上颌骨Le Fort I型截骨术后鼻腔通气功能的评估

Evaluation of nasal ventilation after Le Fort I-osteotomy

摘要:

目的：本研究通过主观及客观性评估方法，对上颌骨Le Fort I型截骨上颌骨向不同方向移动后鼻腔通气功能的变化进行评估。方法：将30例需要接受正颌手术治疗的患者分为2组，前移组13例，采用上颌骨Le Fort I型截骨前移术； 非前移组：17例，采用上颌骨Le Fort I型截骨上抬、后退或下降术。术前、术后3个月及术后6个月分别对研究对象进行前鼻镜及鼻声反射检查。所有研究对象术前及术后6个月均完成NOSE 量表的主观性评估，采用SPSS对术前及术后的结果进行统计学分析。结果：鼻声反射检测结果显示两组患者的鼻腔阻力、鼻腔容积及鼻腔最小截面积3项指标在术后3个月及6个月时均较术前有所改善，但是前后差异没有统计学意义。NOSE量表的主观性评估结果显示，两研究组于术后6个月时的评估分值即主观症状改善较术前下降，然而仅非前移组术前术后差异有统计学意义。结论：上颌骨Le Fort I型单块截骨上颌骨向不同方向移动无论从客观上还是主观上都不会对患者的鼻腔通气功能产生不良影响。同时利用客观性（鼻声反射）及主观性（NOSE量表）检测手段可以有效地对鼻腔结构及功能进行评估。

Abstract:

Objective:To assess changes of nasal ventilation resulting from a one-piece Le Fort I-osteotomy in patients with maxillary dysplasia both objectively and subjectively. Methods:Thirty patients with maxillary dysplasia were classified into 2 groups. In group I (n=13), the surgical treatment plan included a one-piece Le Fort I-osteotomy with maxillary advancement. In group II, the surgical treatment plan included a one-piece Le Fort I-osteotomy with maxillary impaction, inferior or backward reposition. Rhinologic inspection, acoustic rhinometry(AR) were performed preoperatively, 3 and 6 months postoperatively. The nasal obstruction symptom evaluation (NOSE) scales were also completed by all patients preoperatively and 6 months postoperatively. The follow-up results were compared with baseline using SPSS software. Results:Acoustic rhinometry assessment showed that postoperative nasal airway resistance (NAR), nasal volume (NV) and minimal cross- sectional area (MCA) in both groups at 3 and 6 months got improved. But the differences were statistically insignificant. Improvement in nasal breathing was documented (by NOSE scores) at 6 months postoperatively in both groups, but with statistically significant difference in group Ⅱonly. Conclusions:Le Fort I-osteotomy with maxillary migration towards different directions will not aggravate nasal patency in patients with maxillary dysplasia. And the combination of objective (AR) and subjective (NOSE scale) assessment can offer a better evaluation of structure and function of nose.