| 術前症狀 | 手術計畫 |
| 重度睡眠呼吸中止（AHI=40.5）、嚴重日間嗜睡（ESS=17）與明顯鼾聲 | 進行逆時針旋轉型雙顎前移手術，拓寬呼吸道、拉緊呼吸肌群並改善臉型支撐 |
診療計畫及術後改變
這位50歲的女士，罹患重度睡眠呼吸中止(AHI=40.5)，症狀包括嚴重的日間嗜睡(嗜睡度量表ESS=17)，以及惱人的鼾聲。
This 50-year-old woman was diagnosed with severe obstructive sleep apnea (AHI = 40.5), presenting with symptoms including pronounced daytime sleepiness (Epworth Sleepiness Scale, ESS = 17) and disruptive snoring.
比較特別的是，電腦斷層檢查顯示，除了可預期的狹窄呼吸道之外，可以看出她在年輕時，曾經做過Wassmund and Kole Procedure，這是一種將上下顎左右兩邊各拔掉一顆小臼齒後，再透過骨切割，將上下顎骨往後方移動的手術，目的在解決凸嘴型。
Notably, her CT scan revealed not only the expected airway narrowing but also evidence of having undergone the Wassmund and Kole procedures in her youth. These procedures involve extracting one premolar from each quadrant of the upper and lower jaws, followed by osteotomies to reposition the maxilla and mandible posteriorly—typically performed to correct bimaxillary protrusion.
雖然沒有直接證據可以說，Wassmund and Kole procedure會導致睡眠呼吸中止症，但確實有相關研究，支持將上下顎骨往後方移動，會減少後呼吸道的空間，間接增加罹患睡眠呼吸中止的風險。謝醫師幫她設計一個逆時針旋轉型正顎手術(CCWR-MMA)，順利的拉開她受到擠壓的上下顎骨、拓寬呼吸道空間、拉緊呼吸肌群(避免塌陷)，也同時改善了頸部-下巴線條及支撐了中臉-唇周的凹陷感。
Although there is no direct evidence proving that the Wassmund and Kole procedures cause obstructive sleep apnea, existing research does support that posterior repositioning of the jaws can reduce the posterior airway space, thereby indirectly increasing the risk of developing sleep apnea.
Dr. Hsieh designed a counter-clockwise rotational maxillomandibular advancement (CCWR-MMA) surgery for her, which successfully expanded her compressed jaw structures, widened the airway, and tightened the pharyngeal musculature to prevent collapse. The procedure also improved her cervicomental contour and provided structural support to the midface and perioral region.
術後的睡眠報告顯示，AHI降至4.9(<5代表治癒)，嗜睡度量表ESS也降至5(代表正常無日間嗜睡)，也解決了她打鼾的問題。
Postoperative sleep studies showed a reduction in AHI to 4.9 (an AHI <5 indicates resolution), and her ESS score dropped to 5 (within normal range, indicating no daytime sleepiness). Her snoring was also effectively resolved.
手術前後嗜睡度量表、評估
手術前後斷層掃描對比
