口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征患者上气道影响的磁共振研究

A MRI study on upper airway morphology in oral appliance treatment in patients with obstructive sleep apnea/hypopnea syndrome

目的:采用磁共振(MRI)结合三维重建技术观察口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道形态的影响。方法:对12例男性OSAHS患者进行静态MRI扫描,使用咬蜡块的下颌前伸定位方法,在牙尖交错位与口腔矫治器测定的下颌前伸位获得MRI图像。利用三维重建软件重现患者上气道立体形态影像,计算分析患者上气道在戴入口腔矫治器后的整体形态变化以及上气道各段容积、截面积、前后径、左右径的变化。结果:OSAHS患者戴用口腔矫治器后,上气道腭咽部、舌咽部的平均截面积、最小截面积明显增大,口咽及总咽容积亦明显增大(P<0.05)。腭咽部截面形态由戴用前的近似圆形变为以左右径为长轴的椭圆形,整个上气道立体形态也趋向于以左右径为长轴的椭圆柱形。结论:口腔矫治器影响上气道可通过改变气道大小和气道形状2个途径。

Objective： To analyze the change of upper airway morphology by the use of oral appliance（OA） in patients with obstructive sleep apnea/hypopnea syndrom（OSAHS）.Methods： The upper airway of 12 male patients with OSAHS was scanned by magnetic resonance imaging（MRI）.Their mandibles were located at intercuspal positions（ICP） or biting wax simulating OA treatment position（OA position）.Upper airways were reappeared through 3D reconstruction software.The 3D images of the upper airway were observed.Volume,cross sectional area（CSA）,sagittal diameter（SD） and lateral diameter（LD） of every segment in upper airway were measured.Results： After wearing the oral appliances（at OA position） in OSAHS patients,the minimum and mean CSA of velopharynx and glossopharynx,the volume of oropharynx and total pharynx increased（P〈0.05）.The cross-sectional shape of velopharynx changed from a circlar into an oval with its long axle at lateral diameter,the whole shape of the upper airway changed into an oval cylinder with its long axle at lateral diameters.Conclusion： The oral appliance can affect the upper airway by enlarging its size and changing its shape.