手术辅助上颌快速扩弓对鼻气道形态和鼻阻力的影响

目的: 评价手术辅助上颌快速扩弓（surgically assisted rapid maxillary expansion, SARME）对成人鼻腔容积及鼻阻力的影响。方法: 16例上颌横向发育不足,伴一侧或双侧后牙反牙合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,测量鼻腔宽度及鼻腔容积变化,并采用鼻声反射测量（AR）检查鼻腔最小横截面积及鼻阻力的改变。应用SPSS 16.0 软件包中的配对t检验比较治疗前（T1）、扩弓保持3个月后（T2）鼻腔宽度、鼻腔最小横截面积、鼻腔容积和鼻阻力的改变。结果: 上颌快速扩弓后,鼻腔上部及中部宽度无显著变化（P>0.05）,而鼻底宽度显著增加（P<0.01）。鼻腔容积及鼻腔最小横截面积显著增加（P<0.05）,而鼻阻力显著减小（P<0.01）。结论: 手术辅助上颌快速扩弓可对成人鼻气道形态产生影响,使鼻阻力降低。     

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.     

上颌快速扩弓联合前方牵引治疗骨性Ⅲ类错牙合畸形对上气道影响的锥形束 CT 分析

目的：研究上颌快速扩弓联合前方牵引治疗骨性Ⅲ类错(牙合)畸形对上气道影响的三维变化。方法：选择53例伴上颌骨横向发育不足的骨性Ⅲ类错(牙合)畸形患者。所有患者先采用 Hyrax 矫治器进行上颌快速扩弓,然后前方牵引矫治。平均扩弓16 d,前方牵引平均5个月。分别于扩弓前（T0）、扩弓结束时（T1）及前方牵引结束时（T2）拍摄锥形束 CT 并进行三维重建和测量。结果：扩弓结束时鼻咽段最小截面积、最小截面积处冠状径和鼻咽段容积显著增大（P ＜0．05）;前方牵引矫治后鼻咽段4项指标与扩弓治疗前相比明显增大（P ＜0．05）。结论：上颌骨快速扩弓联合前方牵引可显著增加鼻咽段上气道容积。     

气流动力学技术研究鼻气道阻力和横断面积

本文应用气流动力学原理,采用模拟人的上呼吸道模型,研究鼻通气道的阻力及横断面积,提出了有关确定鼻呼吸、口呼吸及口鼻混合呼吸的指标,有助于对鼻腔及上颌骨生长发育的研究,并对唇腭裂患者及外科正畸患者的治疗,提供有益的帮助。     

2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响

目的： 建立骨性Ⅲ类错畸形患者正颌手术前、后上气道三维模型，比较不同正颌术式对骨性Ⅲ类错畸形患者上气道各截面积及容积的影响。方法： 28例骨性Ⅲ类错畸形患者经正颌-正畸联合会诊，制定手术方案，分为2组，实验A组（12例）为单纯双侧下颌支矢状劈开术（BSSRO）后退，即单颌手术组，实验B组（16例）为下颌骨BSSRO 后退 +上颌骨Le Fort I型截骨术前移，即双颌手术组。所有患者于正颌手术前（T1）和术后3个月（T2）分别行CT扫描，基于CT图像，应用Dolphin Imaging 11.7软件建立包含腭咽、舌咽和喉咽腔在内的上气道三维模型，测量、比较2组患者在正颌手术前、后的上气道各截面、腔隙的矢状径、冠状径、横截面积和容积改变的差异。采用SPSS 16.0 软件包进行统计学分析。结果： 在腭咽段，实验A组手术后各项数值均较术前减小；实验B组手术后除冠状径外，其余数值均较术前增大，且2组变化有显著差异（P<0.05）。在舌咽段及喉咽段，2组手术后数值均减小。在横截面积和容积方面，实验A组较实验B组减小更加明显，2组的减小量有显著差异（P<0.05）。结论： 与单颌手术相比，双颌手术对骨性Ⅲ类错畸形患者上气道形态的减小改变影响较小。     

骨性Ⅱ类伴重度阻塞性睡眠呼吸暂停综合征的综合治疗效果评价

目的:评价手术辅助上颌快速扩弓(SARME)联合下颌骨牵张成骨术(DO)矫治年轻骨性Ⅱ类伴重度阻塞性睡眠呼吸暂停综合征(OSAHS)患者的疗效。方法:4例上颌牙弓狭窄及下颌骨发育不足的骨性Ⅱ类患者(其中男2例,女2例,18～23岁,平均20.3岁),经多导睡眠检测为重度OSAHS。采取SARME联合下颌骨DO术矫治骨性Ⅱ类畸形,术后正畸治疗排齐拥挤牙列及咬合精细调整。分别采用CT、鼻声反射检查及多导睡眠检测,比较治疗前、后(T0、T1)上颌骨宽度、鼻腔体积、鼻阻力以及PSG参数的改变。结果:矫治后患者的上颌骨宽度呈"V"形扩大,鼻腔体积增大,鼻阻力减小。多导睡眠检测结果显示,治疗后睡眠呼吸暂停紊乱指数(AHI)显著减小并恢复正常,患者的OSAHS症状得到显著改善。结论:SARME联合下颌骨DO术对治疗严重骨性Ⅱ类伴OSAHS的年轻患者具有较好疗效。     

骨支持式手术辅助上颌骨快速扩弓位移分布的三维有限元分析

目的:研究骨支持式手术辅助上颌骨快速扩弓中颅面部各解剖部位的位移情况.方法:建立骨支持式手术辅助上颌骨快速扩弓系统的三维有限元模型,手术方式采用腭中缝联合侧方皮质骨切开术,模型上选取24个解剖结构,加载横向7mm扩弓量,比较分析颅面部各个解剖部位在矢状向、横向、垂直向的位移分布情况.结果:矢状向观,上颌骨各解剖结构都有明显的向前位移的趋势,而面上部解剖结构都有向后移位的趋势.横向正面观,颅上颌复合体呈金字塔样打开,鼻腔底部明显扩大约4.5mm;殆面观,支抗牙的牙根位移(第一前磨牙为2.92mm,第一磨牙为3.26mm)小于相应区域颊侧牙槽骨的位移(第一前磨牙区3.76mm,第一磨牙区3.93mm),腭板前部比后部扩开更大.垂直向观,上颌骨正中区的腭板有向下位移的趋势,颅面部其余解剖部位都向上移动.结论:骨支持式手术辅助上颌骨快速扩弓时,上颌骨在三维方向上有不同程度的移动、旋转和侧方倾斜,利用这些变化,可以辅助矫正轻度颅颌面畸形.骨支持式扩弓器将扩弓力直接传导到骨骼上,因此可以很好地避免牙支持式扩弓器扩弓时引起的牙及其周围支持组织损伤等严重并发症.     

唇腭裂患者上颌快速扩弓后口咽部气道变化的研究

目的 本回顾性研究中,利用CBCT评估唇腭裂患者上颌快速扩弓(RPE,rapid palatal expansion)前后口咽部气道的变化。方法 选择42例已行唇腭裂修复术的患者,分为2个组,扩弓矫治组21例,未进行扩弓矫治的21例设为阴性对照组。拍摄扩弓前(T1期)、扩弓保持3个月后(T2期)仰卧位CBCT影像,采用图像处理软件V work5.0测量RPE前后口咽部气道的体积、长度、最小的横截面积及上颌宽度,数据输入SPSS16.0分析软件包,两期之间采用配对t检验分析,2组之间采用成组t检验分析。结果 扩弓前、扩弓保持3个月后,治疗组总口咽部气道容积、舌后气道容积、腭后气道容积和上颌宽度在统计学上都有明显的差异(P<0.05),但口咽部气道长度,气道最小横截面积在统计学上没有差异(P>0.05)。阴性对照组2期比较各项测量数据均无差异(P>0.05)。结论 RPE能显著地增加唇腭裂患者的口咽部气道体积,能有效的降低患者气道阻力。     

不同鼻通气量硬腭上表面压强分布的有限元研究

目的通过测定不同鼻通气量硬腭上表面的压强,分析口呼吸对腭盖下降及错畸形影响的机制。方法利用锥形束计算机断层扫描(CBCT)数据和有限元相关软件重建1名健康志愿者的上气道及鼻腔三维模型,并修复空洞、平滑模型、网格划分后进行不同呼吸方式下的边界条件设定和数值模拟。结果成功建立健康人鼻呼吸上气道模型及鼻腔模型,获取了鼻呼吸的吸、呼两相上气道及不同截面的压力云图和不同鼻通气量吸、呼两相压力云图,计算得到不同鼻通气量时硬腭上表面的压强。结论随着鼻通气量的减小,吸气相气流对硬腭上表面压强逐渐增大,呼气相气流对硬腭上表面压强逐渐减小。二者均逐渐接近大气压。吸、呼两相鼻腔内压强梯度均逐渐减小。     

3种手术方式下牙支持式外科辅助上颌骨快速扩弓位移分布的三维有限元分析

目的:研究3种不同截骨方式下牙支持式外科辅助上颌骨快速扩弓中颅颌面部各解剖部位的位移情况。方法:建立3种不同截骨方式的牙支持式外科辅助上颌骨快速扩弓系统的三维有限元模型,模型上选取21个解剖结构,加载横向7mm扩弓量,比较分析颅面部各个解剖部位在X(矢状向)、Y(水平向)、Z(垂直向)方向的位移分布情况。结果:矢状向:上颌骨各解剖结构都有明显向前位移的趋势,而且随着手术范围的增大,颅颌面部各解剖结构向前移动的趋势越来越明显。水平向正面观,颅颌面复合体呈金字塔样打开,鼻腔底部有明显扩大;面观,支抗牙颊尖的位移最大,牙的位移大于相应区域牙槽骨的位移,手术范围的增大可以使上颌骨后部有明显的扩展。垂直向观,上颌骨正中区域的腭板有向下移动的趋势,上颌骨的侧方结构如支抗牙和牙槽骨都向上移动。结论:牙支持式扩弓器行横向扩弓时会出现牙的代偿和骨骼的倾斜和旋转。随着手术范围的增大,支抗牙和牙槽骨区域水平向的位移也随之增大。     

Orthodontic measurements and nasal respiratory function after surgically assisted rapid maxillary expansion: an acoustic rhinometry and rhinomanometry study

The present study sought to assess nasal respiratory function in adult patients with maxillary constriction who underwent surgically assisted rapid maxillary expansion (SARME) and to determine correlations between orthodontic measurements and changes in nasal area, volume, resistance, and airflow. Twenty-seven patients were assessed by acoustic rhinometry, rhinomanometry, orthodontic measurements, and use of a visual analogue scale at three time points: before surgery; after activation of a preoperatively applied palatal expander; and 4 months post-SARME. Results showed a statistically significant increase (p<0.001) in all orthodontic measurements. The overall area of the nasal cavity increased after surgery (p<0.036). The mean volume increased between assessments, but not significantly. Expiratory and inspiratory flow increased over time (p<0.001). Airway resistance decreased between assessments (p<0.004). Subjective analysis of the feeling of breathing exclusively through the nose increased significantly from one point in time to the next (p<0.05). There was a statistical correlation between increased arch perimeter and decreased airway resistance. Respiratory flow was the only variable to behave differently between sides. The authors conclude that the SARME procedure produces major changes in the oral and nasal cavity; when combined, these changes improve patients' quality of breathing.     

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.     

Assessment of changes in the nasal airway after nonsurgical miniscrew-assisted rapid maxillary expansion in young adults

Objectives:To evaluate changes in the volume and cross-sectional area of the nasal airway before and 1 year after nonsurgical miniscrew-assisted rapid maxillary expansion (MARME) in young adults.Materials and Methods:Fourteen patients (mean age, 22.7 years; 10 women, four men) with a transverse discrepancy who underwent cone beam computed tomography before (T0), immediately after (T1), and 1 year after (T2) expansion were retrospectively included in this study. The volume of the nasal cavity and nasopharynx and the cross-sectional area of the anterior, middle, and posterior segments of the nasal airway were measured and compared among the three timepoints using paired t-tests.Results:The volume of the nasal cavity showed a significant increase at T1 and T2 (P < .05), while that of the nasopharynx increased only at T2 (P < .05). The anterior and middle cross-sectional areas significantly increased at T1 and T2 (P < .05), while the posterior cross-sectional area showed no significant change throughout the observation period (P > .05).Conclusions:The results demonstrate that the volume and cross-sectional area of the nasal cavity increased after MARME and were maintained at 1 year after expansion. Therefore, MARME may be helpful in expanding the nasal airway.     

Long-term effects of mini-screw–assisted rapid palatal expansion on airway:: A three-dimensional cone-beam computed tomography study

ObjectivesTo evaluate the long-term effects on airway in patients with mini-screw–assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls with three-dimensional cone-beam computed tomography (CBCT) analysis.Materials and MethodsA total of 180 CBCTs of 60 patients were analyzed at different time points, such as pretreatment, postexpansion, and posttreatment. Patients were divided into three groups: mini-screw assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls. The nasal cavity, nasopharyngeal, oropharyngeal, and laryngopharyngeal airway volume and area were measured. Changes in total airway volume, total airway area, minimal cross-sectional area, maxillary intermolar width, external maxillary width, and palatal width were also evaluated.ResultsBoth MARPE and RPE caused a statistically significant increase in the airway after expansion as compared with the control group, but there was no statistically significant difference in the change in airway between MARPE, RPE, and the control group at posttreatment, except for nasopharyngeal volume, which was significantly increased in the MARPE group. There was no correlation between the amount of expansion and increase in total airway volume.ConclusionsThere was a significant increase in total airway volume, total airway area, and minimal cross-sectional area with MARPE and RPE immediately after expansion, but at posttreatment, the changes in the MARPE and RPE groups were similar to the change in the control group. However, MARPE led to a significant long-term increase in nasopharyngeal volume. The amount of expansion did not correlate with the increase in pharyngeal airway volume.     

Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion

Transverse maxillary deficiency is commonly found in patients with sleep apnea and is also related to abnormal breathing patterns. Maxillary expansion procedures promote widening of the nasal floor and reduce the resistance to airflow, and have a positive influence on nasopharynx function. In order to evaluate volume changes in the upper airway, 15 adult patients with transverse maxillary deficiency underwent surgically assisted rapid maxillary expansion (RME) until a slight overcorrection of the crossbite was obtained. Cone beam computed tomography (CBCT) volumetric images were obtained at three predefined time points. The mean age of the patients was 30.2 (±7.4) years; nine were females and six were males. The area, volume, and the smallest transverse section area of the airway were assessed using Dolphin Imaging 3D software. Statistical comparisons were made of the changes between time periods. No statistically significant differences were found for volume or area. However a significant difference was found between the preoperative and immediate postoperative smallest transverse section area (P < 0.05). Maxillary expansion, as an isolated procedure, does not result in a statistically significant improvement in the airway dimensions and results in an inferior relocation of the smallest transverse section area.     

Structural and functional changes of nasal cavity and maxillary sinus in patients with skeletal class III malocclusion 1 year after bimaxillary surgery

Purpose

This study aimed to analyse changes in the nasal cavity and maxillary sinus structure and function in patients with skeletal class III malocclusion 1 year after bimaxillary surgery.

Materials and Methods

In this study, cone-beam computed tomography (CBCT) images of 20 patients (10 men and 10 women; mean age 24.3 ± 3.4 years) with skeletal class III malocclusion who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were obtained before and 1 year after the surgery. CBCT data were stored opened with element 3D (E3D) to establish a nasal airway model (the paranasal sinus includes only the maxillary sinus). Ansys (ANSYS) software is used for simulation and analysis.

Results

The maxillary sinus and nasal cavity volumes decreased significantly 1 year after the surgery. After surgery, the volume of nasal cavity decreased by 13.5%, and the average volume of maxillary sinus decreased by 7.8%. There was no significant difference in the degree of deviation of the septum and nasal cavity resistance, and air distribution in the maxillary sinus did not change. The nasal cavity wall shear stress change was similar to that before surgery.

Conclusions

The maxillary sinus volume and nasal cavity volume of patients with skeletal class III malocclusion changed significantly after bimaxillary surgery, but there was no significant change in nasal ventilation function 1 year after surgery.     

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.     

Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion

Objectives:To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE).Materials and Methods:Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion.Results:There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (P<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (P<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (P<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly.Conclusions:Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.     

Effects of maxillary distraction osteogenesis on the upper-airway size and nasal resistance in subjects with cleft lip and palate

OBJECTIVES: To investigate the short- and long-term effects of maxillary distraction osteogenesis (DOG) on the upper-airway size and nasal resistance in nine patients with cleft lip and palate (CLP). STUDY DESIGN: Changes in the upper-airway size were measured by using lateral cephalometric radiographs taken immediately before and after DOG, and 1 year later. Nasal resistance was measured with a rhinomanometer. An analysis of variance was used to establish statistical significance. Spearman correlation coefficient was used to evaluate the relationship between changes in the cross-sectional area of the upper airway and nasal resistance in association with DOG. RESULTS: Immediately after DOG, the anteroposterior dimension of the superior part of the upper airway was significantly increased (p < 0.01) and nasal resistance was significantly decreased (p < 0.05). Moreover, the cross-sectional area of the total upper airway was significantly increased (p < 0.01). There was a significant correlation between the increase in the upper-airway cross-sectional area and the reduction in nasal resistance (p < 0.05). The upper-airway size was significantly augmented (p < 0.05) and nasal resistance was significantly reduced (p < 0.05) at 1 year after DOG compared with immediately before DOG. CONCLUSION: An increase in the upper-airway size and a reduction in nasal resistance occurred after maxillary DOG in patients with CLP, and these changes were stable after 1 year.