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山东大学学报 (医学版) ›› 2026, Vol. 64 ›› Issue (4): 44-50.doi: 10.6040/j.issn.1671-7554.0.2025.1576

• 临床医学 • 上一篇    

正颌手术对严重骨性Ⅲ 类患者上气道大小的影响及关键因素筛选

周志远1,石玉心2,顾赫泽3,侯奕阳3,徐欣1   

  • 发布日期:2026-04-09
  • 通讯作者: 徐欣. E-mail:xinxu@sdu.edu.cn

Impact of orthognathic surgery on upper airway dimensions in patients with severe skeletal class Ⅲ malocclusion and identification of key influencing factors

ZHOU Zhiyuan1, SHI Yuxin2, GU Heze3, HOU Yiyang3, XU Xin1   

  1. 1. Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University &
    Shandong Key Laboratory of Oral Tissue Regeneration &
    Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration &
    Shandong Provincial Clinical Research Center for Oral Diseases, Jinan 250012, Shandong, China;
    2. Ningbo Savaid Stomatology &
    Otolaryngology Research Institute, Ningbo 315016, Zhejiang, China;
    3. School of Stomatology, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang, China
  • Published:2026-04-09

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摘要： 目的 探讨正颌手术对严重骨性Ⅲ类错颌畸形患者上气道大小的影响,并筛选出影响上气道大小的关键颅面因素,为优化手术方案和保障气道安全提供科学依据。 方法 回顾性分析接受同一医疗团队行正畸-正颌联合治疗的严重骨性Ⅲ类错颌畸形患者 21 例。全部患者均接受双颌正颌手术(上颌Le Fort I型截骨前徙术+下颌双侧矢状劈开截骨后退术),部分患者同期行颏成型手术。收集患者术前和术后 6 个月以上的锥形束CT影像资料,测量颅颌面指标和上气道相关指标(总容积、各分段容积、最小横截面积),分析手术前后各指标变化及颅面指标与上气道指标变化的相关性。 结果 术后患者矢状向及垂直向关系均显著改善:下颌有效长度缩短5.35 mm,Wits值改善8.77 mm,前后向不调指数减小9.92°,下颌下角减小1.51°,垂直向不调指数增加13.45°(P<0.05)。软组织侧貌显著改善:下唇突点后移7.09 mm,软组织颏前点后移6.36 mm(P<0.001)。上气道总体及各段容积、最小横截面积手术前后差异无统计学意义(P>0.05)。相关性分析显示:上颌骨有效长度变化量(ΔCo-ANS)、下颌骨有效长度变化量(ΔCo-Pog)及下颌磨牙高度变化量(ΔL6-MP)与上气道总容积、最小横截面积及口咽容积的变化量呈显著正相关(r=0.442~0.548, P<0.05)。 结论 以“气道健康为导向、强调上颌充分前移与下颌协同调整”的正颌手术策略,在对严重骨性Ⅲ类错颌畸形患者颌面形态进行矫正的同时,有效维护了上气道空间。ΔCo-ANS、ΔCo-Pog以及ΔL6-MP是促进上气道总容积增加的关键因素,可为临床个性化手术设计提供参考依据。

关键词: 骨性Ⅲ类错颌畸形, 正颌手术, 上气道, 锥形束CT, 关键颅颌面解剖因素

Abstract: Objective To investigate the impact of orthognathic surgery on the upper airway dimensions in patients with severe skeletal class Ⅲ malocclusion and to identify key craniofacial factors influencing upper airway size, thereby providing scientific evidence for optimizing surgical plans and ensuring airway safety. Methods This retrospective study included 21 patients with severe skeletal class III malocclusion who underwent combined orthodontic-orthognathic treatment by the same medical team. All patients underwent bimaxillary orthognathic surgery, with some receiving concomitant genioplasty. Cone-beam computed tomography images were collected preoperatively and at least 6 months postoperatively. Craniofacial and upper airway parameters(total volume, segmental volumes, and minimum cross-sectional area)were measured. Changes in these parameters before and after surgery were analyzed, along with correlations between changes in craniofacial and upper airway indicators. Results Postoperatively, patients showed significant improvements in sagittal and vertical relationships: effective mandibular length decreased by 5.35 mm, Wits appraisal improved by 8.77 mm, APDI decreased by 9.92°, mandibular plane angle decreased by 1.51°, and ODI increased by 13.45°(all P<0.05). Soft tissue profile also improved significantly: lower lip protrusion decreased by 7.09 mm, and soft tissue pogonion decreased by 6.36 mm(both P<0.001). No statistically significant differences were found in total upper airway volume, segmental volumes, or minimum cross-sectional area between preoperative and postoperative measurements(P>0.05). Correlation analysis revealed that ΔCo-ANS(maxillary advancement), ΔCo-Pog(mandibular setback), and ΔL6-MP(change in mandibular molar height)were significantly positively correlated with changes in total upper airway volume, minimum cross-sectional area, and oropharyngeal volume(r=0.442-0.548, P<0.05). Conclusion An orthognathic surgery strategy with an airway-oriented approach, emphasizing adequate ma-xillary advancement and coordinated mandibular adjustment, effectively correct maxillofacial deformities in patients with severe skeletal Class III malocclusion while maintaining upper airway space.The amount of maxillary advancement(ΔCo-ANS), mandibular setback amount(ΔCo-Pog), and changes in mandibular molar height(ΔL6-MP)are key factors contributing to increased upper airway volume, providing a reference for individualized surgical planning in clinical practice.

Key words: Skeletal class Ⅲ malocclusion, Orthognathic surgery, Upper airway, Cone-beam computed tomography, Key craniomaxillofacial anatomical factors

中图分类号: 

  • G649.28
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