正颌外科治疗颞下颌关节强直伴阻塞性睡眠呼吸暂停综合征

目的 评价正颌外科手术治疗颞下颌关节强直伴阻塞性睡眠呼吸暂停综合征(OSAS)的效果。方法 12例颞下颌关节强直伴OSAS患者(男4例，女8例，年龄10～25岁，平均18．4岁；双侧颞下颌关节强直8例，单侧颞下颌关节强直4例)，采用颞下颌关节成形术、下颌矢状劈开前徙术、颏前徙成形术、舌骨悬吊术以及牵张成骨术移动下颌骨和舌骨。术后随访3～36个月。结果 12例患者张口度由术前的0～2mm增大到术后25～40mm；术后患者颜面形态明显改善；其连续血氧饱和度最低值由术前的42％提高至术后的90％以上，睡眠呼吸障碍解除和睡眠质量获得提高。结论 在颞下颌关节强直伴OSAS患者的治疗中，行颞下颌关节成形术的同时，辅助正颌外科手术，不仅可以增大患者的张口度，而且还能解决患者下颌后缩的畸形，同时解除上气道狭窄，从而缓解或纠正患者的低氧血症。

The Application of Orthognathic Surgery to Treatment of Obstructive Sleep Apnea Syndrome Due to Ankylosis of Temporomandibular Joint

Objective To evaluate orthognathic surgery in the treatment of obstructive sleep apnea syndrome (OSAS) resulted from ankylosis of temporomandibular joint (TMJ). Methods 12 cases of TMJ ankylosis with OSAS were selected (4 males, 8 females, bilateral ankylosis in 8, unilateral ankylosis in 4 and all with micrognathism). All patients were examined by polysomnography and OSAS was affirmed. The patients were treated by TMJ arthroplasty, ramus sagittal osteotomy and mandibular advancement, genial advancement and hyoid suspension, or distraction osteogensis (DO) of mandible. 12 cases were followed up in 3-36 months. Results After operation, the maximal mouth opening of the 12 patients increased from 0-2 mm to 25-40 mm, all patients gained good appearance, and continuous oxygen saturation degree increased from 42% to over 90% in average. Conclusion In the treatment of OSAS due to TMJ ankylosis, the mouth opening of patients can be improved and the obstruction of the upper airway can be relieved through TMJ arthroplasty and orthognathic surgery. Thus the hypoxemia of the patients was relieved or corrected.