上颌扩弓对儿童颞下颌关节及气道的影响

Effects of maxillary expansion on temporomandibular joint and airway in children

背景:上颌扩弓技术能够帮助和改善上颌横向宽度发育不足患儿上、下颌骨的协调性,改变上颌骨周围组织的生长方式,尤其是对儿童颞下颌关节及气道改变具有重要作用,能够帮助和引导其沿正常的方向生长。目的:综述上颌扩弓技术对儿童颞下颌关节及气道影响的研究进展。方法:以“maxillary expansion,palatal expansion,temporomandibular joint,masticatory muscle,airway”及“上颌扩弓,腭扩展,颞下颌关节,咀嚼肌,气道”为关键词,在 PubMed、CNKI、万方、Medline数据库中进行相关文献检索,排除质量较低及与文章主题无关的研究及试验,最后纳入71篇文献进行仔细阅读分析与总结。结果与结论:上颌发育不足的患者由于咬合不平衡,双侧髁突常常不对称,使用上颌扩弓技术扩宽上颌骨的同时,对其周围的组织有一定的影响,扩弓能使错牙合畸形患者双侧髁突位置更加对称,肌力分布更加均匀,从而有利于颞下颌关节的生长发育,但对关节盘的位置和形态改变不显著。此外,扩弓还能改善鼻腔的体积大小,提高患者的通气功能,减轻睡眠呼吸暂停低通气综合征所带来的不良后果。

BACKGROUND: The maxillary expansion technique can help and improve the coordination of the maxilla and mandible and can change the growth pattern ofthe tissues around the maxilla. Especially, it plays an important role in the change of the temporomandibular joint and the airway in children, and can help andguide their growth along the normal direction.OBJECTIVE: To review the research progress in the effect of maxillary expansion technique on the temporomandibular joint and airway in children.METHODS: Literature retrieval was conducted in PubMed, CNKI, WanFang, and Medline. The key words were “maxillary expansion, palatal expansion,temporomandibular joint, masticatory muscle, airway” in English and Chinese, respectively. Studies and experiments of low quality and irrelevant to the topicof the article were excluded. Finally, 71 literatures were included for careful reading and analysis.RESULTS AND CONCLUSION: In patients with underdevelopment of the maxillary, the bilateral condyles are often asymmetrical due to the unbalanced bite.When the maxillary extension technique is used to widen the maxilla, it has certain influence on the surrounding tissues. Maxillary expansion can make thecondylar position on both sides of the patients with malocclusion more symmetrical and the muscle force distribution more uniform, which is conducive tothe growth and development of the temporomandibular joint, but has no significant change in the position and shape of the joint disc. In addition, maxillaryexpansion can also improve the volume of the nasal cavity, improve the ventilation function of patients, and therefore, reduce the adverse consequencescaused by obstructive sleep apnea hypopnea syndrome.