Transpalatal distraksiyonun faringeal havayolu boyutları üzerindeki etkilerinin araştırılması

Year 2020, , 64 - 70, 01.09.2020

Hüseyin Can Tükel , Mehmet Emre Benlidayı , Ufuk Tatlı , Aslıhan Uzel Selen Begüm Uzun Mehmet Kürkçü

https://doi.org/10.17214/gaziaot.573426

Abstract

Amaç: Bu çalışmanın amacı, transvers maksiller darlığı (TMD) olan yetişkin hastalarda transpalatal distraktör ile yapılan cerrahi destekli maksiller genişletmenin (TPD+CDMG) faringeal havayolu boyutları üzerindeki etkisini araştırmaktır.

Gereç ve Yöntem: Bu çalışmaya 5 mm’den fazla TMD’si olan hastalar dahil edildi. Bütün hastalara genel anestezi altında, standart Le-Fort I osteotomisi ve maksillada orta hat osteotomisini takiben maksiller genişletme uygulandı. Dört ay sonrasında apareyler çıkartılarak transpalatal ark uygulandı. Hemen ameliyat öncesinde ve distraktör sökümünden en az 6 ay sonra alınan konik ışınlı bilgisayarlı tomografi görüntüleri üzerinde Dolphin 3D Surgery Görüntüleme yazılımının havayolu modülü kullanılarak, faringeal havayolunun nazofaringeal, retropalatal, retroglossal bölümlerinin hacimleri ve faringeal havayolunun en küçük kesit alanı ölçüldü. Sürekli değişkenler için normal dağılım varsayımı Shapiro-Wilk testi ile kontrol edildi ve dağılım tipine göre testler seçildi. Bağımlı yapıda olan TPD+CDMG öncesi ve sonrası ölçümler arasındaki farklılık test edilirken, normal dağılıma sahip olan ölçümler için eşleştirilmiş t-testi, normal dağılıma sahip olmayan ölçümler için ise Wilcoxon testi kullanıldı. İstatistiksel anlamlılık düzeyi p≤0.05 olarak kabul edildi.

Bulgular: Çalışmaya 9’u kadın (%42.9), 12’si erkek (%57.1), toplam 21 hasta dahil edildi. Hastaların yaş ortalaması 22.8±5.7; takip süresi ortalaması 22±11.1 ay olarak bulundu. Retropalatal, retroglossal ve toplam havayolu hacmi ve faringeal havayolunun minimum kesit alanı için TPD+CDMG öncesi ve sonrasında yapılan ölçümler arasında istatistiksel olarak anlamlı fark bulunamadı. Ancak, nazofarinks hacmi için TPD+CDMG öncesi ve sonrası ölçümler arasında anlamlı fark tespit edildi (p≤0.05).

Sonuç: TPD+CDMG sonrası nazofarinks hacminde önemli artış olduğu bulunurken, faringeal havayolunun diğer bölgelerindeki hacimsel ve kesitsel değişikliklerin önemli düzeyde olmadığı bulunmuştur.

Keywords

farinks, maksiller genişletme, maksiller osteotomi

Assessment of the effects of transpalatal distraction on pharyngeal airway dimensions

Abstract

Objective: This study was aimed to compare the pharyngeal airway dimensions before and after surgically-assisted maxillary expansion with a transpalatal distractor (TPD+SAME) in adult patients with a transverse maxillary deficiency (TMD).

Materials and Method: Patients who had more than 5 mm of TMD were included in this study. All patients underwent standard Le-Fort I osteotomies with maxillary midline osteotomy and maxillary expansion. Four months later, the distractor was removed, and transpalatal arch was applied. Before the operation and at least six months after the distraction, cone-beam computed tomography images were taken. Using the airway module of Dolphin 3D Surgery Imaging software, nasopharyngeal, retropalatal and retroglossal volumes, and the smallest cross-sectional area of the pharyngeal airway were measured. The normal distribution assumption was controlled by using the Shapiro-Wilk test. Paired t-test was used for the measurements that had normal distribution, while the Wilcoxon test was used for the measurements that lacked normal distribution. Statistical significance was set at p≤0.05.

Results: Nine female (42.9%) and 12 male (57.1%) patients (total 21) were included in this study. The mean age of the patients was 22.8±5.7 years. The mean follow-up period was 22±11.1 months. For the retropalatal, retroglossal, and total airway volumes and the minimum cross-sectional area of the pharyngeal airway, no statistically significant differences were found between the measurements obtained before and after the TPD+SAME treatment. However, there was a statistically significant difference between the measurements of the nasopharynx volume before and after the TPD+SAME treatment (p≤0.05).

Conclusion: There was a significant increase in the nasopharyngeal volume after the TPD+SAME treatment. Volumetric and cross-sectional changes in other regions of the pharyngeal airway were not significant.

Keywords

maxillary osteotomy, palatal expansion technique, pharynx

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