Effect of maxillary expansion combined with Twin-block on upper airway of children with mouth breathing and dentomaxillofacial malformation

doi:10.19439/j.sjos.2021.06.014

Abstract

Abstract: PURPOSE: This study aimed to investigate the changes of upper airway before and after combined treatment of maxillary expansion and Twin-block(TB) in children with mouth breathing (MB) and malocclusion. METHODS: Twelve children with orthodontic deformities were selected for maxillary expansion and TB. Cone-beam CT was taken before and after treatment, and the images were analyzed using Dolphin imaging software 11.8. The data were analyzed by paired sample t test with SPSS 21.0 software package. RESULTS: The patients' upper airway measurement data showed an overall increase trend after combined treatment, and the upper airway volume increased by 3326.44 mm³（P<0.05）. The glossopharyngeal volume increased the most, with an average increase of 1146.20 mm³（P<0.05）. The narrowest cross-sectional area of the oropharynx and the cross-sectional area of the nasopharynx, palatopharynx, and glossopharynx increased 33.55 mm²（P>0.05）, 71.68 mm²（P<0.05）, 46.23 mm²（P<0.05）, 54.60 mm²（P<0.05）, respectively. The transverse（P>0.05） and sagittal（P<0.05） diameters of the nasopharynx, palatopharynx, and glossopharynx increased, and the ratio of the sagittal diameter to the transverse diameter(P<0.05) all increased. After treatment, only the narrowest cross-sectional area of the oropharynx and the increase in the transverse diameter of the nasopharynx, palatopharynx, and glossopharyngeal cross-sections were not statistically significant. CONCLUSIONS: Maxillary expansion combined with TB treatment can increase the upper airway volume of children with MB and malocclusion. The upper airway shape tends to be oval, respiratory symptoms are improved, which help the children and help establish normal nasal breathing.

Key words: Maxillary expansion, Twin-block, Malocclusion, Child, Upper airway

CLC Number:

R783.5

GUO Jing-han, YU Li-ming, LI Yuan-yuan, LIU Yue-hua. Effect of maxillary expansion combined with Twin-block on upper airway of children with mouth breathing and dentomaxillofacial malformation[J]. Shanghai Journal of Stomatology, 2021, 30(6): 634-638.

References

[1] 朱敏. 张口呼吸的诊断与治疗[J]. 中国临床医生, 2013, 41(7): 8-9.
[2] Izu SC, Itamoto CH, Pradella-Hallinan M, et al.Obstructive sleep apnea syndrome (OSAS) in mouth breathing children[J]. Braz J Otorhinolaryngol, 2010, 76(5): 552-556.
[3] Bresolin D, Shapiro GG, Shapiro PA, et al.Facial characteristics of children who breathe through the mouth[J]. Pediatrics, 1984, 73(5): 622-625.
[4] Jefferson Y.Mouth breathing: adverse effects on facial growth, health, academics, and behavior[J]. Gen Dent, 2010, 58(1): 18-25.
[5] 刘月华. 正畸医生在生命全周期上气道管理中的作用[J]. 中国实用口腔科杂志, 2017, 10(2): 65-69.
[6] Paolantonio EG, Ludovici N, Saccomanno S, et al.Association between oral habits, mouth breathing and malocclusion in Italian preschoolers[J]. Eur J Paediatr Dent, 2019, 20(3): 204-208.
[7] Grippaudo C, Paolantonio EG, Antonini G, et al.Association between oral habits, mouth breathing and malocclusion[J]. Acta Otorhinolaryngol Ital, 2016, 36(5): 386-394.
[8] Izuka EN, Feres MF, Pignatari SS.Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers[J]. Dental Press J Orthod, 2015, 20(3): 43-49.
[9] Pirelli P, Saponara M, De Rosa C, et al.Orthodontics and obstructive sleep apnea in children[J]. Med Clin North Am, 2010, 94(3): 517-529.
[10] Zhang C, He H, Ngan P.Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study[J]. Sleep Breath, 2013, 17(4): 1309-1314.
[11] Cappellette M Jr, Nagai LHY, Gonçalves RM, et al.Skeletal effects of RME in the transverse and vertical dimensions of the nasal cavity in mouth-breathing growing children[J]. Dental Press J Orthod, 2017, 22(4): 61-69.
[12] 刘月华, 曾祥龙, 傅民魁, 等. 阻塞性睡眠呼吸暂停综合征患者上气道及周围结构的头影测量[J]. 中华口腔医学杂志, 1999, 34(4): 213-244.
[13] Osorio F, Perilla M, Doyle DJ, et al.Cone beam computed tomography: an innovative tool for airway assessment[J]. Anesth Analg, 2008, 106(6): 1803-1807.
[14] Moshiri M, Scarfe WC, Hilgers ML, et al.Accuracy of linear measurements from imaging plate and lateral cephalometric images derived from cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2007, 132(4): 550-560.
[15] Chung Leng Munzo I, Beltri Orta P. Comparison of cephalometric patterns in mouth breathing and nose breathing children[J]. Int J Pediatr Otorhinolaryngol, 2014, 78(7): 1167-1172.
[16] Zhong Z, Tang Z, Gao X, et al.A comparison study of upper airway among different skeletal craniofacial patterns in nonsnoring Chinese children[J]. Angle Orthod, 2010, 80(2): 267-274.
[17] Yildirim N, Fitzpatrick MF, Whyte KF, et al.The effect of posture on upper airway dimensions in normal subjects and in patients with the sleep apnea/hypopnea syndrome[J]. Am Rev Respir Dis, 1991, 144(4): 845-847.
[18] 杨莉, 韩蓓蕾, 邓海艳, 等. 矢状骨面型错畸形对成年人上气道影响的CBCT研究[J]. 口腔医学, 2017, 37(2): 144-148.