Twin-block联合上颌扩弓器矫治下颌后缩儿童前后舌位的改变及上气道的三维变化

Changes in tongue position and three-dimensional changes in upper airway before and after treatment with Twin-block combined with maxillary expansion appliance in children with mandibular retrusion

目的:观察有口呼吸病史的下颌骨后缩儿童使用Twin-block联合上颌扩弓器矫治后上气道容积的三维变化及舌位改变。方法:选择安氏Ⅱ类伴下颌骨后缩的儿童患者20例,使用Twin-block联合上颌扩弓器进行矫治,将治疗前后的锥形束CT(CBCT)导入Mimics 21.0软件,测量治疗前后上气道(鼻咽段+口咽段)总容积以及鼻咽段、舌咽段、口咽段分段气道容积,舌咽段腭垂尖端处的气道横截面积、最大矢状径,上颌骨宽度。观察治疗前后舌位的高低改变。采用SPSS 26.0软件包对数据进行统计学分析。结果:矫治后,患者上气道总容积及鼻咽、口咽、舌咽段气道容积显著增加(P<0.05);舌咽段腭垂尖端处的气道横截面积及最大矢状径、上颌骨宽度显著增大(P<0.05),舌位升高且前移。结论:Twin-block联合上颌扩弓器可以使安氏Ⅱ类下颌骨后缩儿童鼻咽段、口咽段、舌咽段及上气道总容积增加,对口咽部的前后向深度有扩张作用,使上颌骨宽度增加、舌位趋于正常,有助于气道通畅性提高。

PURPOSE:To observe changes of upper airway in three dimensions and tongue position after correction with Twin-block combined with maxillary expansion appliance in children with mandibular retrusion and history of mouth breathing.METHODS:Twenty children with ClassⅡmalocclusion and mandibular retrusion were selected and treated with Twin-block combined with maxillary expansion appliance.Cone-beam CT(CBCT)data before and after treatment were imported into Mimics 21.0 software to measure the total volume of the upper airway(nasopharyngeal segment+oropharyngeal segment),as well as segmental airway volume of nasopharyngeal,glossopharynx and oropharyngeal space.The cross-sectional area and maximum sagittal diameter at the tip of uvula in glossopharyngeal airway,and maxillary width were measured,too.Anterior-posterior and height changes of tongue position were observed.SPSS 26.0 software package was used to perform paired sample t test and Wilcoxon signed rank test of the data.RESULTS:The total upper airway volume and the airway volume of the nasopharyngeal,oropharyngeal and glossopharyngeal segments increased significantly after correction.The cross-sectional area and maximum sagittal diameter at the tip of uvula in glossopharyngeal segment,and the maxillary width were increased significantly.Tongue position increased and moved forward.All the above data had significant different(P<0.05).CONCLUSIONS:Twin-block combined with maxillary expansion appliance can increase the total volume of the nasopharyngeal segment,oropharyngeal segment,glossopharyngeal segment and upper airway in children with ClassⅡmalocclusion and mandibular retrusion and expand the anterior-posterior depth of oropharynx airway.In addition,the treatment can increase maxillary width and normalize the tongue position,and contribute to the improvement of airway patency.