应改善.OSAS患者存在上呼吸道的解剖性狭窄,戴入OA后,气道各分段截面积和容积均有变化,腭咽、喉咽段增大(P＜0.01),口咽段减小(P＜0.05).结论:OSAS存在形态学病因机制,下颌前伸矫治器通过前伸下颌骨,使上气道减小,内部变化而更平滑稳定,减小涡流和狭窄,进而发挥治疗效果.