JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES) ›› 2015, Vol. 53 ›› Issue (8): 71-78.doi: 10.6040/j.issn.1671-7554.0.2014.636

Previous Articles     Next Articles

CBCT evaluation of the upper airway morphological changes in skeletal Class Ⅲ malocclusion patients using protraction and rapid maxillary expansion appliance

CHEN Xueling1,2,3, WU Zizhong4, LIU Dongxu1,2, XIE Yongtao5, GUO Tiantian1, ZHANG Shijie3   

  1. 1. Department of Orthodontics, School of Stomatology, Shandong University, Jinan 250012, Shandong, China;
    2. Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan 250012, Shandong, China;
    3. Department of Stomatology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    4. Department of Stomatology, the 88th Hospital of Chinese People's Liberation Army, Taian 271000, Shandong, China;
    5. Department of Stomatology, Shandong Traditional Chinese Medicine Hospital, Jinan 250012, Shandong, China
  • Received:2014-09-22 Published:2015-08-10

PDF (PC)

431

Abstract: Objective To evaluate the effects of protraction headgear with rapid maxillary expansion (PE) on the upper airway morphological dimensions in growing patients with skeletal Class III malocclusion. Methods The pre-treatment (T1) and post-treatment (T2) cone beam computed tomography (CBCT) data of 30 patients aged 8 to 11 years who had completed PE therapy were collected. After the data were reconstructed and registered, the morphological changes of the upper airway were measured. The t-test was used to assess the statistical differences. Results After the PE treatment, the subspinale (A) of maxillary and upper incisor (UI) moved in the anterosuperior direction. The gnathion (Gn) of mandible moved in the posterior-inferior direction. The placement of the hyoid bone, length and width of dentalarch, volume and mean cross-sectional area of nasopharynx and oropharynx region had significant differences, while the hypopharynx showed no remarkable change. The ratio of the largest anteroposterior/lateral diameter of the oropharynx increased, while that of the hypopharynx decreased. Conclusion The PE treatment of Class Ⅲ malocclusion with maxillary skeletal deficiency produces a significant enlargement in the nasopharynx and oropharynx, but the hypopharynx shows no significant changes. The oropharynx is found to be more circular and the hypopharynx becomes more elliptic in transverse shape.

Key words: Rapid palatal expansion, 3-dimensional virtual model reconstruction, Airway, Protraction headgear, Angle Class III, Cone beam computed tomography

CLC Number: 

  • R783.5
[1] Krneta B, Primožič J, Zhurov A, et al. Three-dimensional evaluation of facial morphology in children aged 5–6 years with a Class III malocclusion[J]. Eur J Orthod, 2014, 36(2): 133-139.
[2] Iwasaki T, Hayasaki H, Takemoto Y, et al. Oropharyngeal airway in children with Class III malocclusion evaluated by cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2009, 136(3): 318. e1-9; discussion 318-319.
[3] Handler SD. Upper airway obstruction in craniofacial anomalies: diagnosis and management[J]. Birth Defects Orig Artic Ser, 1985, 21(2): 15-31.
[4] Hui S, Wing YK, Kew J, et al. Obstructive sleep apnea syndrome in a family with Crouzon's syndrome[J]. Sleep, 1998, 21(3): 298-303.
[5] Nargozian C. The airway in patients with craniofacial abnormalities[J]. Pediatr Anesth, 2004(14): 53-59.
[6] Stratemann S, Huang JC, Maki K, et al. Three-dimensional analysis of the airway with cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2011, 140(5): 607-615.
[7] Celikoglu M, Oktay H. Effects of maxillary protraction for early correction of Class III malocclusion[J]. Eur J Orthod, 2014, 36(1): 86-92.
[8] Shadrick V, Walker M. Facemask therapy between ages six to ten years may lead to short term improvements for Class III malocclusions[J]. Evid Based Dent, 2013, 14(4): 112-113.
[9] Aloufi F, Preston CB, Zawawi KH. Changes in the upper and lower pharyngeal airway spaces associated with rapid maxillary expansion[J]. ISRN Dent, 2012, 2012: 290964. doi:10.5402/2012/290964.
[10] Mucedero M, Baccetti T, Franchi L, et al. Effects of maxillary protraction with or without expansion on the sagittal pharyngeal dimensions in Class III subjects[J]. Am J Orthod Dentofacial Orthop, 2009, 135(6): 777-781.
[11] Aboudara C, Nielsen I, Huang JC, et al. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2009, 135(4): 468-479.
[12] Makdissi J. Cone beam CT in orthodontics: the current picture[J]. Int Orthod, 2013, 11(1): 1-20.
[13] Guijarro-Martinez R, Swennen GR. Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature[J]. Int J Oral Maxillofac Surg, 2011, 40(11): 1227-1237.
[14] Nada RM, Maal TJ, Breuning KH, et al. Accuracy and reproducibility of voxel based superimposition of cone beam computed tomography models on the anterior cranial base and the zygomatic arches[J]. PLoS One, 2011, 6(2): e16520. doi:10.1371/journal.pone.0016520.
[15] O'Reilley MT, Yanniello GJ. Mandibular growth changes and maturation of cervical vertebrae-a longitudinal cephalometric study[J]. Angle Orthod, 1988, 58(2): 179-184.
[16] Pamporakis P, Nevzatogˇlu S, Küükkeles N. Three-dimensional alterations in pharyngeal airway and maxillary sinus volumes in Class III maxillary deficiency subjects undergoing orthopedic facemask treatment[J]. Angle Orthod, 2014, 84(4): 701-707.
[17] Chen Y, Hong L, Wang CL, et al. Effect of large incisor retraction on upper airway morphology in adult bimaxillary protrusion patients[J]. Angle Orthod, 2012, 82(6): 964-970.
[18] Plooij JM, Maal TJ, Haers P, et al. Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review[J]. Int J Oral Maxillofac Surg, 2011, 40(4): 341-352.
[19] Cevidanes LH, Heymann G, Cornelis MA, et al. Superimposition of 3-dimensional cone-beam computed tomography models of growing patients[J]. Am J Orthod Dentofacial Orthop, 2009, 136(1): 94-99.
[20] 郭泾, 高雪梅, 李向东, 等. 不同年龄组成年男性上气道及周围组织磁共振影像的测量[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(9): 676-680. GUO Jing, GAO Xuemei, LI Xiangdong, et al. Magnetic resonance imaging survey of the upper airway in different age non-snoring males[J]. Chin J Otorhinolaryngol Head Neck Surg, 2008, 43(9): 676-680.
[21] 邹茵, 潘永初, 王林. 上气道在正畸学中的研究进展[J]. 口腔医学, 2012, 32(08): 499-501.
[22] Li L, Liu H, Cheng H, et al. CBCT evaluation of the upper airway morphological changes in growing patients of Class II division 1 malocclusion with mandibular retrusion using twin block appliance: a comparative research[J]. PLoS One, 2014, 9(4): e94378. doi:10.1371/journal.pone.0094378.eCollection 2014.
[23] 邓金荣,高雪梅,曾祥龙. 儿童颅面和气道形态与阻塞性睡眠呼吸暂停低通气综合征关系的病例-对照研究[J]. 北京大学学报: 医学版, 2010, 42(6): 697-702. DENG Jinrong, GAO Xuemei, ZENG Xianglong. Relationship between craniofacial and airway structure and pediatric obstructive sleep apnea and hyponea syndrom es: a case-control study[J]. Journal of Peking University: Health Sciences, 2010, 42(6): 697-702.
[24] Tsai HH, Ho CY, Lee PL, et al. Cephalometric analysis of nonobese snorers either with or without obstructive sleep apnea syndrome[J]. Angle Orthod, 2007, 77(6): 1054-1061.
[25] Houston WJ. The analysis of errors in orthodontic measurements[J]. Am J Orthod, 1983, 83(5): 382-390.
[26] 咸红红,刘洪,马德东,等. 基于CT数据的影像学方法在口腔正畸的临床应用[J]. 中国实用口腔科杂志, 2012, 5(5): 277-282. XIAN Honghong, LIU Hong, MA Dedong, et al. Orthodontic treatment outcome assessment basing on the CT images[J]. Chinese Journal of Practical Stomatology, 2012, 5(5): 277-282.
[27] Halazonetis DJ. From 2-dimensional cephalograms to 3-dimensional computed tomography scans[J]. Am J Orthod Dentofacial Orthop, 2005, 127(5): 627-637.
[28] Oktay H, Ulukaya E. Maxillary protraction appliance effect on the size of the upper airway passage[J]. Angle Orthod, 2008, 78(2): 209-214.
[29] Li H, Lu X, Shi J, et al. Measurements of normal upper airway assessed by 3-dimensional computed tomography in Chinese children and adolescents[J]. Int J Pediatr Otorhinolaryngol, 2011, 75(10): 1240-1246.
[30] Ozbek MM1, Memikoglu TU, Ggen H, et al. Oropharyngeal airway dimension and functional-orthopedic treatment in skeletal Class Ⅱcases[J]. Angle Orthod, 1998, 68(4): 327-336.
[31] Hino CT, Cevidanes LH, Nguyen TT, et al. Three-dimensional analysis of maxillary changes associated with facemask and rapid maxillary expansion compared with bone anchored maxillary protraction[J]. Am J Orthod Dentofacial Orthop, 2013, 144(5):705-714.
[32] Karthi M, Anbuselvan GJ, Kumar BP. Early correction of Class III malocclusion with rapid maxillary expansion and face mask therapy[J]. J Pharm Bioallied Sci, 2013, 5(Suppl 2): S169-172.
[33] Hiyama S, Suda N, Ishii-Suzuki M, et al. Effects of maxillary protraction on craniofacial structures and upper-airway dimension[J]. Angle Orthod, 2002, 72(1): 43-47.
[34] Li YM, Liu JL, Zhao JL, et al. Morphological changes in the pharyngeal airway of female skeletal Class III patients following bimaxillary surgery: a cone beam computed tomography evaluation[J]. Int J Oral Maxillofac Surg, 2014, 43(7): 862-867.
[35] Kim MA, Kim BR, Choi JY, et al. Three-dimensional changes of the hyoid bone and airway volumes related to its relationship with horizontal anatomic planes after bimaxillary surgery in skeletal Class III patients[J]. Angle Orthod, 2013, 83(4): 623-629.
[36] Iwasaki T, Saitoh I, Takemoto Y, et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study[J]. Am J Orthod Dentofacial Orthop, 2013, 143(2): 235-245.
[37] El H, Palomo JM. Three-dimensional evaluation of upper airway following rapid maxillary expansion: a CBCT study[J]. Angle Orthod, 2014, 84(2): 265-273.
[1] LAI Guoxiang, WANG Qing. Clinical application of bronchoscopy in the airway management of patients undergoing mechanical ventilation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(4): 14-18.
[2] JIN Faguang. Expatiation of the diagnosis and treatment of benign central airway stenosis [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(4): 7-13.
[3] LI Yuanyuan, WANG Ximing, WANG Long, JI Congshan, DUAN Yanhua,CHENG Zhaoping, LIU Yanping, CHEN Jing. Application of flash spiral acquisition by dual-source CT in children with cardiovascular airway constriction [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(11): 59-64.
[4] LIU Qingfa, WANG Chao, SUN Qijing, GONG Xiaodan, ZHANG Caiqing. Effect of interleukin-25 on inducing the airway remodeling of asthma mice by nuocyte cells [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 28-33.
[5] LIU Lin, LIU Chunhong, WANG Dexiang, WU Jinxiang, ZHAO Jiping, LIU Tian, ZHANG Yuanyuan, WANG Junfei, LIU Yahui, CAO Liuzhao, DONG Liang. Estimation on small airway function in asthmatic patients with fractional exhaled nitric oxide and impulse oscillometry [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 78-83.
[6] CHEN Dong, LI Xiaoying, MA Jing, WANG Yunfeng, ZHANG Wen. Applications of electronic bronchoscope in diagnosis and treatment of dyspnea in newborns [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 84-87.
[7] WEN Fangjing, SHI Xiaowu. Clinical research of stent placement by electronic bronchoscopy on malignant airway stenosis with one side lung ventilation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(12): 62-66.
[8] LIU Lu, LI Rongrong, LIU Mengjun, ZHANG Yan, LIU Dongxu. Alveolar bone volume around upper incisors in adult patients with Class Ⅰ bimaxillary protrusion [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(8): 66-70.
[9] ZHOU Jing, ZHANG Lijuan, DONG Youjing. Effect of sevflurane on the airway smooth muscle tension in the ovalbumin-sensitized hyperresponsiveness airways [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(5): 52-54.
[10] HUANG Yan, KUANG Xin, Xiong Hua, LIU Xin, LUO Xiao-qin, LIU Bin. Effects of Chaipu decoction on expression of VEGF and TGF-β1on airway remodeling in asthmatic rats [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(S1): 14-17.
[11] SHI Xiaowu, ZHAO Su. Clinical research of cryotherapy and balloon dilation for severe benign central airway stenosis through laryngeal mask [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(11): 68-72.
[12] MICHAEL M. P. NG'WANAMASELE, HAN Yanzhao, ZHANG Fenghe, TONG Dongdong, LI Liang, CHENG Huijuan, WANG Chunling, LIU Dongxu. Three dimensional registration method to evaluate the upper airway morphologic changes after mandibular setback surgery [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(10): 61-65,71.
[13] WANG Na-na, CAO Cong, LIU Dong-xu. Changes in mandibular direction during and after protraction headgear treatment [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2013, 51(9): 95-99.
[14] DU Lin-na1， GUO Jing2. Comparison of responders and nonresponders to oral appliance for
the treatment of obstructive sleep apnea syndrome [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(8): 120-123.
[15] LIU Wei-ying, YU Qin, ZHANG Jia-bin, YUE Hong-mei， PU Jia-yuan. Plasma levels of β-endorphin, neuropeptide Y and ghrelin  in the patients  with obstructive sleep apnea syndrome and CPAP intervention [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(1): 89-93.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd