PDF(Pubmed)
Abstract：
The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA.
The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation.
Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region.
The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation.
Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region.
The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
摘要：
背景：下颌前移装置（MAD）和上颌下颌前移装置（MMA）在改善上气道（UA）通畅方面的功效已被描述为与持续气道正压（CPAP）结果相当。然而,以前没有研究比较MAD和MMA治疗上呼吸道扩大的结局.这项研究旨在与MMA相比，三维评估MAD后患者的UA变化和下颌旋转。
方法：样本包括17名接受MAD治疗的患者和17名接受MMA治疗的患者，高度,体重指数。两种治疗前后的锥形束计算机断层扫描用于测量总UA，上/下口咽体积和表面积；和下颌旋转。
结果：治疗后两组上口咽体积均显著增加（p=0.003），MMA组增加更大（p=0.010）。在MAD组中，考虑到下体积，没有发现统计学差异，而MMA组显示出显着的增加（p=0.010）和更大的体积（p=0.024）。两组均显示下颌前移位。然而,下颌旋转在组间有统计学差异(p<0.001)。而MAD组显示顺时针旋转模式（-3.97±1.07和-4.08±1.30），MMA组呈逆时针方向(2.40±3.43和3.41±2.79)。在MAD组中,下颌线性前移与上[p=0.002（r=-0.697）]和下[p=0.004（r=0.658）]口咽体积相关，提示下颌前移量增加与上口咽减少和下口咽增加有关.在MMA组中,上口咽体积与下颌前后[p=0.029(r=-0.530)]和垂直位移[p=0.047(r=0.488)]相关，表明更大量的下颌前移可能导致上口咽体积的最低增益，而下颌上位的大移位与该区域的改善有关。
结论：MAD治疗导致下颌顺时针旋转，增加上口咽的尺寸;而在MMA治疗中显示出所有UA区域增加更大的逆时针旋转。
方法：样本包括17名接受MAD治疗的患者和17名接受MMA治疗的患者，高度,体重指数。两种治疗前后的锥形束计算机断层扫描用于测量总UA，上/下口咽体积和表面积；和下颌旋转。
结果：治疗后两组上口咽体积均显著增加（p=0.003），MMA组增加更大（p=0.010）。在MAD组中，考虑到下体积，没有发现统计学差异，而MMA组显示出显着的增加（p=0.010）和更大的体积（p=0.024）。两组均显示下颌前移位。然而,下颌旋转在组间有统计学差异(p<0.001)。而MAD组显示顺时针旋转模式（-3.97±1.07和-4.08±1.30），MMA组呈逆时针方向(2.40±3.43和3.41±2.79)。在MAD组中,下颌线性前移与上[p=0.002（r=-0.697）]和下[p=0.004（r=0.658）]口咽体积相关，提示下颌前移量增加与上口咽减少和下口咽增加有关.在MMA组中,上口咽体积与下颌前后[p=0.029(r=-0.530)]和垂直位移[p=0.047(r=0.488)]相关，表明更大量的下颌前移可能导致上口咽体积的最低增益，而下颌上位的大移位与该区域的改善有关。
结论：MAD治疗导致下颌顺时针旋转，增加上口咽的尺寸;而在MMA治疗中显示出所有UA区域增加更大的逆时针旋转。
