- 期刊
以正顎手術矯治下顎後縮併發之阻塞性睡眠絕息症－病例報告
Orthognathic Surgery for Obstructive Sleep ApneaSyndrome Resulting from Mandibular Retrognathism-A Case Report
摘要
台灣約1.7~4.3%人口患有阻塞性睡眠絕息症候群(OSAS)，其臨床症狀有打鼾、白天嗜睡、記憶力減退，可能造成高血壓、心臟病及猝死等併發症，或導致較高的交通事故發生率。治療上需不同次專科配合，治療方式包含減重，使用持續性正壓呼吸器、止鼾器，或接受懸雍垂顎咽整形術、正顎手術等。本病例爲一名28歲女性，因年幼外傷造成左側子顳顎關節黏連，導致下顎骨發育不良，下巴嚴重後縮。睡覺時有嚴重打鼾及呼吸中止等症狀，經胸腔科醫師安排睡眠多項生理檢查(Polysomnography, PSG)，證實爲中度OSAS，建議以正顎手術矯治。患者同時合併有上顎骨生長過剩，因此接受上顎分段式勒福式Ⅰ型及雙側下顎骨上升技垂直矢狀骨切閑術（前移8 mm），前移式頦造形術(8 mm)。術後半年追蹤，症狀明顯改善，由中度轉變爲輕度的OSAS，PSG的呼吸暫停／通氣不足指數（AHI值）由術前的18.3/h改善爲8.0/h。基於OSAS病例漸受重視，如何提供有效益的治療方式，改善患者的生活品質並降低長期併發症的發生率，已成爲重要的課題。文獻中提及慎選病例以正顎手術增加呼吸道空閒可改善部分OSAS病例，而且是目前比較穩定的手術治療方式。
並列摘要
In Taiwan, 1.7 to 4.3 percent of the adult population suffered from obstructive sleep apnea syndrome (OSAS). The clinical manifestations of OSAS include snoring, excessive daytime somnolence, and decreased faculty of memory. These may result in hypertension, stroke, angina, cardiac dysrhythmias or high percentage of motor vehicle accidents. The treatments of OSAS include weight loss, continuous positive airway pressure (CPAP), oral appliance, and surgical treatments (such as uvulopalataopharyngoplasty, orthognathic surgery and etc). This case report presents a 28-year-old female who had history left TMJ ankylosis leading to mandibular retrognathism and chin deficiency. She had loud snoring and sleep apnea. Moderate obstructive sleep apnea was diagnosed using polysomnography by the chest physician and orthognathic surgery was suggested to improve this condition. She received maxillary segmental Le Fort Ⅰ osteotomy due to maxillaru excess, bilateral vertical sagittal ramus osteotomy (BVSRO) for mandibular advancement and genioplasty. In a following up of one half year after operation, the AHI (apnea/hypopnea index) was improved from 18.3/h to 8.0/h. It is an important topic to offer an efficient therapy for patients with OSAS to improve the life quality and to decrease long term complications. It was reported in the literature that to increase the air way space with orthognathic surgery was a stable therapy for some OSAS cases.
延伸閱讀
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