骨性Ⅲ类畸形正颌外科术后咽腔间隙短期及长期影响的锥形束CT分析

上海口腔医学 ›› 2016, Vol. 25 ›› Issue (4): 487-491.

骨性Ⅲ类畸形正颌外科术后咽腔间隙短期及长期影响的锥形束CT分析

王宏伟¹, 李丽艳¹, 齐素青¹, 闫明², 张超¹, 任素峰¹, 班建东¹

1.河北省眼科医院口腔正畸科,2.口腔外科,河北邢台 054001

收稿日期:2015-07-02 出版日期:2016-08-25 发布日期:2016-09-06
通讯作者: 齐素青,E-mail: qsq7615038@163.com
作者简介:王宏伟(1984-),男,硕士研究生,主治医师,E-mail: hongwei840126@163.com

Cone-beam computed tomography evaluation of short- and long-term airway changes in patients with skeletal Class Ⅲ malocclusion treated by orthodontic therapy and bimaxillary surgery with or without mandibular setback surgery

WANG Hong-wei¹, LI Li-yan¹, QI Su-qing¹, YAN Ming², ZHANG Chao¹, REN Su-feng¹, BAN Jian-dong¹

1.Department of Orthodontics, 2. Department of Oral and Maxillofacial Surgery, Hebei Eye Hospital. Xingtai 054001, Hebei Province, China

Received:2015-07-02 Online:2016-08-25 Published:2016-09-06

摘要/Abstract

摘要： 目的评价正畸联合单颌或双颌手术治疗骨性Ⅲ类畸形对咽腔间隙短期及长期的影响。方法选取骨性Ⅲ类患者54例（男28例,女26例）,A组(28例)采用正畸联合下颌支矢状劈开术治疗。B组患者(26例)采用正畸联合上颌支Le Fort I型加下颌矢状劈开术治疗,正畸治疗前1周(T0)、术后6个月(T1)及术后3年(T2)拍摄锥形束CT（CBCT）,三维重建上气道模型,对治疗前、后各段矢状径、冠状径、截面积和容积进行定量分析。采用SPSS17.0软件包进行统计学分析,比较治疗前、术后6个月及3年上气道的三维变化。结果A组患者术后6个月各段矢状径和截面积均显著减小（P<0.05）,口咽段、舌咽段容积及总容积显著小于治疗前（P<0.05）。术后3年,除第一颈椎平面处矢状径和截面积恢复到治疗前水平(T2-T0：P>0.05, T2-T1：P<0.05）外,其余部位均有所增加但未恢复到治疗前水平。B组患者术后6个月第二、三、四颈椎平面处矢状径和截面积显著减少,但在术后3年大部分缩窄的部位恢复到治疗前水平。结论正畸-正颌联合治疗骨性Ⅲ类畸形会造成咽腔缩窄,随着时间延长,会有一定程度的恢复,但不能完全恢复到治疗前水平。

关键词: 正畸-正颌联合治疗, 骨性Ⅲ, 类畸形, 咽腔, 锥形束CT

Abstract: PURPOSE: To evaluate the short-term and long-term effects of pharyngeal airway in skeletal Class Ⅲ malocclusion patients who underwent bimaxillary surgery or isolated mandibular setback-orthodontic treatment. METHODS: The sample included 54 patients (28 males, 26 females) who were diagnosed with skeletal Class Ⅲ malocclusion. Patents in group A (n=28) underwent mandibular setback surgery and orthodontic treatment. Cone-beam CT (CBCT) was taken at one week before treatment (T0), 6 months (T1) and 3 years after surgery (T2).Patents in group B(n=26) underwent Le Fort I procedures with bilateral split ramus osteotomies-orthodontic treatment; The raw data reconstructed into 3D model. Sagittal and transversal measurements, cross sectional areas, partial and total volumes were evaluated. The data were statistically analyzed using SPSS 17.0 software package to determine the changes in each group. RESULTS: Six months after surgery, the sagittal diameters and cross sectional areas of each section in group A were significantly decreased (P<0.05). Oropharyngeal volume, hypopharyngeal volume and total volume were significantly narrowed (P<0.01). Three years after surgery, only sagittal and cross sectional areas in the first cervical vertebra plane were returned to the original levels (T2-T0：P>0.05, T2-T1: P<0.05). In group B, the sagittal diameters and cross sectional areas of each section (except CV1 plane) were significantly decreased(P<0.05) 3 years after surgery, but most measurements returned to the original levels. CONCLUSIONS: Pharyngeal airway space decreased after combined therapy in the short term; however, relapse occurred and not to its original position in the long term.

Key words: Orthodontic-surgery treatment, Skeletal Class Ⅲ, malocclusion, Pharyngeal airway, Cone-beam CT

中图分类号:

R783.5

王宏伟, 李丽艳, 齐素青, 闫明, 张超, 任素峰, 班建东. 骨性Ⅲ类畸形正颌外科术后咽腔间隙短期及长期影响的锥形束CT分析[J]. 上海口腔医学, 2016, 25(4): 487-491.

WANG Hong-wei, LI Li-yan, QI Su-qing, YAN Ming, ZHANG Chao, REN Su-feng, BAN Jian-dong. Cone-beam computed tomography evaluation of short- and long-term airway changes in patients with skeletal Class Ⅲ malocclusion treated by orthodontic therapy and bimaxillary surgery with or without mandibular setback surgery[J]. Shanghai Journal of Stomatology, 2016, 25(4): 487-491.

参考文献

[1] Chen F, Terada K, Hua Y, et al. Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities [J]. Am J Orthod Dentofacial Orthop, 2007, 131(3): 372-377.
[2] Degerliyurt K, Ueki K, Hashiba Y, et al. A comparative CT evaluation of pharyngeal airway changes in Class Ⅲ patients receiving bimaxillary surgery or mandibular setback surgery [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 105(4): 495-502.
[3] Raskin S, Gilon Y, Limme M. Cephalometric assessment in obstructive sleep apnea and hypopnea syndrome [J]. Rev Stomatol Chir Maxillofac, 2007, 103(3): 158-163.
[4] Park SB, Kim YI, Son WS, et al. Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with Class Ⅲ skeletal deformities: bimaxillary surgery and mandibular set back surgery [J]. Int J Oral Maxillofac Surg, 2012, 41(1): 87-93.
[5] Wickwire NA, White RP, Proffit WR. The effect of mandibular osteomy on tongue position [J]. J Oral Surg, 1972, 30 (3): 184-191.
[6] Riley RW, Powell NB, Guilleminault C, et al. Obstructive sleep apnea syndrome following surgery for mandibular prognathism [J]. J Oral Maxillofac Surg, 1987, 45(5): 450-452.
[7] Efendiyeva R, Aydemir H, Karasu H, et al. Pharyngeal airway space, hyoid bone position, and head posture after bimaxillary orthognathic surgery in Class Ⅲ patients: long-term evaluation [J]. Angle Orthod, 2014, 84 (5): 773-781.
[8] Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery [J]. J Oral Maxillofac Surg, 2000, 58(3): 282-285.
[9] Frongia G, Piancino MG, Bracco P. Cone-beam computed tomography: accuracy of three-dimensional cephalometry analysis and influence of patient scanning position [J]. J Craniofac Surg, 2012, 23(4): 1038-1043.
[10] 王宏伟, 王建国, 齐素青, 等. 正畸-正颌联合治疗骨性Ⅲ类错畸形对咽腔间隙影响的三维重建分析 [J]. 中华口腔医学杂志, 2012, 47(4): 221-224.
[11] Degerliyurt K, Ueki K, Hashiba Y, et al. The effect of mandibular setback or two-jaws surgery on pharyngeal airway among different genders [J]. Int J Oral Maxillofac Surg, 2009, 38(6): 647-652.
[12] Kim JS, Kim JK, Hong SC, et al. Pharyngeal airway changes after sagittal split ramus osteotomy of the mandible: a comparison between genders [J]. J Oral Maxillofac Surg, 2010, 68(8): 1802-1806.
[13] Kawakami M, Yamamoto K, Fujimoto M, et al. Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery[J]. J Craniomaxillofac Surg, 2005,33(2): 107-110.
[14] Kim MA, Kim BR, Choi JY, et al. Three-dimensional changes of the hyoid bone and airway volumes related to its relationship with horizontal anatomic planes after bimaxillary surgery in skeletal class Ⅲ patients [J]. Angle Orthod, 2013, 83(4): 623-629.
[15] Eggensperger N, Smolka W, Iizuka T. Long-term changes of hyoid bone position and pharyngeal airway size following mandibular setback by sagittal split ramus osteotomy [J]. J Craniomaxillofac Surg, 2005, 33(2): 111-117.