手术辅助快速扩弓矫治上颌横向发育不足的临床疗效分析

目的:评价手术辅助快速扩弓矫治成人上颌横向发育不足病例牙齿和基骨的变化。方法:上颌发育不足患者20例(男13例,女7例)按年龄分为扩弓组和手术组,扩弓组(平均年龄12.51±0.82岁)行矫形快速扩弓治疗;手术组(平均年龄19.07±2.54岁)行手术协助快速扩弓治疗。所有患者治疗前后摄头颅定位正侧位片和咬合片,头影测量分析、比较。结果:两组病例均有明显的扩弓效果,手术组牙弓宽度增加更为显著,扩弓组牙弓长度增加明显,但组间均无显著性差异;治疗前后,手术组B点显著后移,而扩弓组B点前移,组间有显著性差异(P<0.05);治疗前后,手术组腭平面后旋,扩弓组腭平面前旋,组间有显著性差异(P<0.01);治疗前后,两组病例上颌切牙均内倾,组间无显著性差异。结论:手术协助快速扩弓治疗成人上颌横向发育不足,可取得良好的扩弓效果;对上下颌骨、上颌切牙在矢状面的改变更有利于III类错畸形的矫正;在病例的选择上,更适用于低角病例。     

上颌快速扩弓后上气道容积变化的Meta分析

目的:采用Meta分析的方法根据现有临床证据系统评价上颌快速扩弓后上气道容积的变化情况.方法:检索中英文电子数据库中有关上颌快速扩弓与上气道容积变化方面的所有文献.按照相关性、是否符合纳入标准等对文献进行筛选.将数据输入RevMan 5.3进行分析.结果:最后纳入11 篇文献,Meta分析结果显示鼻咽容积变化为+0.62 cm3(P=0.000 2),腭咽容积变化为+0.62 cm3(P=0.02),舌咽变化为+0.39 cm3(P=0.11),口咽总体积变化+0.40 cm3(P=0.27).结论:现有临床证据表明,上颌快速扩弓对上气道容积的影响主要在鼻咽、腭咽部位,对舌咽及口咽总容积无明显影响.     

Segment tilting associated with surgically assisted rapid maxillary expansion

This study aimed to evaluate, via computed tomography, the direction and magnitude of the segmental tilting that may occur after surgically assisted rapid maxillary expansion (SARME) in patients with a transverse maxillary deficiency. Thirty adult patients with a transverse maxillary deficiency greater than 5 mm were treated by SARME. The procedures consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a tooth-borne orthopaedic device postoperatively. Axial and coronal images were obtained before and 6 months after SARME to evaluate the segment tilting. The greatest expansion occurred in the most inferior (5.4 ± 1.1 mm) and anterior (4.0 ± 1.3 mm) regions of the maxilla. The expanded segment tilted outward inferiorly and anteriorly in coronal and axial images, respectively. The segment tilting was 2.0 mm (2.3%) inferiorly and 3.1 mm (12.8%) anteriorly. It can be concluded that an outward tilting occurs in the most inferior and anterior portions of the maxilla during SARME procedures. Hence the direction and magnitude of such segmental tilting must be considered preoperatively when determining the surgical objectives.     

Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion

ObjectivesTo evaluate changes in dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion (MARME) and observe correlations between changes of upper airway and vertical skeletal pattern in young adults.Materials and MethodsIn this retrospective study, 22 patients (mean age, 22.6 ± 4.5 years; 4 male 18 female) with transverse discrepancy underwent MARME. Cone beam computed tomography was taken before and 3 months after expansion. Vertical and horizontal dimensions and volume of the nasal cavity, nasopharyngeal, retropalatal, retroglossal and hypopharyngeal airway were compared before and after MARME. Correlations between changed volume and dimensions were explored, as well as the vertical skeletal pattern.ResultsNasal osseous width, maxillary width, volume of the nasal cavity and nasopharynx increased significantly (P < .05). Enlarged nasopharyngeal volume correlated with increased nasal width at the PNS plane (P < .05). There were no correlations between expanded volume and maxillary width. No measurements except nasal cavity volume had a correlation with Sum angle. Increased maxillary width correlated negatively with hard palate thickness (P < .05).Conclusions(1) MARME caused an increase in volume of the nasal cavity and nasopharynx, with expansion of nasal osseous width and maxillary width. (2) Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed no direct relation with increased volume. (3) In this study, it was unclear about the association between changes of the upper airway and vertical skeletal pattern because of complex structures. (4) Palate thickness affected skeletal expansion of the maxilla in MARME.     

外科辅助上颌骨快速扩弓后牙-上颌骨的变化

目的通过头颅侧位片及数字化三维(Three Dimensional 3D)牙模的测量,分析上颌牙弓狭窄的患者经过外科辅助上颌骨快速扩弓(surgically assisted rapid maxillary expansion,SARME)后牙-上颌骨的变化,从而为临床的治疗提供一定的理论依据。方法收集2012年8月～2013年8月上海交通大学医学院附属第九人民医院口腔颅颌面外科经过SARME术的患者15例,无相关颅颌面综合征。术前一周及术后六个月扩弓器拆掉即刻拍摄头颅侧位片及制取石膏牙模,并将石膏牙模进行激光扫描,获取3D牙模。将所得资料进行测量分析,得出患者术后的变化。测量结果采用SPSS17.0统计包中的配对t检验进行检验。结果头颅侧位片示:SNA、NA-FH减小,术前、术后的差异具有统计学意义。3D牙模分析:ANGLE 4、ANGLE 5、ANGLE 6、R3-L3、R41-L41、R51-L51、R61-L61都明显增大,所有改变都具有统计学意义。结论 SARMR后A点后退,10例患者上颌骨发生顺时针旋转,5例患者上颌骨逆时针旋转。双侧第一前磨牙及第一磨牙发生明显的倾斜,平均...     

上颌横向发育不足的研究进展

上颌横向发育不足是临床中常见的错(牙合)畸形。准确判断有无上颌横向发育不足是正畸临床诊断、制定治疗方案和实现矫治目标的重要前提。本文就上牙弓和上颌骨的横向发育、上颌横向发育不足的病因及常用的诊断方法作一综述,以期为正畸临床提供有效参考。     

上颌骨性扩弓器对成年女性眼眶容积的评价

评价上颌骨性扩弓器（MSE）治疗成年女性上颌骨宽度不足（MTD）对眼眶容积及眶周骨骼间宽度的影响。     

Nationwide survey of surgically assisted rapid maxillary expansion

We aimed to gather data on the current practice of surgically assisted rapid maxillary expansion (SARME) in the UK. Surveys were posted in the mail to all members of the British Association of Oral and Maxillofacial Surgeons (n = 379) and 166 (44%) responded. In the previous year 69 responders (42%) had done at least one SARME operation. The technique used by individual surgeons may be more experience-based than evidence-based, which leads to considerable variation.     

Strategies for surgically assisted rapid maxillary expansion according to the region of transverse maxillary deficiency

This study evaluated different techniques for surgically assisted rapid maxillary expansion (SARME) according to the type of transverse maxillary deficiency using computed tomography (CT). Six adult patients with bilateral transverse maxillary deficiencies underwent SARME. The patients were equally divided into three groups: Group I, maxillary atresia in both the anterior and posterior regions; Group II, greater maxillary atresia in the anterior region; and Group III, increased maxillary atresia in the posterior region. In Group I, a subtotal Le Fort I osteotomy was used. In Group II, a subtotal Le Fort I osteotomy was used without pterygomaxillary suture disjunction. In Group III, a subtotal Le Fort I osteotomy was used with pterygomaxillary suture disjunction and fixation of the anterior nasal spine with steel wire. The midpalatal suture opening was evaluated preoperatively and immediately after the activation period using CT. For Group I, the opening occurred parallel to midpalatal suture; for Group II, the opening comprised a V-shape with a vertex on the posterior nasal spine; and for Group III, the opening comprised a V-shape with a vertex at the anterior nasal spine. The conclusion was that the SARME technique should be individualized according to the type of transverse maxillary deficiency.     

采用超声骨刀在局部麻醉下行外科辅助上颌骨快速扩弓术的临床应用

目的 探讨采用超声骨刀在局部麻醉下进行外科辅助上颌骨快速扩弓（SARME）手术的可行性。方法 选择14例上颌骨横向发育不足的患者（其中男性6例,女性8例）为研究对象,在局部麻醉下用超声骨刀行 SARME手术,手术方式采用腭中缝截骨术+侧方骨皮质切开术+双侧翼颌连接截骨术。采用问卷调查方式调查患者的术中感受。结果 所有患者的SARME手术均在门诊手术室采用局部麻醉完成,患者均耐受并配合手术。超声骨刀损伤小,可以精确截骨,术后反应小。问卷调查结果显示,术中没有或者仅感觉到轻度震动感的有8例（占 57.14%）;术中没有或仅感觉到轻度疼痛和牙齿酸痛的有12例（占85.71%）;对超声骨刀的声音无畏惧感或仅有轻度畏惧感的有 11例（占78.57%）。患者术前和术后6个月牙弓宽度的测量值显示手术扩弓的效果非常明显。结论 利用超声骨刀在局部麻醉下行SARME手术是可行的,但需要更多病例的实践和更长时间的随访。     

手术辅助上颌骨快速扩弓对鼻气道流场特征的影响

目的： 采用计算机数值模拟方法,研究手术辅助上颌骨快速扩弓对鼻腔气流动力学特征的影响。方法： 选择8例上颌骨横向发育不足,伴一侧或双侧后牙反的成人患者进行手术辅助上颌快速扩弓。所有研究对象均在治疗前（T1）、扩弓保持3个月后（T2）拍摄螺旋CT,采用Mimics10.0软件建立上气道三维模型,并利用ANSYS14.0软件系统对三维气道进行网格划分、流场数值模拟以及计算模拟结果的后处理,以获得鼻腔内气流速率、压力,鼻腔各截面面积、鼻腔容积和鼻阻力数据。采用SPSS 16.0 软件包中的配对t检验比较T1、 T2时期鼻气道气流场参数的改变。结果： 扩弓后鼻腔整体流速趋于稳定,流速较治疗前减小;术前鼻腔内多处见湍流形成,而术后则较少见湍流及涡流形成;鼻腔负压绝对值显著减小（P<0.05）,鼻腔横截面积及鼻腔容积增加,且鼻阻力显著降低（P<0.05）。结论： 手术辅助快速扩弓可对鼻气道形态及气流动力学特征产生一定影响,有利于鼻气道通气功能改善。     

上颌快速扩弓联合前方牵引后骨性Ⅲ类伴上颌骨发育不足患者上气道变化的meta分析

目的 系统评价上颌快速扩弓联合前方牵引后骨性Ⅲ类伴上颌骨发育不足患者上气道的变化情况。方法 计算机检索 PubMed、Cochrane Library、Embase、CNKI、CBM、维普及万方数据库等中英文数据库中所有关于上颌快速扩弓联合前方牵引后骨性Ⅲ类伴上颌骨发育不足患者上气道变化方面的文献,检索时限均为建库至 2018年 3 月1日。由 2 名研究者根据纳入与排除标准筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3 软件进行 meta 分析。结果 最后纳入 12 篇文献,Meta 分析结果显示,上颌快速扩弓联合前方牵引后,鼻咽容积[MD=0.89 cm³,95%CI(0.36 cm³,1.42 cm³),P=0.001]显著大于治疗前,口咽容积[MD=0.44 cm³,95%CI(-0.01 cm³,0.89 cm³),P=0.05]、喉咽容积[MD=0.37 cm³,95%CI（-1.31 cm³,1.76 cm³）,P=0.61]较治疗前差异无统计学意义。上气道上部变化PNS-ad1[MD=2.11 mm,95%CI（1.87 mm,3.94 mm）,P<0.00001]、 PNS-ad2[MD=2.91mm,95%CI(1.87 mm,3.94 mm),P<0.00001]显著大于治疗前,上气道下部MPS[MD=0.47 mm,95%CI(-0.89 mm,1.87 mm),P=0.5]、IPS[MD=0.42 mm,95%CI(-0.90 mm,1.75 mm,P=0.53)]较治疗前差异无统计学意义。结论 上颌快速扩弓联合前方牵引可以增加安氏Ⅲ类伴上颌骨发育不足患者鼻咽部容积及矢状径,可通过扩大气道间隙,降低上颌骨发育不足患者发生阻塞性睡眠呼吸暂停综合征的风险。     

Transverse changes after surgically assisted rapid palatal expansion

The aim of this retrospective study was to investigate the amount of skeletal and dental expansion in patients submitted to surgically assisted rapid palatal expansion (SARPE). The sample consisted of 21 patients (14 female and seven male) with a mean age of 25.4 years (range 17.4–41.8 years). Postero-anterior (PA) cephalograms were taken pre-expansion (T1), immediately after expansion (T2), and at post-expansion retention of 120 days (T3). SARPE promoted significant transverse skeletal changes, which were maintained from T2 to T3. Dentoalveolar expansion and dental tipping were also observed in the region of the first molars and first premolars; however the net effect at the first molars was significantly less than that at the first premolars. No statistically significant effect on the width of the nasal cavity was observed. The findings indicate that peculiarities inherent to dental effects may influence the clinical options for SARPE. Skeletal expansions with SARPE were significant and stable. Dental changes were different between molars and premolars. The transverse changes after SARPE should be observed for future procedures related to the retention and the completion of orthodontic treatment.     

外科辅助上颌骨快速扩弓对鼻气道和上颌复合体影响的系统评价

目的 评价外科辅助上颌骨快速扩弓对鼻气道和上颌复合体的影响.材料和方法 我们计算机检索和手动检索以下数据库:PubMed,ISI Web of Knowledge,Ovid,EBSCO Dentistry & Oral Science Source,Cochrane Library and Cochrane Central Register of Controlled Trials (CENTRAL),纳入采用外科辅助上颌骨快速扩弓治疗的研究,要求受试者人数＞10.依据方法学质量评价量表对纳入的文献进行质量评价.结果 初步检索后获得111篇相关的文献,最终对符合纳入标准且方法学质量评价得分较高的4篇文献的4个结果进行Meta分析.结果表明扩弓后,鼻腔后部容积、使用鼻粘膜减充血剂后鼻腔后部最小横截面积、牙弓前后部宽度均增加显著(P＜0.05).结论 从本研究Meta分析中得出结论:随着上颌基骨和牙槽骨的增宽,外科辅助上颌骨快速扩弓增加鼻腔后部最小横截面积并显著增加鼻腔容积,从而减小鼻气道阻力.     

快速扩弓结合前方牵引对牙颌作用的三维测量研究

目的探讨应用快速扩弓结合前方牵引矫治替牙期骨性Ⅲ类反在三维方向上的作用。方法选取30例替牙期骨性Ⅲ类反患者,应用快速扩弓结合前方牵引的方法进行治疗。分别对矫治前、后的X线头颅侧位片和石膏模型进行测量分析,并运用SPSS12.0软件进行统计学处理。结果快速扩弓结合前方牵引治疗替牙期骨性Ⅲ类反作用为:①水平方向上增加上颌牙弓宽度;②矢状方向上上颌突度的增加是上前牙唇倾,上颌骨向前生长的结果;下颌突度的减小是下颌后下旋转和髁突在关节窝内移位共同作用的结果;③垂直方向的变化与水平和矢状方向的变化密切相关,面下高度增加,下颌平面角增大。结论快速扩弓结合前方牵引治疗可有效矫正替牙期骨性Ⅲ类反,但使牙颌结构在三维方向上都产生极其复杂的不同的变化,应根据错的特点调整相应的治疗措施以使在各个方向上增加有利的变化,避免或减少不利的变化。     

Volumetric changes of the nose and nasal airway 2 years after tooth‐borne and bone‐borne surgically assisted rapid maxillary expansion

This study aimed to assess the effects of bone‐borne and tooth‐borne surgically assisted rapid maxillary expansion on the volumes of the nose and nasal airway 2 yr after maxillary expansion. This prospective cohort study included 32 patients with transverse maxillary hypoplasia. Expansion was performed with a tooth‐borne distractor (Hyrax) in 19 patients and with a bone‐borne distractor [transpalatal distractor (TPD)] in the remaining 13. Cone beam computed tomography scans and three‐dimensional (3D) photographs of the face were acquired before treatment and 22 ± 7 months later, and were used to evaluate the volumes of the nose and nasal airway. Nasal volume increased by 1.01 ± 1.6% in the Hyrax group and by 2.39 ± 2.4% in the TPD group. Nasal airway volume increased by 9.7 ± 5.6% in the Hyrax group and by 12.9 ± 12.7% in the TPD group. Changes in the nasal volume and in the nasal airway volume between the pre‐ and post‐treatment measurements were statistically significant, whereas differences between the treatment groups were not; 22 months after surgically assisted rapid maxillary expansion, the increases in the nasal volume and in the nasal airway volume were comparable between tooth‐borne and bone‐borne devices.     

Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography

Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.

Objective

To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).

Material and Methods

Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.

Results

Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.

Conclusions

The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).