Immediate Changes in Pharyngeal Airway Dimensions in Skeletal Class III Patients Undergoing Bilateral Intraoral Vertical Ramus Osteotomy and Intermaxillary Fixation

骨性三級咬合不正病人經下顎雙側垂直截骨術及上下顎間固定術後之短期呼吸道變化

張晁熙(Chao-Hsi Chang) ； 吳哲輝(Jeffery Wu) ； 莊世昌(Shih-Chang Chuang) ； 張明智(Ming-Chih Chang) ； 李嘉鐸(Chia-Tuo Lee) ； 游竣傑(Chun-Chieh Yu) ； 張鈞喨(Chun-Liang Chang) ； 林宏政(Hung-Cheng Lin)

《臺灣口腔顎面外科學會雜誌》 33卷4期 (2022/12) Pp. 235-245

摘要

Introduction: This study aimed to evaluate the changes in the pharyngeal airway dimensions right after mandibular setback surgery and to verify its correlation with the amount of mandibular movement in mandibular prognathism patient. Materials & Methods: This retrospective study included 22 patients with mandibular prognathism who underwent orthognathic surgery only by bilateral intraoral vertical ramus osteotomy and intermaxillary fixation. Patients who had cone-beam computed tomography before surgery, immediately after surgery were included. Airway dimensions, including airway volume of nasopharyngeal airway, oropharyngeal airway, and total airway, as well as the most constriction area were measured to evaluate the changes following mandibular setback surgery. The relationship between immediate post operation change of airway dimensions and the amount of mandible movement was confirmed using correlation analysis and linear regression. Results: The nasopharyngeal, oropharyngeal, and total volume, and most constriction area had decreased right postoperatively. We noted a significant decrease (P value ＜ .05) in total airway volume, oropharyngeal volume, nasopharyngeal airway volume, and the most constricted area. Besides, we found a poor to moderate correlation between oropharyngeal airway volume and the amount of mandible movement with the significance p value ＜ 0.05. Conclusion: The results of this study suggest significant alterations in pharyngeal airway measurements right after mandibular setback surgery (BVRO). Post operation swelling may also cause airway decreasing and both the factors make the post operation care become more challenging especially in case of BVRO under the status of intermaxillary fixation. The results illustrate the correlation between amount of mandibular movement and airway decreasing, and furthermore, we could predict the post operation status of patient that the amount of change in oropharyngeal airway volume might be -3097.59 + 898.64* (amount of mandible movement) and how intensively we have to intervene to maintain the patient's airway.

關鍵字

Orthognathic surgery ； Bilateral vertical ramus osteotomy ； Intermaxillary fixation ； Pharyngeal airway ； Cone-beam computed tomography

並列摘要

引言：本篇研究之目的在於評估下顎骨退縮手術之病人，術後短期的呼吸道變化，並且驗證下顎骨退縮量和呼吸道變化量之關係。方法：本篇為回溯性研究，包含22位下顎骨前突單獨進行下顎雙側垂直截骨術及上下顎間固定術，以及術前、術後三天內錐狀射束電腦斷層掃描。呼吸道的測量包括鼻咽呼吸道體積變化量、口咽呼吸道體積變化量、總呼吸道體積變化量、呼吸道最窄截面積變化量。並且利用統計軟體判斷兩者的相關、相依性以及線性關係。結果：本篇包含7位男性和15位女性。可以觀察到術後的鼻咽呼吸道體積、口咽呼吸道體積、總呼吸道體積、呼吸道最窄截面積有顯著的減少。此外，我們發現下顎骨退縮量和口咽呼吸道體積變化量、總呼吸道體積變化量、呼吸道最窄截面積變化量分別有低到中等程度的相關性。然而，僅有下顎骨退縮量和口咽呼吸道體積變化量之相關性達到顯著性。結論：結果顯示呼吸道測量的各項數值在術後都有立即的變化。儘管有其他因素例如術後的腫脹同樣也會造成呼吸道的減少，但不論是何種原因都會照成術後照護的困難，尤其是進行下顎雙側垂直截骨術往往必須搭配術後的上下顎間固定。因此，本篇研究能夠闡明下顎骨退縮量與呼吸道改變的關係，進而去預測患者術後呼吸道的情況，可以大略計算為鼻咽呼吸道體積改變量為-3097.59 ± 898.64 mm^3（下顎骨移動量），從而了解到在什麼時機、用什麼方式去介入維持患者的吸吸道。除此之外，我們也能了解到下顎雙側垂直截骨術級上下顎間固定術的手術退縮量限制。

並列關鍵字

正顎手術 ； 下顎雙側垂直截骨術 ； 上下顎間固定術 ； 咽呼吸道 ； 錐狀射束電腦斷層掃描