骨性Ⅱ类错颌畸形伴OSAHS患者双颌前移术后上气道变化1例报告及文献复习

doi:10.13481/j.1671-587X.20250224

摘要/Abstract

摘要：

骨性Ⅱ类错颌畸形患者常伴有上气道的结构和功能异常，严重者可发生阻塞性睡眠呼吸暂停低通气综合征（OSAHS），本文作者观察1例骨性Ⅱ类错颌畸形伴OSAHS患者双颌前移（MMA）术后上气道发生的形态学和流体力学改变。患者，男性，27岁，骨性Ⅱ类错颌畸形伴中度OSAHS，采用正畸正颌联合治疗方案，前移上下颌骨，对比患者手术前后面相和口内相，可见咬合关系良好，覆颌覆盖和尖磨牙关系正常。上气道流场改善明显，术后2年鼻咽气道横截面积增加10.76%，压强降低55.36%；腭咽气道横截面积增加108.25%，压强降低98.14%；舌咽气道横截面积增加97.51%，压强降低351.03%；喉咽气道横截面积增加27.54%，压强降低95.62%。呼吸暂停和低通气指数（AHI）降低55.45%，基本达到治疗目标。形态学测量结合流体力学分析能够更加全面地评价上气道状况，计算流体力学（CFD）分析得到的上气道临界闭合压（Pcrit）近似值可作为评估上气道状况的一项简便的定量指标。

关键词: 双颌前移术, 上气道, 阻塞性睡眠呼吸暂停低通气综合征, 计算流体力学, 病例报告

Abstract:

The patients with skeletal class Ⅱ malocclusion are often accompanied by structural and functional abnormalities of the upper airway， and obstructive sleep apnea hypopnea syndrome （OSAHS） may occur in severe cases. The morphologic and fluid dynamic changes of the upper airway in one patient with skeletal class Ⅱ malocclusion accompanied by OSAHS after maxillomandibular advancement （MMA） surgery were observed.The patient was a 27-year-old male with skeletal class Ⅱ malocclusion and moderate OSAHS. Combined orthodontic and orthognathic treatment was conducted， involving the anterior movement of the maxilla and mandible. After surgery， the patient’s facial and intraoral features showed a satisfactory occlusion relationship with normal overbite， overjet and canine-molar relationships. There was also a significant improvement in the upper airway flow field. Two years after surgery， the cross-sectional area of the nasopharyngeal airway increased by 10.76% with a 55.36% reduction in pressure. The oropharyngeal airway showed a 108.25% increase in cross-sectional area with a 98.14% pressure reduction. The hypopharyngeal airway exhibited a 97.51% increase in cross-sectional area with a 351.03% pressure reduction. The laryngopharyngeal airway demonstrated a 27.54% increase in cross-sectional area with a 95.62% pressure reduction. The apnea-hypopnea index （AHI） decreased by 55.45%， achieving the treatment goal. Morphological measurements combined with fluid dynamic analysis can comprehensively evaluate the condition of the upper airway. The approximate value of the critical closing pressure（Pcrit） obtained from computational fluid dynamics （CFD） analysis may serve as a simple quantitative indicator for assessing the upper airway condition.

Key words: Maxillomandibular advancement surgery, Upper airway, Obstructive sleep apnea- hypopnea syndrome, Computational fluid dynamics, Case report

中图分类号:

R782.2

胡向锦,孙秀梅,陈楷,吴国民. 骨性Ⅱ类错颌畸形伴OSAHS患者双颌前移术后上气道变化1例报告及文献复习[J]. 吉林大学学报(医学版), 2025, 51(2): 493-500.

Xiangjin HU,Xiumei SUN,Kai CHEN,Guomin WU. Changes of upper airway in patient with skeletal class Ⅱ malocclusion accompanied by OSAHS after maxillomandibular advancement surgery: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2025, 51(2): 493-500.

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参考文献 24

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Term	T0	T1	T2
Sleep cycle
N1 (η/%)	12.1	13.2	19.2
N2 (η/%)	48.7	53.8	69.3
N3 (η/%)	23.3	23.6	3.0
REM (η/%)	15.9	9.4	8.5
Duration (t/min)	350.3	387.5	467.0
AHI
Total (times·h^-1)	10.1	2.4	4.5
NREM (times·h^-1)	5.6	11.5	3.6
REM (times·h^-1)	23.2	1.4	13.7
SpO₂
Average SpO₂ (η/%)	97.0	96.0	96.0
Minimal SpO₂ (η/%)	89.0	91.0	86.0

Terms	T0			T1			T2
	REM	NREM	Total	REM	NREM	Total	REM	NREM	Total
Apnea
Index (times·h^-1)	17.1	1.6	5.8	0	0	0	7.6	0.8	1.4
Maximal duration （t/s）	50.0	50.0	50.0	0	0	0	25.5	53.5	53.5
Average duration （t/s）	25.5	32.2	27.6	0	0	0	15.3	29.7	25.4
Hypopnea
Index (times·h^-1)	6.1	3.9	4.3	11.5	1.4	2.4	6.1	2.8	3.1
Maximal duration （t/s）	71.0	125.0	125.0	117.0	93.0	117.0	47.5	81.5	81.5
Average duration （t/s）	45.1	58.6	55.4	59.1	37.3	47.5	42.1	37.3	38.1
AHI (times·h^-1)	23.2	5.6	10.1	11.5	1.4	2.4	13.7	3.6	4.5

Term	Before surgery	Six months after surgery	Two years after surgery
Volume of nasopharynx (V/mm³)	6 391.56	6 808.67	7 079.00
Area of PNS plane (S/mm²)	280.72	374.08	334.03
Pressure of choana plane (P/cmH₂O)	-2.24	-8.97	-3.48
Pressure of PNS plane (P/cmH₂O)	-2.31	-8.02	-2.38
Volume of palatopharynx (V/mm³)	3 196.84	6 373.83	6 326.22
Area of uvula plane (S/mm²)	111.98	203.99	233.20
Pressure of uvula plane (P/cmH₂O)	-2.69	-8.59	-5.33
Volume of glossopharynx (V/mm³)	3 668.78	4 780.87	5 990.12
Area of TE plane (S/mm²)	129.09	239.18	254.97
Pressure of TE plane (P/cmH₂O)	-2.92	-9.02	-13.17
Volume of hypopharynx (V/mm³)	3 607.24	4 864.47	4 962.51
Area of bite plane (S/mm²)	287.48	390.90	366.64
Pressure of bite plane (P/cmH₂O)	-5.02	-22.35	-9.82

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