双期正畸治疗对骨性Ⅲ类单侧唇腭裂与非裂患者矢状上气道的影响

Evaluation of two-phase orthodontic treatment on the sagittal upper pharyngeal airway between skeletal ClassⅢpatients with and without unilateral complete cleft lip and palate

目的评估骨性Ⅲ类单侧完全性唇腭裂(unilateral complete cleft lip and palate,UCLP)和非唇腭裂患者矢状上气道的差异,及正畸治疗对两类患者矢状上气道的影响。方法回顾性研究了通过替牙期矫形治疗和恒牙期固定矫治(以下简称双期正畸治疗),获得良好咬合关系和面部美观的骨性Ⅲ类UCLP患者12例,年龄(11.25±1.42)岁,UCLP组,骨性Ⅲ类非唇腭裂患者14例,年龄(11.79±1.32)岁,SⅢ组,比较分析两组患者双期正畸治疗前、后矢状上气道的差异。结果治疗后UCLP组颅底点对应的气道宽度增加了6.25 mm[治疗前(17.85±3.95)mm,治疗后(22.05±3.50)mm,P=0.006],腺样体对应气道宽度增加了5.75mm[治疗前(13.90±2.89)mm,治疗后(19.15±2.81)mm,P<0.001],口咽上段最短气道宽度增加了1.75 mm[治疗前(8.35±3.73)mm,治疗后(10.40±2.83)mm,P=0.032],软腭尖对应气道宽度增加了1.00 mm[治疗前(9.00±3.42)mm,治疗后(10.85±2.76)mm,P=0.049];而SⅢ组颅底点对应的气道宽度增加了3.00 mm[治疗前(22.18±3.91)mm,治疗后(25.04±3.27)mm,P=0.006],腺样体对应气道宽度增加了5.79 mm[治疗前(19.71±7.10)mm,治疗后(24.36±5.85)mm,P<0.001],口咽上段最短气道宽度增加了2.86 mm[治疗前(9.21±3.55)mm,治疗后(11.86±4.13 mm),P=0.002],软腭尖对应气道宽度增加了4.50 mm[治疗前(9.71±3.48)mm,治疗后(12.68±4.14 mm),P=0.001],口咽下段最短气道宽度增加了2.75 mm[治疗前(9.68±3.99)mm,治疗后(12.86±3.86)mm,P=0.001],会厌瓣对应气道宽度增加了5.93 mm[治疗前(16.21±4.61)mm,治疗后(22.32±3.60)mm,P<0.001]。结论双期正畸治疗后,除UCLP患者口咽下段外,UCLP与SⅢ患者的矢状上气道宽度均明显增宽。

Objective The purpose of this study was to evaluate the morphological difference of the sagittal upper pharyngeal airway between skeletal classⅢpatients with unilateral complete cleft lip and palate(UCLP)and skeletal classⅢpatients with noncleft,and to explore the influence of orthodontic treatment on the sagittal upper airway of the two types of patients.Methods This retrospective study selected twelve UCLP patients with skeletal ClassⅢ[age(11.25±1.42)years old],and fourteen non-cleft lip and palate patients with skeletal ClassⅢpatients[age(11.79±1.32)years old](SⅢgroup),who obtained good occlusal relationship and facial aesthetics after two-phase orthodontic treatment(which included orthopedic treatment during mixed dentition and fixed orthodontic treatment during permanent dentition).The sagittal diameters of upper airway nasopharyngeal segment(the airway width at the level of Basion and the adenoid tissue),upper oropharyngeal segment(the narrowest width of the upper oropharynx and the airway width at the level of the tip of the soft palate),and lower oropharyngeal segment(the narrowest width of the lower oropharynx and the airway width at the level of the vallecula epiglottis)were measured on lateral cephalometric radiographs.The differences of sagittal upper airway before and after two-phase orthodontic treatment were compared and analyzed between the two groups.Results Following orthodontic treatment,in the UCLP group,the airway width at the level of Basion increased by 6.25 mm[(17.85±3.95)mm before treatment vs(22.05±3.50)mm after treatment,P=0.006],and the airway width at the level of the adenoid tissue increased by 5.75 mm[(13.90±2.89)mm before treatment vs(19.15±2.81)mm after treatment,P<0.001],and the narrowest width of the upper oropharynx increased by 1.75 mm[(8.35±3.73)mm before treatment vs(10.40±2.83)mm after treatment,P=0.032],and the airway width at the level of the tip of the soft palate increased by 1.00 mm[(9.00±3.42)mm before treatment vs(10.85±2.76)mm after treatment,P=0.049];in the SⅢgroup,the airway width at the level of Basion increased by 3.00 mm[(22.18±3.91)mm before treatment vs(25.04±3.27)mm after treatment,P=0.006],the airway width corresponding to the adenoid tissue increased by 5.79 mm[(19.71±7.10)mm before treatment vs(24.36±5.85)mm after treatment,P<0.001],the narrowest width of the upper oropharynx increased by 2.86 mm[(9.21±3.55)mm before treatment vs(11.86±4.13)mm after treatment,P=0.002],the airway width at the level of the soft palate increased by 4.50 mm[(9.71±3.48)mm before treatment vs(12.68±4.14)mm after treatment,P=0.001],the narrowest width of the lower oropharynx increased by 2.75 mm[(9.68±3.99)mm before treatment vs(12.86±3.86)mm after treatment,P=0.001],the airway width at the level of the vallecula epiglottis increased by 5.93 mm[(16.21±4.61)mm before treatment vs(22.32±3.60)mm after treatment,P<0.001].Conclusions Upper pharyngeal airway dimensions were significantly improved both in SⅢand UCLP groups after the two-phase treatment except of the lower oropharyngeal airway dimensions in UCLP groups.