| 术前症状 | 手术计画 |
| 夜间严重打鼾与日间嗜睡，中度睡眠呼吸中止症（AHI 17.3） | 进行逆时针旋转型双颚前移手术，前移上颚、下颚与舌骨以拓宽气道 |
诊疗计画及术后改变
这位患者主诉为夜间严重打鼾及日间嗜睡，影响生活品质。多项睡眠检查结果显示中度阻塞性睡眠呼吸中止症（AHI = 17.3），睡眠期间最低血氧浓度降至83%，显示显著的通气障碍。
This patient presented with complaints of severe snoring during sleep and excessive daytime sleepiness, significantly affecting quality of life. Polysomnography revealed moderate obstructive sleep apnea (OSA) with an apnea–hypopnea index (AHI) of 17.3, and a minimum oxygen saturation of 83% during sleep, indicating substantial ventilatory compromise.
电脑断层影像显示，患者后方呼吸道空间明显狭窄，主因为上下颚骨发育不足，未能适当向前成长。上颚骨后缩合并气道塌陷，使松弛的悬壅垂在狭窄空间中震动，产生明显鼾声；下颚骨后缩则导致舌头后倾、舌肌张力不足、舌骨位置偏低，成为阻塞性呼吸中止的主要结构性因素。
Computed tomography (CT) imaging demonstrated a markedly narrowed posterior airway space, primarily due to underdeveloped maxillary and mandibular growth. The retruded maxilla, combined with airway collapse, allowed the relaxed uvula to vibrate within the constricted space, producing loud snoring. The retrognathic mandible further contributed to posterior tongue displacement, reduced tongue muscle tone, and a low-positioned hyoid bone—key anatomical factors in the pathogenesis of OSA.
针对上述解剖与功能问题，我们为患者规划逆时针旋转型双颚前移手术（Counter-Clockwise Rotation Maxillomandibular Advancement, CCWR-MMA）。
整个手术设计的中心思想有三个：
1. 上颚骨前移有效拉紧软颚肌群，使悬壅垂向前牵引，远离后咽壁，减少鼾声产生
2. 下颚骨前移则牵引舌根部位，使舌头向前移动，减少舌根后坠
3. 与此同时，舌骨亦被牵引至前上方位置，远离气道后壁，显著扩大咽腔空间，改善通气效率。
To address these structural and functional issues, we planned a counter-clockwise rotation maxillomandibular advancement (CCWR-MMA) procedure. This surgical approach included:
- Maxillary advancement, which tightened the soft palate musculature and repositioned the uvula anteriorly, away from the posterior pharyngeal wall, thereby reducing snoring;
- Mandibular advancement, which, through its anatomical connection to the tongue base, repositioned the tongue anteriorly, minimizing posterior collapse;
- Additionally, the hyoid bone was drawn forward and upward, distancing it from the posterior airway wall and significantly expanding the pharyngeal space to improve airflow.
术前与术后的电脑断层影像清楚显示，骨骼位置调整后，软组织张力提升，气道空间随之拓宽，结构性改善明确。
术后睡眠报告显示AHI 降至6.3，最低血氧浓度提升至89%。患者术后自述睡眠品质显著改善，日间精神状态明朗，整体生活品质亦获得提升。
Pre- and postoperative CT scans clearly demonstrated how skeletal repositioning led to soft tissue tensioning and airway enlargement. Postoperatively, the patient's AHI decreased from 17.3 to 6.3, and minimum oxygen saturation improved from 83% to 89%. Clinically, the patient reported markedly improved sleep quality and daytime alertness, with a refreshed and energized demeanor.
外观改变
手术前后断层扫描对比
