引用本文:娄 珊,刘盈盈,罗春花,郑之峻.上颌快速扩弓治疗后上气道变化的CBCT特征[J].中国临床新医学,2018,11(11):1072-1077.
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上颌快速扩弓治疗后上气道变化的CBCT特征
娄 珊,刘盈盈,罗春花,郑之峻
550000 贵州,贵阳市口腔医院正畸科(娄 珊,郑之峻);550000 贵州,黔南民族医学高等专科学校(刘盈盈,罗春花)
摘要:
[摘要] 目的 应用锥形束CT(CBCT)观察上颌发育不足青少年上气道三维形态,并观察该类患者上颌快速扩弓治疗后上气道的改变特征。方法 研究一随机选取上颌发育不足青少年患者20例,颌骨发育正常的青少年20名,均拍摄CBCT,用Dolphin软件对数据进行重建、定点、建立三维坐标系,测量标志点到坐标平面的距离,以及测量正中矢状面上鼻咽平面、腭咽平面及舌咽平面的矢状径、冠状径、横截面积,各段体积及总体积,采用t检验进行统计学分析,比较正常组和上颌发育不足组上气道的差异。研究二选取上颌发育不足的安氏Ⅲ类青少年患者21例,对比治疗前后气道三维形态的变化情况。结果 研究一上颌发育不足组的鼻咽段、腭咽段矢状径、冠状径以及体积均小于正常组,差异有统计学意义(P<0.05)。研究二上颌发育不足患者快速扩弓联合前方牵引治疗后,气道鼻咽段的矢状径及横径增大,而腭咽段和舌咽段未见明显变化,且有减小的趋势,上气道各段高度矫治前后差异统计学意义(P>0.05)。治疗后鼻咽段的横截面积明显增大,而腭咽段和舌咽段变化,鼻咽段体积和总体积矫治前后差异有统计学意义(P<0.05)。结论 研究一上颌发育不足青少年的鼻咽段、腭咽段矢状径、冠状径以及体积小于正常组,提示上气道的形态结构与周围的颌骨组织存在一定相关性。上颌快速扩弓治疗后上气道鼻咽段的矢状径、横径、横截面积及容积增大,这可能是由于快速扩弓改变了上颌骨及鼻腔的宽度,从而使上气道的间隙发生改变,上气道通气量改善,为治疗上颌发育不足的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)青少年患者提供一定的参考。
关键词:  锥形束CT  上颌发育不足  上气道的三维结构
DOI:10.3969/j.issn.1674-3806.2018.11.02
分类号:R 783.5
基金项目:贵阳市卫生局立项课题(编号:筑卫发【2009】450号)
Changes of the upper airway following rapid maxillary arch expansion: analysis by cone-beam computed tomography
LOU Shan, LIU Ying-ying, LUO Chun-hua, et al.
Department of Orthodontics, Guiyang Stomatological Hospital, Guizhou 550000, China
Abstract:
[Abstract] Objective To observe the three-dimensional morphology of the upper airway and the changes of the upper airway following treatment of rapid maxillary arch expansion using cone-beam computed tomography(CBCT). Methods 20 cases of juveniles with maldevelopment of maxilla(the maxillary maldevelopment group) and 20 cases of juveniles with normal jaw development(the jaw normal group) were randomly selected and CBCT was taken in them. Dolphin software was used for reconstruction of the data, point and establishment of three-dimensional coordinate system. The distance from the mark points to the plane coordinate was measured. The median sagittal plane of the hard palate and soft palate edge of the plane and the epiglottis top plane of the sagittal diameter, coronary diameter, cross-sectional area, the segment volume and the total volume were measured. SPSS Software Package was used for data analysis and t-test was used for statistical analysis and comparison of the upper airway and maxillary hard tissues between the jaw normal group and the maxillary maldevelopment group. 21 adolescent patients with Class Ⅲ malocclusion of the maxillary maldevelopment were selected and all the patients were treated with rapid arch dilation and CBCT was taken before and after the correction. The three dimensional changes of the airway were compared before and after treatment. Results Compared with those in the jaw normal group, the values of the upper airway of the hard palate plane, the soft palate edge plane of the sagittal diameter, coronary diameter and nasopharynx, palatal pharyngeal segment volume, and the total volume were significantly reduced in the maxillary maldevelopment group(P<0.05). There was no significant difference in the measured value of glossopharyngeum region between the two groups(P>0.05). The measured values of maxillary length, width and height in the maxillary maldevelopment group were lower than those in the normal group, which indicated that the maxillary development of three dimension in the maxillary maldevelopment group was less than that in the normal group. After rapid arch extension combined with forward traction in the patients with maxillary dysplasia, the sagittal and transverse diameters of the airway nasopharyngeal segment were enlarged, and the palatal pharynx segment and lingual pharynx segment were not obviously changed, and the upper airway sections had no differences before and after the height correction. The cross-sectional area of nasopharyngeal segment was significantly increased, but there was no change in the palatopharyngeal segment, and there were significant differences in the nasopharyngeal segment volume and total volume before and after the correction. Conclusion  In the juveniles with maldevelopment of maxilla, the morphological structure of the upper airway is correlated with the surrounding jaw tissues. After rapid expansion of the upper jaw, the sagittal diameter of the nasal passages, the cross-section, the area and the volume increase, which may be the results of the rapid expansion of the maxilla and the width of the nasal cavity, and which changes the gap of the airway, so that the air in the upper airway can be improved, providing a certain treatment reference for the OSAHS patients with maldevelopment of maxilla.
Key words:  Cone-beam computed tomography(CBCT)  Maldevelopment of maxilla  Three-dimensional morphology of the upper airway