骨性Ⅱ类错畸形患者双颌手术前后颌骨矢状向移动量与咽气道容积变化分析

doi:10.19438/j.cjoms.2025.02.005

摘要/Abstract

摘要： 目的：探讨骨性Ⅱ类患者双颌手术前后颌骨矢状向移动量和咽气道变化的关系。方法：选择2021年1月—2024年6月于上海交通大学医学院附属第九人民医院接受正颌-正畸联合治疗的上颌骨前突伴下颌骨后缩患者28例。正颌术式为上颌骨Le Fort I型截骨术后退伴下颌支矢状劈开截骨术（BSSRO）前移,将下颌骨前移量减去上颌骨后退量定义为上下颌骨矢状向移动差。根据上下颌骨矢状向移动差将患者分为2组,A组（14例）为上下颌骨矢状向移动差>0 mm组,B组（14例）为上下颌骨矢状向移动差≤0 mm组。患者均于术前正畸结束时（T0）和正颌术后6个月时（T1）进行CT扫描。使用Dolphin Imaging 11.9 软件进行咽气道形态参数及颌骨移动量测量,采用SPSS 29.0软件包对数据进行统计学分析。结果：A组上下颌骨矢状向移动差与口咽气道容积呈线性正相关;B组上下颌骨矢状向移动差与口咽气道容积呈非线性关系,上下颌骨矢状向移动差分别小于-1.24 mm（R²=0.8225,P<0.05）、-1.02 mm（R²=0.6670,P<0.05）、-1.34 mm（R²=0.7717,P<0.05）和-1.17 mm（R²=0.7332,P<0.05）时,咽气道总容积、鼻咽气道容积、口咽气道容积以及喉咽气道容积减少。结论：接受上颌骨后退伴下颌骨前移术的骨性Ⅱ类患者中,当上颌骨后退量较下颌骨前移量多1 mm以上时,咽气道容积显著减小。因此,对有咽气道狭窄倾向的骨性Ⅱ类患者,应适当调整方案以减少气道风险。

关键词: 骨性Ⅱ类错, 正颌手术, 咽气道, 颌骨矢状向移动量

Abstract: PURPOSE: To explore the relationship between jaw movements and changes in pharyngeal airway morphology and volume by studying the preoperative and postoperative jaw movements and pharyngeal airway alterations in skeletal Class Ⅱ patients undergoing bimaxillary surgery. METHODS: A total of 28 skeletal Class Ⅱpatients with maxillary protrusion and mandibular retrusion who received orthognath-orthodontic combined treatment in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2021 to June 2024 were selected. All patients underwent maxillary setback via Le Fort I osteotomy combined with mandibular advancement using bilateral sagittal split ramus osteotomy(BSSRO). The difference in sagittal movement of the mandible was defined by subtracting the maxillary retraction from the mandibular forward movement. According to the difference of sagittal movement of the mandible,the patients were divided into two groups: group A(n=14) with a sagittal movement difference > 0 mm, and group B (n=14) with a sagittal movement difference ≤; 0 mm. All patients received CT scans at the end of preoperative orthodontics (T0) and six months after orthognathic surgery(T1). The CT data were imported into Dolphin Imaging 11.9 software to measure pharyngeal airway morphological parameters and jaw movements. Statistical analysis was performed using SPSS 29.0 software package. RESULTS: In group A, the sagittal movement difference was positively and linearly correlated with oropharyngeal airway volume. In group B, the sagittal movement difference had a nonlinear relationship with oropharyngeal airway volume. When the sagittal movement difference was less than -1.24 mm(R²=0.8225, P< 0.05), -1.02 mm(R²=0.6670, P< 0.05), -1.34 mm(R²=0.7717, P< 0.05), and -1.17 mm(R²=0.7332, P< 0.05), the total pharyngeal airway volume, nasopharyngeal airway volume, oropharyngeal airway volume, and hypopharyngeal airway volume decreased, respectively. CONCLUSIONS: In skeletal ClassⅡ patients undergoing maxillary setback combined with mandibular advancement, when the amount of maxillary setback exceeds the amount of mandibular advancement by more than 1 mm, there is significant reduction in pharyngeal airway volume. Therefore, for skeletal Class Ⅱ patients with a predisposition to pharyngeal airway narrowing, the treatment plan should be appropriately adjusted to mitigate airway risks.;

Key words: Skeletal Class Ⅱ malocclusion, Orthognathic surgery, Pharyngeal airway space, Sagittal jaw movements

中图分类号:

R782.2

吴嘉晴, 沈爱丽, 钱轶峰, 刘加强. 骨性Ⅱ类错畸形患者双颌手术前后颌骨矢状向移动量与咽气道容积变化分析[J]. 中国口腔颌面外科杂志, 2025, 23(2): 129-136.

WU Jia-qing, SHEN Ai-li, QIAN Yi-feng, LIU Jia-qiang. Analysis of sagittal jaw movements and pharyngeal airway changes in skeletal Class Ⅱ patients following bimaxillary surgery[J]. China J Oral Maxillofac Surg, 2025, 23(2): 129-136.

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