成人骨性Ⅲ类与Ⅰ类错■畸形患者上气道形态对比

Morphology of upper airway in adult patients with skeletal class Ⅲ and class Ⅰ malocclusion

目的对比成人骨性Ⅲ类与Ⅰ类错[牙合]畸形患者上气道形态。方法选取2014年12月至2017年12月在河南省口腔医院放射科拍摄锥形束计算机体层摄影(CBCT)的20例成人骨性Ⅰ类正常者,20例骨性Ⅲ类上颌后缩患者,20例骨性Ⅲ类下颌前突错[牙合]畸形患者,分别作为骨性Ⅰ类正常组、骨性Ⅲ类上颌后缩组、骨性Ⅲ类下颌前突组。收集治疗前CBCT,结合三维重建Dolphin软件对图像进行三维重建,测量各组上气道各段高度H、矢状径L1、横径L2、截面积S、容积V,鼻咽段为Ha、Sa、L1a、L2a、Va,腭咽段为Hb、Sb、L1b、L2b、Vb,舌咽段为Hc、Sc、L1c、L2c、Vc,喉咽段为Hd、Sd、L1d、L2d、Vd,并对结果进行统计学分析。结果骨性Ⅲ类上颌后缩组Ha、Sa、L1a、L2a、Va、Sb、L2b均低于骨性Ⅰ类正常组和骨性Ⅲ类下颌前突组,差异有统计学意义(均P<0.05)。骨性Ⅲ类下颌前突组Hc、L2c、Sc、Vc、Hd、L2d、Sd均高于骨性Ⅲ类上颌后缩组和骨性Ⅰ类正常组,差异有统计学意义(均P<0.05)。Sa、Sb、Va、Vb与∠SNA、∠ANS-PNS呈正相关(均P<0.05),Sc、Sd、Vc、Vd与∠SNB、∠Go-Gn、∠Ar-Gn呈正相关(均P<0.05)。结论成人骨性Ⅲ类与Ⅰ类错[牙合]畸形患者上气道形态存在差异,成人骨性Ⅲ类错[牙合]畸形患者上气道形态大小受上下颌骨大小及位置影响。

Objective To contrast the morphology of upper airway in adult patients with skeletal class Ⅲ malocclusion and class Ⅰ malocclusion. Methods A total of 20 cases of normal adult skeletal type Ⅰ, 20 cases of skeletal class Ⅲ maxillary retraction and 20 cases of skeletal class Ⅲ malocclusion of mandibular protrusion who underwent cone-beam computed tomography (CBCT) in Henan Provincial Stomatological Hospital from December 2014 to December 2017 were selected as skeletal class Ⅰnormal group, skeletal class Ⅲ maxillary retraction group and skeletal class Ⅲ mandibular protrusion group, respectively. The CBCT images before treatment were collected and three-dimensional reconstruction was carried out, combining with three-dimensional reconstruction of Dolphin software image. The height H, sagittal diameter L1, transverse diameter L2, cross-sectional area S and volume V of each upper airway segment were measured. Nasopharyngeal segments were H a, S a, L1 a, L2 a, V a. Palatine pharynx segments were H b, S b, L1 b, L2 b, V b. Glossopharyngeal segments were H c, S c, L1 c, L2 c, V c. Hypopharyngeal segments were H d, S d, L1 d, L2 d, V d. The results were statistically analyzed. Results The H a, S a, L1 a, L2 a, V a, S b, L2 b of skeletal class Ⅲ maxillary retraction group were all lower than those of skeletal class Ⅰnormal group and skeletal class Ⅲ mandibular protrusion group, and the differences were statistically significant (all P < 0.05). The H c, L2 c, S c, V c, H d, L2 d, S d of skeletal class Ⅲ mandibular protrusion group were all higher than those of skeletal class Ⅰnormal group and skeletal class Ⅲ maxillary retraction group, and the differences were statistically significant (all P < 0.05). S a, S b, V a and V b were positively correlated with ∠SNA and ∠ANS-PNS (all P < 0.05). S c, S d, V c and V d were positively correlated with ∠SNB,∠Go-Gn and ∠Ar-Gn (all P < 0.05). Conclusion There are differences in upper airway morphology between skeletal class Ⅲ malocclusion and skeletal class Ⅰ malocclusion in adults. The shape and size of the upper airway in adult patients with skeletal class Ⅲ malocclusion were affected by size and position of maxilla and mandible bones.