联合运用牵张成骨及颏成形术矫治颞下颌关节强直继发小下颌畸形伴OSAHS

Application of mandibular osteodistraction and advancement genioplasty in staged treatment of tem- poromandibular joint ankylosis with micrognathia and OSAHS

目的：探讨联合运用牵张成骨及颏成形术配合正畸治疗矫治颞下颌关节强直继发小下颌畸形伴阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的可行性。方法：9例双侧关节强直继发小下颌畸形伴OSAHS患者，一期通过关节成形术解除关节强直，完成正畸治疗后，二期运用牵张成骨及颏成形术矫治小下颌畸形伴OSAHS，随访8—36月，评价其治疗效果。结果：患者平均张口度由术前3．1mm提高到术后36．5mm，小下颌畸形得到有效治疗，OSAHS得到同期治愈。结论：联合运用牵张成骨及颏成形术并配合正畸治疗，是矫治关节强直继发小下颌畸形伴OSAHS的有效治疗方案。

Objective： To evaluate a staged treatment of temporomandibular joint（TMJ） ankylosis with micrognathia and obstructive sleep apnea and hypopnea syndrome （OSAHS） using arthroplasty, mandibular distraction osteogenesis （DO） and advancement genio- plasty. Methods： 9 bilateral TMJ ankylosis patients （aged 17 to 27 years） with micrognathia and OSAHS were treated by arthroplasty as the initial surgery, followed by orthodontic treatment and correction of mandibular micrognathia by osteodistraction and advancement genioplasty. Clinical results were evaluated by mouth opening, radiography and clinical observation. The patients were followed up for 8 to 36 months. Results ： The TMJ ankylosis was released successfully in all patients. The mouth opening was increased from 3.1 mm to 36.5 mm after treatment. Mandibular micrognathia was corrected and OSAHS was cured. Satisfactory occlusion was achieved by or- thodontic treatment. Conclusion： A staged and surgical-orthodontic treatment combined with mandibular osteodistraction and ad- vancement genioplasty might be a good approach for the treatment of TMJ ankylosis with mandibular hypoplasia and OSAHS.