上颌前方牵引联合扩弓治疗骨性Ⅲ类错[牙合]畸形对气道及舌影响的研究

The effect of maxillary protraction with expansion on upper airway and tongue in the treatment of skeletal ClassⅢmalocclusion

目的观察上颌前方牵引联合扩弓治疗骨性Ⅲ类患者对气道及舌形态的影响。方法选取替牙期骨性Ⅲ类错[牙合]畸形患者30例(平均年龄9.5±1.5岁),使用上颌前方牵引联合扩弓治疗。获取患者治疗前(T1)及治疗后(T2)CBCT(cone beam computed tomography,CBCT),重建上气道及舌的三维结构模型并对颌面部硬组织、气道及舌相关指标进行测量。结果上颌前方牵引联合扩弓矫治器使上颌骨长度、宽度增加,下颌顺时针旋转,舌骨向前下移动(P<0.05)。治疗后鼻咽段上气道体积、腭咽段体积及上气道总体积较治疗前增大,差异具有统计学意义(P<0.05),舌咽段体积、喉咽段体积差值无明显差异(P>0.05)。矫治后舌体积与固有口腔体积增大,舌体积占口腔体积的比例减小(P<0.05)。结论使用上颌前方牵引联合扩弓治疗骨性Ⅲ类错[牙合]可促进上颌骨生长,增大鼻咽、腭咽上气道体积,同时固有口腔容积增加,舌体积发生适应性增大。

Objective The aim of this study was to evaluate the effects on airway and tongue morphology after using maxillary protraction with expansion in growing skeletal ClassⅢpatients.Methods Thirty patients(mean age9.5±1.5 years)with skeletal ClassⅢwere treated with maxillary protraction with expansion.The cone beam computed tomography(CBCT)were obtained at pre-treatment(T1)and post-treatment(T2).A three-dimensional structural model of upper airway and tongue were reconstructed.The hard tissues of the maxillofacial region,the airway and the tongue were measured.Results The maxillary length and width increased,the mandibular rotated clockwise,and the hyoid bone moved forwardly and downwardly after treatment(P<0.05).The volume of nasopharyngeal airway,palatopharyngeal airway and the total volume of upper airway increased compared with baseline(P<0.05),while there was no significant difference in the volume of glossopharyngeal airway and laryngeal airway(P>0.05).The tongue volume and intrinsic oral cavity volume increased and the proportion of tongue volume to oral cavity volume decreased after treatment(P<0.05).Conclusion Maxillary protraction with expansion promotes the growth of maxilla and increases the volume of nasopharyngeal,palatopharyngeal airway.At the same time,the expanded inherent oral volume may lead to the volume of the tongue increases adaptively.