腭中缝骨皮质切开辅助上颌骨快速扩弓治疗对头姿的影响

doi:10.6040/j.issn.1671-7554.0.2017.1149

摘要/Abstract

摘要： 目的观察腭中缝骨皮质切开辅助上颌骨快速扩弓(MCRME)对成年正畸患者头姿的影响。方法选取上颌横向发育不足患者20例,其中男6例,女14例,26~32岁,平均(28.30±1.97)岁。所有患者均行腭中缝骨皮质切开辅助上颌骨快速扩弓,分别于治疗前(T0)、扩弓结束保持6个月(T1)拍摄面牙合相、头颅侧位片及锥形束CT(CBCT), 对下颌位置、舌骨位置及头姿相关的参数进行测量、对比。应用SPSS 19.0软件进行统计学分析。结果下颌逆时针旋转,下颌平面角(MP-FH)减小(P<0.05),面轴角(NBa-PtGn)及颏顶点与过翼上颌裂点真垂线水平距离(Gn-PmTVL)增加(P<0.05);舌骨前上移位,舌骨与垂直参考面水平距离(H-VRP)增加(P<0.05),且舌骨与过翼上颌裂点真垂线水平距离(H-PmTVL)减小(P<0.05),同时舌骨与水平参考面垂直距离(H-HRP)及舌骨到前鼻棘点与颅底点连线垂直距离(H-ANS-Ba)均减小(P<0.05);颅颈角前颅底平面与颈椎齿突切线夹角(SN-OPT)、前颅底平面与颈椎切线夹角(SN-CVT)均减小(P<0.05)。代表髁突位置的参数关节内间隙(MJS)减小(P<0.05),关节外间隙(LJS)增加(P<0.05),关节上间隙(SJS)变化差异无统计学意义(P>0.05)。结论 MCRME在获得良好的骨性扩弓效应的同时,下颌平面可发生逆时针旋转,舌骨位置呈向前、向上趋势,前伸头姿有所改善。

关键词: 腭中缝劈开, 上颌骨扩弓, 下颌位置, 舌骨位置, 头姿

Abstract: Objective To observe the effects of mid-palatal corticotomy assisted rapid maxillary expansion(MCRME)on the head posture and its mechanism in adults. Methods A total of 20 patients with maxillary transverse discrepancy who were 26-32 years old were included(6 male and 14 female, average 28.30±1.97 years). All patients were subjected to MCRME treatment. Facial and dental photographs, lateral cephalometric radiographs and cone-beam computed tomography(CBCT)were taken before treatment(T0)and 6 months after the retention(T1). The mandibular position, hyoid bone position and head posture were measured and evaluated. The parameters were analyzed with SPSS 19.0 software. Results The mandible demonstrated an anticlockwise rotation as shown by the significant decrease of MP-FH, increase of the NBa-PtGn and Gn-PmTVL(all P<0.05). The hyoid bone position was changed as indicated by significant increase of H-VRP, decrease of H-PmTVL, H-HRP and H-ANS-Ba(all P<0.05). The head posture was 山东大学学报 (医学版)56卷2期 -周咛,等. 腭中缝骨皮质切开辅助上颌骨快速扩弓治疗对头姿的影响 \=-significantly changed as revealed by the significant decrease in SN-OPT and SN-CVT(both P<0.05). In addition, the condylar position was changed with a significant decrease of MJS and increase of LJS(both P<0.05). Conclusion MCRME is a procedure capable of changing the head posture as well as causing anticlockwise rotation of mandible, and anterior and superior movement of hyoid bone.

Key words: Mid-palatal corticotomy, Maxillary expansion, Mandibular position, Hyoid bone position, Head posture

中图分类号:

R782.2

周咛,卢璐, 郭泾. 腭中缝骨皮质切开辅助上颌骨快速扩弓治疗对头姿的影响[J]. 山东大学学报 (医学版), 2018, 56(2): 62-67.

ZHOU Ning, LU Lu, GUO Jing. Changes in head posture after mid-palatal corticotomy assisted rapid maxillary expansion[J]. Journal of Shandong University (Health Sciences), 2018, 56(2): 62-67.

参考文献

[1] Mattar SE, Anselmo-Lima WT, Valera FC, et al. Skeletal and occlusal characteristics in mouth-breathing pre-school children[J]. J Clin Pediatr Dent, 2004, 28(4):315-318.
[2] Omargabriel De Silva Fo CVLF. Rapid maxillary expansion in the primary and mixed dentitions:a cephalometric evaluation[J]. Am J Orthod Dentofacial Orthop, 1991, 100(2):171-179.
[3] Gungor K, Taner L, Kaygisiz E. Prevalence of posterior crossbite for orthodontic treatment timing[J]. J Clin Pediatr Dent, 2016, 40(5):422-424.
[4] Timms DJ. The dawn of rapid maxillary expansion[J]. Angle Orthod, 1999, 69(3):247-250.
[5] Tecco S, Caputi S, Festa F. Evaluation of cervical posture following palatal expansion:a 12-month follow-up controlled study[J]. Eur J Orthod, 2007, 29(1):45-51.
[6] Suri L, Taneja P. Surgically assisted rapid palatal expansion:a literature review[J]. Am J Orthod Dentofacial Orthop, 2008, 133(2):290-302.
[7] Lagravère MO, Major PW, Floresmir C. Dental and skeletal changes following surgically assisted rapid maxillary expansion[J]. Int J Oral Maxillofac Surg, 2006, 35(6):481-487.
[8] Naimi A, Papageorge M, Shastri K. Dental and skeletal changes following surgically assisted rapid palatal expansion[J]. International Journal of Oral & Maxillofacial Surgery, 2007, 36(11):1021.
[9] 翁露茜, 宋晓佳, 李娟, 等. 腭中缝骨皮质切开辅助快速扩弓矫治15~25岁上颌横向宽度不足患者临床研究[J]. 浙江大学学报(医学版), 2017, 46(2):198-205. WENG Luxi, SONG Xiaojia, LI Juan, et al. Midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults[J]. Journal of Zhejiang University(Medical Sciences), 2017, 46(2):198-205.
[10] Berretin-Felix G, Yamashita RP, Filho HN, et al. Short- and long-term effect of surgically assisted maxillary expansion on nasal airway size[J]. J Craniofac Surg, 2006, 17(6):1045-1049.
[11] Candido MSDC, Monnazzi MS, Spinneto R, et al. Pharyngeal airway space cephalometric evaluation in transverse maxillary deficient patients after SARME[J]. Braz J Oral Sci, 2014, 13(4):288-91.
[12] 聂萍, 陶丽, 唐艳梅, 等. 手术辅助上颌快速扩弓对鼻气道形态和鼻阻力的影响[J]. 中国口腔颌面外科杂志, 2015, 13(2):147-150. NIE Ping, TAO Li, TANG Yanmei, et al. Effect of surgically assisted rapid maxillary expansion on the dimension of the nasal air way and nasal air resistance[J]. China Journal of Oral and Maxillofacial Surgery, 2015, 13(2):147-150.
[13] Angelieri F, Cevidanes LHS, Franchi L, et al. Midpalatal suture maturation:classification method for individual assessment before rapid maxillary expansion[J]. Am J Orthod Dentofacial Orthop, 2013, 144(5):759-769.
[14] 曾祥龙, 唐志慧. 矢状骨面型与上气道形态和舌骨位置关系的研究[J]. 现代口腔医学杂志, 2004, 18(3):231-234. ZENG Xianglong, TANG Zhihui. A study of relationship between upper airway form and hyoid position and sagittal facial type[J]. Journal of Modern Stomatology, 2004, 18(3): 231-234.
[15] Phoenix A, Valiathan M, Nelson S, et al. Changes in hyoid bone position following rapid maxillary expansion in adolescents[J]. Angle Orthod, 2011, 81(4): 632-638.
[16] Kjurchieva-Chuchkova G, Kanurkova L, Evska CB. Changes in head posture after rapid maxillary expansion in patients with nasopharyngeal obstruction[J]. South Eur J Orthod Dentofac Res, 2016, 3(2): 39-43.
[17] Zhang YL, Song JL, Xu XC, et al. Morphologic analysis of the temporomandibular joint between patients with facial asymmetry and asymptomatic subjects by 2D and 3D evaluation: A preliminary study[J]. Medicine, 2016, 95(13): 3052.
[18] Ueki K, Moroi A, Sotobori M, et al. Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry[J]. J Craniomaxillofac Surg, 2012, 40(8): 821-827.
[19] Lima AC, Lima AL, Filho RMAL, et al. Spontaneous mandibular arch response after rapid palatal expansion: a long-term study on Class I malocclusion[J]. Am J Orthod Dentofacial Orthop, 2004, 126(5): 576-582.
[20] Oliveira TFM, Pereira-Filho VA, Gabrielli MFR, et al. Effects of surgically assisted rapid maxillary expansion on mandibular position: a three-dimensional study[J]. Prog Orthod, 2017, 18(1): 22. doi:10.1186/s40510-017-0179-8.
[21] Raafat El, Ghetany HA. Changes in the pharyngeal airway spaces and hyoid bone position associated with surgically assisted rapid maxillary expansion[J]. J Am Sci, 2013, 9(6): 561-565.
[22] Pracharktam N, Nelson S, Hans MG, et al. Cephalometric assessment in obstructive sleep apnea[J]. Am J Orthod Dentofacial Orthop, 1996, 109(4): 410-419.
[23] 封小霞, 赵志河. 头姿势与颅面形态和错牙合畸形的关系[J]. 国际口腔医学杂志, 2011, 06: 708-711.
[24] Ying L, Sun X, Chen Y, et al. Relationships of sagittal skeletal discrepancy, natural head position, and craniocervical posture in young Chinese children[J]. Cranio, 2015, 34(3): 155-162.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed