正顎手術如何改善睡眠呼吸中止症？
正顎手術原本是設計來改善患者的咬合以及外觀，但在治療阻塞型睡眠呼吸中止的這個領域，正顎手術（上下顎骨的前移）（Maxillo-Mandibular Advancement/MMA）變成是拉緊塌陷（鬆弛）肌肉的手段，而非目的，外觀及咬合的改善變成是上下顎骨前移的附加價值。
- Maxillomandibular advancement (MMA) is a surgical procedure used to treat severe obstructive sleep apnea (OSA). Here’s how it works:
- Expansion of Airway: MMA involves moving the upper and lower jaws (maxilla and mandible) forward. This expansion increases the size of the airway, reducing the likelihood of it collapsing during sleep.
- Stabilization: By advancing the jaws, the soft tissues and muscles around the airway are also pulled forward, which helps stabilize the airway and keeps it open.
- Improved Airflow: The increased space and stabilization result in better airflow, reducing the occurrence of apnea events (breathing pauses) and hypopnea events (shallow breathing).
診療計畫及術後改變
透過上呼吸道肌群的拉緊，睡眠時呼吸道變得穩定而不容易塌陷，所以得以保持暢通。從患者術前術後的照片及電腦斷層可以看出，正顎手術將上下顎骨往前方（遠離脊椎的方向）固定，拉緊其後方肌群，軟腭肌群、舌肌群、舌骨、舌骨上肌群也明顯被往前、往上拉開，遠離後胭壁，臉部線條有所支撐，咬合也順道改善。
Orthognathic surgery was originally designed to improve the patient’s occlusion and appearance. However, in the field of treating obstructive sleep apnea, orthognathic surgery (maxillo-mandibular advancement/MMA) has become a means to tighten collapsed (loosened) muscles rather than the purpose itself. The improvement in appearance and occlusion has become an added value of maxillo-mandibular advancement. By tightening the upper airway muscles, the airway becomes stable and less likely to collapse during sleep, thus remaining unobstructed. From the preoperative and postoperative photos and CT scans of the patients, it can be seen that orthognathic surgery fixes the maxilla and mandible forward (away from the spine), tightening the muscles behind the upper and lower jaw bones. The soft palate muscles, tongue muscles, hyoid bone, and suprahyoid muscles are also significantly pulled forward, away from the posterior pharyngeal wall. The facial soft tissue envelope is supported, and the occlusion is also improved.
AHI（呼吸暫停指數）從36.5降為0.9（學術上定義AHI如果20以下為手術成功，5以下為手術治癒），最低血氧濃度從67%，升高到91%。除了這些睡眠指標的改善，最重要的是，患者本身感覺手術後，睡眠品質大增，已沒有日間嗜睡的問題，精神變好也更有活力！！！
The AHI (apnea-hypopnea index) decreased from 36.5 to 0.9 (defined as surgical success if AHI is below 20, and surgical cured if below 5). The lowest blood oxygen concentration increased from 67% to 91%. In addition to these improvements in sleep indicators, the most important thing is that the patient feels that the quality of sleep has greatly increased after the surgery, no longer has daytime sleepiness, and feels more energetic and vibrant!
外觀改變
