双颌正颌手术后上气道及睡眠质量变化：骨性III类错𬌗中后鼻棘位移的影响。
Upper airway and sleep quality changes after bimaxillary orthognathic surgery: influence of posterior nasal spine displacement in skeletal class III malocclusion.
文献信息
| PMID | 42800778 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | T Kaewja |
| 作者单位 | Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand. |
| 期刊 | International journal of oral and maxillofacial surgery |
| SCI 分区 | Q2 |
| IF | 2.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
骨性III类错𬌗常需双颌正颌手术，但后鼻棘（PNS）位移对上气道尺寸和睡眠质量的影响尚不明确。这项双向性队列研究评估了33例接受Le Fort I截骨术和双侧矢状劈开截骨术的骨性III类错𬌗成人中，三维PNS位移与术后上气道尺寸及睡眠质量变化之间的关系。术前和术后进行了基于体素叠加的锥形束计算机断层扫描和III级便携式多导睡眠监测（筛查工具）。上气道体积被分割为鼻咽、口咽和下咽区域。平均PNS位移为向前3.71 ± 1.38 mm和向上2.12 ± 1.83 mm。鼻咽体积从T0到T1显著减少，平均减少555 mm3（约基线的7%）。多变量线性回归进一步显示，PNS向上位移与这种减少显著相关（β = -453 mm3/mm，P = 0.001）。这种减少并未导致客观睡眠参数的临床显著恶化。匹兹堡睡眠质量指数评分术后显著改善（P = 0.040）。口咽、下咽和总气道体积未见显著变化。PNS向上位移导致统计学显著但功能代偿的鼻咽体积减少，表明在术前无明显阻塞性睡眠呼吸暂停的患者中，控制性上颌后部压入可能不会对睡眠质量产生不利影响。
英文摘要
Skeletal class III malocclusion often requires bimaxillary orthognathic surgery, but the impact of posterior nasal spine (PNS) displacement on upper airway dimensions and sleep quality remains unclear. This ambispective cohort study evaluated the relationship between three-dimensional PNS displacement and postoperative changes in upper airway dimensions and sleep quality in 33 adults with skeletal class III malocclusion who underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Cone-beam computed tomography with voxel-based superimposition and level III portable polysomnography (screening tool) were performed preoperatively and postoperatively. Upper airway volumes were segmented into nasopharyngeal, oropharyngeal, and hypopharyngeal regions. Mean PNS displacement was 3.71 ± 1.38 mm anteriorly and 2.12 ± 1.83 mm superiorly. Nasopharyngeal volume decreased significantly from T0 to T1 by a mean of 555 mm3 (∼7% from baseline). Multivariable linear regression further revealed that superior PNS displacement was significantly associated with this reduction (β = -453 mm3/mm, P = 0.001). This reduction did not result in clinically significant deterioration of objective sleep parameters. Pittsburgh Sleep Quality Index scores improved significantly postoperatively (P = 0.040). Oropharyngeal, hypopharyngeal, and total airway volumes showed no significant changes. Superior PNS displacement causes a statistically significant but functionally compensated nasopharyngeal volume reduction, suggesting that controlled posterior maxillary impaction may not adversely affect sleep quality in patients with no significant preoperative obstructive sleep apnea.