颌骨后退术后舌骨位置和后气道间隙变化的相关性研究

ALTERATION OF THE POSITION OF THE HYOID AND THE PHARYNGEAL AIRWAY SPACE AFTER MANDIBULAR SETBACK SURGERY

目的 通过X线头影测量分析下颌后退手术对舌骨位置和后气道间隙 (PAS)变化的影响 ,为临床治疗提供依据。方法 下颌前突畸形患者 18例 ,均接受经口内下颌骨升支垂直截骨术 ,术前和术后 1个月拍摄标准颅颌侧位片进行头影测量 ,测量项目 6项 ,测量数值配对t检验 ,并将下颌骨后退距离与各测量项目变化作相关分析。结果 术后下颌骨后退的平均值是 (10 .2 0± 1.31)mm。各测量项目显著差异的有 :舌骨垂直方向变化 ,舌根后缘至咽后壁的距离 ,后气道间隙面积。下颌骨后退距离与PAS面积的减小值和舌骨垂直方向变化密切相关 ,与PAS宽度减小值和舌骨水平方向变化没有密切相关。结论 双侧下颌升支垂直截骨后退术后近期 ,舌骨向下移位 ,舌根后移 ,咽腔气道缩小 ,如果患者同时具有超重、短颈、舌体大等其他危险因素 ,下颌骨后退手术可能导致睡眠呼吸暂停综合征的发生。下颌骨后退距离与后气道间隙面积的减小值和舌骨垂直方向变化呈正相关。

Objective Using X-ray cephelometrics, we analyzed the effect of the setback of the jaw bone on the position of the hyoid bone and the pharyngeal airway space, so that we could purpose some suggestions for the clinical treatment. Methods 18 adult patients with mandibular prognathism were undergone mandibular setback by way of bilateral ramus vertical osteotomy. 6 parameters were measured using lateral cephalometrics X-ray films taken before and 1 month post treatment. All the quantized figures was analyzed using paired t-test. The relationship between the distance of the setback of the mandibular and the change of the measured figures was also analyzed. Results The mean amount of mandibular setback was (10.20±1.31)mm. The variation which is significant is the measured figures in the following groups: vertical change of the hyoid bone, the distance from the posterior margin of tongue base to the posterior pharyngeal wall and the pharyngeal airway area. There was a significant correlation between the amount of mandibular setback and the vertical change of hyoid and pharyngeal airway area. Conclusion Mandibular setback surgery caused the hyoid downward, the tongue base moved posteriorly and decreased in pharyngeal airway space. In patients who have other risk factors, for example, overweight short necks, or large tongues, a mandibular setback procedure could possibly predispose to the development of sleep apnea syndrome. There was a strong correlation between the amount of mandibular setback and the vertical change of hyoid and pharyngeal airway area.