病例报告：正颌手术联合牵张成骨治疗单侧颞下颌关节强直继发的重度阻塞性睡眠呼吸暂停。
Case Report: Orthognathic surgery combined with distraction osteogenesis for severe obstructive sleep apnea secondary to unilateral temporomandibular joint ankylosis.
文献信息
| PMID | 42835352 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Zhengyang Wang |
| 作者单位 | Department of Oral and Maxillofacial Surgery, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China. |
| 期刊 | Frontiers in bioengineering and biotechnology |
| SCI 分区 | Q1 |
| IF | 6.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
本病例报告评估了正颌手术、牵张成骨与颞下颌关节手术联合治疗颞下颌关节强直继发重度阻塞性睡眠呼吸暂停的疗效。一名33岁女性表现为右侧颞下颌关节强直、张口受限、下颌后缩、面部不对称、重度OSA（AHI：94次/小时，LSaO2：66%）以及慢性心功能不全。治疗包括牵张成骨联合颞下颌关节成形术以改善张口度、面部对称性和气道尺寸，随后进行双颌正颌手术（Le Fort I型截骨术和颏成形术）以优化咬合、面部美观和气道通畅性。采用头影测量分析、气道分析和CBCT成像评估结局。下颌后缩（ANB角）和面部对称性获得显著改善。在24个月的治疗期间，咬合、气道参数（体积、AHI、氧饱和度）和张口度均得到改善。经下颌支截骨进行的垂直牵张成骨同时增加了下颌支高度并提供了髁突重建。同期颏成形术有助于咽气道和上气道容积的扩大。本病例表明，将正颌手术、颞下颌关节手术和牵张成骨相结合的分阶段方案可为颞下颌关节强直继发的重度OSA带来良好结局。需要在更大队列和更长随访中加以验证。
英文摘要
This case report evaluates the efficacy of combined orthognathic surgery, distraction osteogenesis, and temporomandibular joint surgery for severe obstructive sleep apnea secondary to temporomandibular joint ankylosis. A 33-year-old female presented with right temporomandibular joint ankylosis, limited mouth opening, mandibular retrusion, facial asymmetry, severe OSA (AHI: 94 events/hour, LSaO2: 66%), and chronic cardiac insufficiency. Treatment included distraction osteogenesis with temporomandibular joint arthroplasty to improve mouth opening, facial symmetry, and airway dimensions, followed by bimaxillary orthognathic surgery (Le Fort I osteotomy and genioplasty) to optimize occlusion, facial esthetics, and airway patency. Outcomes were assessed using cephalometric analysis, airway analysis, and CBCT imaging. Significant improvement in mandibular retrusion (ANB angle) and facial symmetry was achieved. Occlusion, airway parameters (volume, AHI, oxygen saturation), and mouth opening improved over a 24-month treatment period. Vertical distraction osteogenesis via ramus osteotomy simultaneously increased ramus height and provided condylar reconstruction. Concurrent genioplasty contributed to the expansion of the pharyngeal airway and upper airway volume. This case demonstrates that a staged protocol combining orthognathic surgery, temporomandibular joint surgery, and distraction osteogenesis can yield favorable outcomes for severe OSA secondary to temporomandibular joint ankylosis. Validation in larger cohorts with longer follow-up is required.