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Kiefer-Gesichts-chirurgische Diagnostik und Therapie schlafbezogener Atmungsstörungen

Surgical maxillofacial diagnosis and treatment of obstructive sleep apnea

  • Leitthema
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Zusammenfassung

Bei den obstruktiven schlafbezogenen Atmungsstörungen (SBAS) handelt es sich um ein funktionelles Problem mit Kollaps der oberen Atemwege im Schlaf, die durch Form und Stellung des Gesichtsskeletts bzw. der Kiefer beeinflusst werden. Die Beurteilung der skeletalen und pharyngealen Verhältnisse mit der Kephalometrie ist somit essenziell in der Diagnostik der SBAS. Kraniofaziale Veränderungen des Gesichtsschädels sind bei etwa 40% der Patienten die zweithäufigste Ursache für SBAS. Dann besteht eine Indikation zur chirurgischen Behandlung durch maxillomandibuläre Osteotomie als Alternative zur lebenslangen konservativen Positivdruckbeatmung (CPAP). Unser Konzept favorisiert eine primäre simultane Ober- und Unterkiefervorverlagerung um 10 mm durch eine Le-Fort-I-Osteotomie bzw. bilaterale retromolare sagittale Osteotomie. In 98% der Fälle führt dies zur Beseitigung der SBAS. Nur in etwa 5% der Fälle sind zusätzliche sekundäre Maßnahmen (Uvulopalatopharyngoplastik oder Kinnosteotomie) erforderlich.

Abstract

Pathophysiologic preconditions for obstructive sleep apnea (OSA) are, in addition to obesity, certain craniofacial disorders of the viscerocranium as mandibular and/or maxillary deficiency (retrognathia) or vertical dolichofacial type. The steep mandibular plane leads to dorsocaudal displacement of the tongue and suprahyoid muscles and thus provokes pharyngeal obstruction. Cephalometric evaluation of the viscerocranium should be essential in the diagnostics of OSA. About 40% of OSA patients have pathologic craniofacial changes. In these patients surgical maxillofacial correction is an effective alternative treatment to lifelong conventional conservative treatment with nasal positive pressure ventilation. The Marburg protocol schedules surgical maxillo-mandibulary advancement of about 10 mm as a first step procedure. Maxillary advancement is achieved by Le Fort-I osteotomy or mandibulary advancement by bilateral retromolar sagittal split osteotomy. This primary procedure is successful in 98% of the cases selected according to cephalometric parameters. In about 5% of the cases second stage procedures, such as uvulopalatopharyngoplasty or genioglossal advancement, are necessary.

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  1. Mund-, Kiefer-, Gesichtschirurgie,Plastische Operationen, Schützenstraße 84, 78315, Radolfzell, Deutschland

    W. Hochban

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Hochban, W. Kiefer-Gesichts-chirurgische Diagnostik und Therapie schlafbezogener Atmungsstörungen. MKG-Chirurg 1, 111–118 (2008). https://doi.org/10.1007/s12285-008-0016-7

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