安格氏骨性三級異常咬合患者雙頷正顎手術的上呼吸道變化評估

嚴重下顎前突患者的治療選擇，主要治療方案為下顎後退手術。有研究指出，無論是否同時做上顎前移，手術都可能引起上呼吸道空間(Upper airway space, UAS)的變化。因此，本研究旨在評估安格氏骨性三級異常咬合患者，接受雙顎正顎手術(上顎前移和下顎後退)以及頦成形術後，口咽區上呼吸道的變化。本研究的樣本包括 20 名患者(10位男性及10女性)的 40 次錐形束電腦斷層掃描(Cone-beam computed tomography, CBCT)。放射線檢查是在手術前及手術後進行。 上呼吸道空間(Upper airway space)體積、長度、矢狀面積與最小軸向面積及寬度、深度和位置是在Dolphin Imaging TM軟體 (版本11.95 Premium)的輔助下進行測量。應用Student's paired t-test檢定，對數據進行統計處理；另外使用Wilcoxon signed-rank test，一種無母數的檢定方法，來比較術前與術後的中位數在統計上是否有顯著差異，並以 p 值<0.05 誤差條件下，對實驗數據進行變數間的統計分析。結果顯示所有評估項目：上呼吸道矢狀面積、體積、長度、矢狀面積與最小軸向面積及其深度、寬度和位置的測量值在95％信賴區間下，都沒有統計上的顯著差異。術後口咽部(oropharynx)也未觀察到明顯變化的測量值在統計學上都沒有顯著差異(P>0.05)。藉由本研究可以得知，患者接受雙顎正顎手術和下顎整形術後，口咽部空間未觀察到明顯變化。

The primary treatment option for severe mandible prognathism patients is mandible setback surgery. Previous studies have showed that whether the surgical procedure is combined with maxillary advancement or not, one jaw or two jaw orthognathic surgery could induce changes in the upper airway space. Thus, the objective of this study is to evaluate the upper airway change after bimaxillary orthognathic surgery (maxilla advancement and mandible setback) combined with genioplasty in Angle’s skeletal Class III patients. The sample of this study included 20 patients (10 male and 10 female) and 40 cone-beam computed tomography images of the patients. The radiographic examination was performed before and after surgery. The measurements of upper airway space including sagittal area dimension, airway length, airway volume, minimum axial area depth, minimum axial width and minimum axial location were analyzed using Dolphin Imaging TM software (11.95 Premium edition). Statistical analysis was performed by applying Student’s paired t-test and Wilcoxon signed-rank test. The Wilcoxon signed-rank test compares the median of pre-surgical and post-surgical measurements and tests whether there are significant differences. The results showed that at the 95% confidence level there were no statistically significant differences in all the evaluated measurements. (P>0.05) In summary, there are no significant differences in the upper airway space in patients who had undergone bimaxillary orthognathic surgery and genioplasty surgery.