腺样体和/或扁桃体肥大相关替牙期骨性Ⅱ类儿童颌面部特点研究

Maxillofacial characteristics of adenoidal and/or tonsillar hypertrophy related skeletal classⅡmalocclusion in children with mixed dentition

目的探究单纯腺样体病理性肥大、单纯扁桃体病理性肥大及腺样体合并扁桃体病理性肥大对替牙列期骨性Ⅱ类错畸形患儿颌面部发育的影响。方法纳入替牙期骨性Ⅱ类患儿56例,根据上气道阻塞部位和"口呼吸自检"结果进行分组,分为无张口表现且气道不阻塞组(N0),有张口表现但气道不阻塞组(N1),单纯腺样体肥大组(A),单纯扁桃体肥大组(T),腺样体肥大合并扁桃体肥大组(AT),进行头影测量和统计学分析。结果N0组的下面高比例(51.75±2.21)%显著小于A组[(55.05±1.79)%,P<0.001]、AT组[(54.14±1.39)%,P<0.01]及N1组[(54.79±2.01)%,P<0.01]的患儿;T组的下面高比例(52.87±2.28)%显著小于A组[(55.05±1.79)%,P<0.01]及N1组[(54.79±2.01)%,P<0.05]的患儿;N0组的前下面高与后下面高之比(1.09±0.10)%显著小于A组[(1.51±0.14)%,P<0.01],T组[(1.44±0.20)%,P<0.05],以及AT组[(1.49±0.11)%,P<0.005]或不阻塞组患儿N1组[(1.51±0.10)%,P<0.01]。结论腺样体和/或扁桃体肥大与张口呼吸现象密切相关,即使没有经口腔的呼吸气流,张口现象本身仍可以造成骨性Ⅱ类儿童长而高角的面型特点。

Objective To explore the effects of adenoidal and/ortonsillar hypertrophy on the development of maxillofacial structures in skeletal ClassⅡmalocclusion with mixed dentition.Methods 56 mixed dentition patients with skeletal classⅡmalocclusion were included.They were grouped according to the sites of upper airway obstruction and self-examination results on mouth breathing.Cephalometrics were done and statistically analyzed.Results The lower facial height of patients with no mouth-breathing and no obstruction is significantly shorter than that of patients with adenoidal hypertrophy combing with or without tonsillar hypertrophy,and shorter than that of patients with mouth-breathing but no obstruction.The lower facial height of patients with tonsillar hypertrophy is significantly shorter than that of patients with adenoidal hypertrophy,mouth-breathing but no obstruction.The anterior lower facial height and posterior lower facial height in patients without mouth-breathing and no obstruction are significantly shorter than that in patients with mouth-breathing with or without obstruction.Conclusions Adenoidal and/or tonsillar hypertrophy is strongly related with mouth-breathing.Even without airway obstruction,habitual mouth-breathing can still induce long facial height and high angle skeletal classⅡcharacteristics in mixed dentition patients.