儿童安氏Ⅰ、Ⅱ、Ⅲ类错畸形患者舌体积、舌骨位置、气道容积及颌面部形态的关系

Relationships among tongue volume, hyoid position, airway volume and maxillofacial form in paediatric patients with Class Ⅰ, Class Ⅱ and Class Ⅲ malocclusions

目的:探讨儿童安氏Ⅰ、Ⅱ、Ⅲ类错畸形患者舌体积、舌骨位置、气道容积及颌面部形态的关系。方法:收集2015年12月—2018年12月无锡市儿童医院口腔科收治的112例错畸形患儿资料,采用安氏分类法分为Ⅰ类(42例)、Ⅱ类(38例)和Ⅲ类(32例)。利用口腔B超测量舌体积,头颅侧位片评估舌骨位置,锥形束CT(CBCT)测量气道容积和评估颌面部形态。对患儿舌体积、舌骨位置、气道容积及颌面部形态进行相关性分析。采用SPSS 20.0软件包对数据进行统计分析。结果:Ⅲ类患儿舌体积显著大于Ⅰ类和Ⅱ类(P<0.05);Ⅱ类患儿H-FH、H-MP显著大于Ⅰ类和Ⅲ类,H-VL显著小于Ⅰ类和Ⅲ类(P<0.05);Ⅲ类患儿H-FH、H-MP显著小于Ⅰ类,H-S显著大于Ⅰ类(P<0.05);3组患儿V_(喉)从小到大依次为Ⅱ类、Ⅰ类、Ⅲ类,组间差异有统计学意义(P<0.05);3组患儿V_(鼻)从小到大依次为Ⅲ类、Ⅰ类、Ⅱ类,Ⅲ类患儿V_(鼻)显著小于Ⅰ类和Ⅱ类(P<0.05);3组患儿SNB角从小到大依次为Ⅱ类、Ⅰ类、Ⅲ类,组间差异有统计学意义(P<0.05);3组患儿ANB角从小到大依次为Ⅲ类、Ⅱ类、Ⅰ类,组间差异显著(P<0.05);患儿舌体积与V_(喉)、V_(鼻)、SNB呈正相关,与H-FH、ANB呈负相关(P<0.05);H-FH和H-MP与SNB角呈负相关,与H-MP和ANB角呈正相关(P<0.05);患儿V_(鼻)与SNB角呈负相关,V_(喉)与ANB角呈负相关(P<0.05)。结论:安氏Ⅲ类错畸形患儿舌体积较大,舌骨向上移位,鼻咽容积较小。安氏Ⅱ类错畸形患儿舌体积较小,舌骨向下移位,口咽容积较小。错畸形患儿舌体积、舌骨位置、气道容积及颌面部形态具有相关性。正畸治疗时,应重视下颌骨后退对上气道形态的影响,以达到最佳的美观和治疗效果。

PURPOSE:To investigate the relationships among tongue volume,hyoid position,airway volume and maxillofacial form in paediatric patients with ClassⅠ,ClassⅡand ClassⅢmalocclusion.METHODS:Data of 112 children with malocclusion in the Department of Stomatology,Wuxi Children’s Hospital from December 2015 to December2018 were collected.The children were divided into three groups according to Angle’s classification:ClassⅠ(n=42),ClassⅡ(n=38)and ClassⅢ(n=32).Tongue volume was evaluated by oral B-ultrasound,the hyoid position was obtained by lateral cephalogram,then the airway volume and maxillofacial form were evaluated by cone-beam CT(CBCT).Relationship among tongue volume,hyoid position,airway volume and maxillofacial form were analyzed.The data were processed by SPSS 20.0 software package.RESULTS:The tongue volume of Class III was significantly larger than that of Class I and Class II(P<0.05);H-FH and H-MP of Class II were significantly larger than those of Class I and Class III,and H-VL was significantly smaller than that of Class I and Class III(P<0.05).H-FH and H-MP of Class III were significantly smaller than those of Class I,and H-S was significantly larger than that of Class I(P<0.05);V throat of three types was the largest in ClassⅢ,followed by Class I and ClassⅡ,with significant difference(P<0.05).V nose of three types was the largest in ClassⅡ,followed by Class I and ClassⅢ,with significant difference(P<0.05).SNB angle of three types was the largest in ClassⅢ,followed by ClassⅠand ClassⅡ,with significant difference(P<0.05).ANB angle was the largest in Class I,followed by ClassⅡand ClassⅢ,with significant difference(P<0.05).Tongue volume was positively correlated with V throat,V nose,and SNB,and negatively correlated with H-FH and ANB(P<0.05).H-FH and H-MP were negatively correlated with SNB angle and positively correlated with H-MP and ANB angle(P<0.05).CONCLUSIONS:Children with ClassⅢmalocclusion have larger tongue volume,upward displacement of hyoid,and smaller nasopharyngeal volume.Children with Class II malocclusion have small tongue volume,downward displacement of hyoid,and small oropharyngeal volume.Tongue volume,hyoid position,airway volume and maxillofacial form are significantly correlated in paediatric patients with malocclusions,the influence of mandibular recession on the shape of upper airway should be considered during orthodontic treatment,in order to achieve the best aesthetic and therapeutic effects.