腺样体肥大致口呼吸患儿颅颌面发育特征的研究

Characteristics of craniomaxillofacial development in mouth breathing children caused by adenoid hypertrophy

目的对比分析腺样体肥大致口呼吸患儿的颅颌面发育特征及相关影响因素。方法本研究为横断面研究,纳入8~18岁正畸初诊判断为腺样体肥大致口呼吸的患儿62例为口呼吸组,和性别年龄匹配无腺样体肥大且无口呼吸的患儿62例为对照组,初诊均拍摄大视野锥形束CT,完成头影测量分析;对腺样体肥大指标、口呼吸起始年龄和持续时间与头影测量指标进行相关性分析。对口呼吸组中21例患儿进行睡眠监测并进行睡眠监测指标与头影测量的相关性分析。结果①口呼吸组下齿槽座角76.34°±3.48°小于对照组77.88°±3.41°(P=0.014),上下齿槽座角5.53°±2.01°大于对照组3.82°±2.41°(P<0.001),颏凸距(0.42±1.39)mm小于对照组(1.16±1.38)mm(P=0.004),下颌平面角37.63°±5.51°大于对照组34.41°±4.58°(P=0.001),下颌升支高度(50.86±4.53)mm小于对照组(54.36±5.82)mm(P<0.001),上前牙槽骨高度(28.35±2.92)mm大于对照组(26.93±2.69)mm(P=0.006),上颌骨宽度(66.66±3.06)mm小于对照组(69.74±4.09)mm(P<0.001),下颌骨宽度(83.53±5.01)mm小于对照组(88.42±5.33)mm(P<0.001),上切牙暴露量(4.43±1.82)mm大于对照组(3.66±1.53)mm(P=0.012),前牙覆盖(6.19±2.18)mm大于对照组(4.56±2.02)mm(P<0.001),下颌双侧尖牙间宽度(26.44±2.71)mm小于对照组(28.12±2.52)mm(P=0.001),下颌双侧第一磨牙间宽度(54.83±4.22)mm小于对照组(57.24±4.32)mm(P=0.002)。②相关性分析显示,腺样体肥大指标与上颌骨宽度(r=-0.225,P=0.012)和下颌骨宽度(r=-0.235,P=0.009)等呈负相关,与前牙覆盖(r=0.201,P=0.025)和上唇突度(r=0.299,P=0.001)呈正相关;口呼吸起始年龄与上下齿槽座角(r=-0.515,P<0.001)和上唇突度(r=-0.360,P=0.004)等呈负相关,与后面部高度(r=0.252,P=0.048)和下颌升支高度(r=0.256,P=0.044)等呈正相关;口呼吸持续时间与上下齿槽座角(r=0.633,P<0.001)和腭平面-前颅底平面角(r=0.264,P=0.038)等呈正相关,与下颌升支高度(r=-0.302,P=0.017)和上中切牙突距(r=-0.317,P=0.012)等呈负相关;睡眠呼吸暂停低通气指数与上下齿槽座角(r=0.562,P=0.008)呈正相关。结论本组腺样体肥大致口呼吸患儿颅颌面结构符合腺样体面容的特征;该面部特征与腺样体肥大程度、口呼吸起始年龄和持续时间及睡眠呼吸暂停均有密切相关。

ObjectiveThe objective of this study was to conduct a comparative analysis of craniomaxillofacial development characteristics and related influencing factors in mouth-breathing children caused by adenoid hypertrophy.MethodsThis study was a cross-sectional study,including 62 patients aged 8 to 18 as the mouth-breathing group,and 62 patients matched for sex and age,with no adenoid hypertrophy and no mouth breathing,as the control group.The correlation between adenoid hypertrophy,age of mouth breathing initiation and duration,and cephalometric measurements were analyzed.Twenty-one children in the mouth-breathing group were monitored for sleep,and the correlation between sleep monitoring indicators and cephalometric measurements was analyzed.Results①Mouth breathing group SNB 76.34°±3.48°was smaller than the control group 77.88°±3.41°(P=0.014),ANB 5.53°±2.01°was greater than the control group 3.82°±2.41°(P<0.001),Distance from Pog to the N-B line(0.42±1.39)mm was smaller than the control group(1.16±1.38)mm(P=0.004),MP-SN 37.63°±5.51°was greater than the control group 34.41°±4.58°(P=0.001),mandibular ramus lengths(50.86±4.53)mm was smaller than the control group(54.36±5.82)mm(P<0.001),U1-PP(28.35±2.92)mm was greater than the control group(26.93±2.69)mm(P=0.006),Maxillary Width(66.66±3.06)mm was smaller than the control group(69.74±4.09)mm(P<0.001),Mandibular Width(83.53±5.01)mm was smaller than the control group(88.42±5.33)mm(P<0.001),Mx1 Incisor exposure(4.43±1.82)mm was greater than the control group(3.66±1.53)mm(P=0.012),overjet(6.19±2.18)mm was greater than the control group(4.56±2.02)mm(P<0.001),Lower Intercuspid width(26.44±2.71)mm was smaller than the control group(28.12±2.52)mm(P=0.001),Lower Intermolar Width(54.83±4.22)mm was smaller than the control group(57.24±4.32)mm(P=0.002).②The correlation analysis showed that the index of adenoid hypertrophy(A/N)were negatively correlated with Maxillary Width(r=-0.225,P=0.012)and Mandibular Width(r=-0.235,P=0.009),positively correlated with Overjet(r=0.201,P=0.025)and UL-EP(r=0.299,P=0.001);the starting age of mouth breathing were negatively correlated with ANB(r=-0.515,P<0.001)and UL-EP(r=-0.360,P=0.004),positively correlated with S-Go(r=0.252,P=0.048)and mandibular ramus lengths(r=0.256,P=0.044);the duration time of mouth breathing was positively correlated with ANB(r=0.633,P<0.001)and SN-PP(r=0.264,P=0.038),negatively correlated with mandibular ramus lengths(r=-0.302,P=0.017)and U1-NA(r=-0.317,P=0.012);AHI were positively correlated with ANB(r=0.562,P=0.008).ConclusionsThe craniomaxillofacial structure of mouth-breathing children caused by adenoid hypertrophy conforms to the characteristics of adenoid facial features.These facial features are closely related to the degree of adenoid hypertrophy,the age of mouth breathing initiation and duration,and sleep apnea.