小下颌畸形伴阻塞性睡眠呼吸暂停综合征的手术矫治

SURGICAL TREATMENT OF MICROMANDIBULAR DEFORMITY ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

目的 观察下颌升支截骨下颌骨前徙术治疗小下颌畸形伴阻塞性睡眠呼吸暂停综合征 (OSAS)的疗效。方法 1998年 4月～ 2 0 0 2年 2月 ,对 12例 (女 7例 ,男 5例 ,年龄 14～ 36岁 )伴有严重 OSAS症状及张口度 0～ 3.0 cm的小下颌畸形患者 ,7例采取下颌升支倒“L”形截骨、升支倒置颞下颌关节重建术的同时施行下颌体部前徙和颏成形术 ;3例在颞下颌关节重建术后进行下颌角部截骨、植骨下颌骨前徙术 ;2例施行下颌升支矢状劈开、下颌骨前徙术。其中 8例施行了舌骨下肌群离断、舌骨悬吊术。截骨段以小钛板坚强内固定。 结果 术后创口 期愈合 ,经过 6～ 4 8个月随访 ,12例患者张口度均恢复至 3.0～ 3.8cm,面部外形明显改善 ,睡眠打鼾、憋醒、大汗症状消失或明显改善 ,睡眠时血氧饱和度由术前的 82 %～ 92 %增加至术后的 97%～ 99%。 结论 下颌升支截骨下颌骨前徙术治疗小下颌畸形伴OSAS,对扩张口咽通气道、解除睡眠时呼吸阻塞症状可获得较满意的效果 ,并同时改善了面部容貌。

Objective To study the effects of jaw advancement in treating micromandibular deformity associated with obstructive sleep apnea syndrome (OSAS) by ramus osteotomy and genioplasty. Methods From April 1998 to February 2002, 12 patients with micromandibular deformity associated with OSAS ( aged 14-36 years, 7 females and 5 males) were treated. Invert 'L'shape ramus osteotomy and inverted replantation of posterior segment of ramus were performed to reconstruct the TMJ with the jaw advancement and genioplasty at the same time in 7 cases; mandibular angle osteotomy, bone grafts and genioplasty in 3 cases; and the jaw advancement by ramus sagittal osteotomy and genioplasty in 2 cases of the first branchial arch syndrome. Results The follow-up period was 6 months to 4 years. All the patients gained good appearance and had the distance of opening movement over 3.0 cm. Micromandible and facial asymmetries were corrected satisfactorily. The ratio of SaO 2 was ascended from 82%-92%(preoperation) to 97%-99%(postoperation). OSAS was relieved. Conclusion The jaw advancement by ramus osteotomy and genioplasty for treating micromandibular deformity associated with OSAS can correct the maxillofacial deformities and enlarge the upper airway space to relieve OSAS. This method has achieved satisfactory result.