Öz
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.
Anahtar Kelimeler
Kaynakça
- Betts NJ, Vanarsdall RL, Barber HD, Higgins-Barber K, Fonseca RJ. Diagnosis and treatment of transverse maxillary deficiency. Int J Adult Orthodon Orthognath Surg. 1995;10:75-96.
- Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008;52:686-717.
- Wheatley JR, Tangel DJ, Mezzanotte WS, White DP. Influence of sleep on response to negative airway pressure of tensor palatini muscle and retropalatal airway. J Appl Physiol (1985) 1993;75:2117-24.
- Series FJ, Simoneau SA, St Pierre S, Marc I. Characteristics of the genioglossus and musculus uvulae in sleep apnea hypopnea syndrome and in snorers. Am J Respir Crit Care Med 1996;153:1870-4.
- Carlson DM, Onal E, Carley DW, Lopata M, Basner RC. Palatal muscle electromyogram activity in obstructive sleep apnea. Am J Respir Crit Care Med 1995;152:1022-7.
- Morrison DL, Launois SH, Isono S, Feroah TR, Whitelaw WA, Remmers JE. Pharyngeal narrowing and closing pressures in patients with obstructive sleep apnea. Am Rev Respir Dis 1993;148:606-11.
- Neelapu BC, Kharbanda OP, Sardana HK, Balachandran R, Sardana V, Kapoor P, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med Rev 2017;31:79-90.
- White BC, Woodside DG, Cole P. The effect of rapid maxillary expansion on nasal airway resistance. J Otolaryngol 1989;18:137-43.
- Hartgerink DV, Vig PS, Abbott DW. The effect of rapid maxillary expansion on nasal airway resistance. Am J Orthod Dentofacial Orthop 1987;92:381-9.
- Timms DJ. The effect of rapid maxillary expansion on nasal airway resistance. Br J Orthod 1986;13:221-8.
- Kilic N, Oktay H. Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review. Int J Pediatr Otorhinolaryngol 2008;72:1595-601.
- Buck LM, Dalci O, Darendeliler MA, Papadopoulou AK. Effect of Surgically Assisted Rapid Maxillary Expansion on Upper Airway Volume: A Systematic Review. J Oral Maxillofac Surg 2016;74:1025-43.
- Romulo de Medeiros J, Ferraro Bezerra M, Gurgel Costa FW, Pinheiro Bezerra T, de Araujo Alencar CR, Studart Soares EC. Does pterygomaxillary disjunction in surgically assisted rapid maxillary expansion influence upper airway volume? A prospective study using Dolphin Imaging 3D. Int J Oral Maxillofac Surg 2017;46:1094-101.
- Pereira-Filho VA, Monnazzi MS, Gabrielli MA, Spin-Neto R, Watanabe ER, Gimenez CM, et al. Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2014;43:581-6.
- Vinha PP, Faria AC, Xavier SP, Christino M, de Mello-Filho FV. Enlargement of the Pharynx Resulting From Surgically Assisted Rapid Maxillary Expansion. J Oral Maxillofac Surg 2016;74:369-79.
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.
- Langer MR, Itikawa CE, Valera FC, Matsumoto MA, Anselmo-Lima WT. Does rapid maxillary expansion increase nasopharyngeal space and improve nasal airway resistance? Int J Pediatr Otorhinolaryngol 2011;75:122-5.
- Usumez S, Iseri H, Orhan M, Basciftci FA. Effect of rapid maxillary expansion on nocturnal enuresis. Angle Orthod 2003;73:532-8.
- Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L. Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol 2014;78:23-7.
- Smith T, Ghoneima A, Stewart K, Liu S, Eckert G, Halum S, et al. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2012;141:618-26.
- Ribeiro AN, de Paiva JB, Rino-Neto J, Illipronti-Filho E, Trivino T, Fantini SM. Upper airway expansion after rapid maxillary expansion evaluated with cone beam computed tomography. Angle Orthod 2012;82:458-63.
- Zeng J, Gao X. A prospective CBCT study of upper airway changes after rapid maxillary expansion. Int J Pediatr Otorhinolaryngol 2013;77:1805-10.
- Kurt G, Altug-Atac AT, Atac MS, Karasu HA. Changes in nasopharyngeal airway following orthopedic and surgically assisted rapid maxillary expansion. J Craniofac Surg 2010;21:312-7.
- Basciftci FA, Mutlu N, Karaman AI, Malkoc S, Kucukkolbasi H. Does the timing and method of rapid maxillary expansion have an effect on the changes in nasal dimensions? Angle Orthod 2002;72:118-23.
- Akay MC, Aras I, Gunbay T, Aras A. Does transpalatal distraction affect pharyngeal airway dimensions and related soft tissues? J Oral Maxillofac Surg 2014;72:1559-64.
- Nada RM, van Loon B, Schols JG, Maal TJ, de Koning MJ, Mostafa YA, et al. Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion. Eur J Oral Sci 2013;121:450-6.
- Zhao Y, Nguyen M, Gohl E, Mah JK, Sameshima G, Enciso R. Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2010;137:S71-8.
Öz
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.
Anahtar Kelimeler
Kaynakça
- Betts NJ, Vanarsdall RL, Barber HD, Higgins-Barber K, Fonseca RJ. Diagnosis and treatment of transverse maxillary deficiency. Int J Adult Orthodon Orthognath Surg. 1995;10:75-96.
- Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008;52:686-717.
- Wheatley JR, Tangel DJ, Mezzanotte WS, White DP. Influence of sleep on response to negative airway pressure of tensor palatini muscle and retropalatal airway. J Appl Physiol (1985) 1993;75:2117-24.
- Series FJ, Simoneau SA, St Pierre S, Marc I. Characteristics of the genioglossus and musculus uvulae in sleep apnea hypopnea syndrome and in snorers. Am J Respir Crit Care Med 1996;153:1870-4.
- Carlson DM, Onal E, Carley DW, Lopata M, Basner RC. Palatal muscle electromyogram activity in obstructive sleep apnea. Am J Respir Crit Care Med 1995;152:1022-7.
- Morrison DL, Launois SH, Isono S, Feroah TR, Whitelaw WA, Remmers JE. Pharyngeal narrowing and closing pressures in patients with obstructive sleep apnea. Am Rev Respir Dis 1993;148:606-11.
- Neelapu BC, Kharbanda OP, Sardana HK, Balachandran R, Sardana V, Kapoor P, et al. Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep Med Rev 2017;31:79-90.
- White BC, Woodside DG, Cole P. The effect of rapid maxillary expansion on nasal airway resistance. J Otolaryngol 1989;18:137-43.
- Hartgerink DV, Vig PS, Abbott DW. The effect of rapid maxillary expansion on nasal airway resistance. Am J Orthod Dentofacial Orthop 1987;92:381-9.
- Timms DJ. The effect of rapid maxillary expansion on nasal airway resistance. Br J Orthod 1986;13:221-8.
- Kilic N, Oktay H. Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review. Int J Pediatr Otorhinolaryngol 2008;72:1595-601.
- Buck LM, Dalci O, Darendeliler MA, Papadopoulou AK. Effect of Surgically Assisted Rapid Maxillary Expansion on Upper Airway Volume: A Systematic Review. J Oral Maxillofac Surg 2016;74:1025-43.
- Romulo de Medeiros J, Ferraro Bezerra M, Gurgel Costa FW, Pinheiro Bezerra T, de Araujo Alencar CR, Studart Soares EC. Does pterygomaxillary disjunction in surgically assisted rapid maxillary expansion influence upper airway volume? A prospective study using Dolphin Imaging 3D. Int J Oral Maxillofac Surg 2017;46:1094-101.
- Pereira-Filho VA, Monnazzi MS, Gabrielli MA, Spin-Neto R, Watanabe ER, Gimenez CM, et al. Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2014;43:581-6.
- Vinha PP, Faria AC, Xavier SP, Christino M, de Mello-Filho FV. Enlargement of the Pharynx Resulting From Surgically Assisted Rapid Maxillary Expansion. J Oral Maxillofac Surg 2016;74:369-79.
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.
- Langer MR, Itikawa CE, Valera FC, Matsumoto MA, Anselmo-Lima WT. Does rapid maxillary expansion increase nasopharyngeal space and improve nasal airway resistance? Int J Pediatr Otorhinolaryngol 2011;75:122-5.
- Usumez S, Iseri H, Orhan M, Basciftci FA. Effect of rapid maxillary expansion on nocturnal enuresis. Angle Orthod 2003;73:532-8.
- Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L. Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol 2014;78:23-7.
- Smith T, Ghoneima A, Stewart K, Liu S, Eckert G, Halum S, et al. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2012;141:618-26.
- Ribeiro AN, de Paiva JB, Rino-Neto J, Illipronti-Filho E, Trivino T, Fantini SM. Upper airway expansion after rapid maxillary expansion evaluated with cone beam computed tomography. Angle Orthod 2012;82:458-63.
- Zeng J, Gao X. A prospective CBCT study of upper airway changes after rapid maxillary expansion. Int J Pediatr Otorhinolaryngol 2013;77:1805-10.
- Kurt G, Altug-Atac AT, Atac MS, Karasu HA. Changes in nasopharyngeal airway following orthopedic and surgically assisted rapid maxillary expansion. J Craniofac Surg 2010;21:312-7.
- Basciftci FA, Mutlu N, Karaman AI, Malkoc S, Kucukkolbasi H. Does the timing and method of rapid maxillary expansion have an effect on the changes in nasal dimensions? Angle Orthod 2002;72:118-23.
- Akay MC, Aras I, Gunbay T, Aras A. Does transpalatal distraction affect pharyngeal airway dimensions and related soft tissues? J Oral Maxillofac Surg 2014;72:1559-64.
- Nada RM, van Loon B, Schols JG, Maal TJ, de Koning MJ, Mostafa YA, et al. Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion. Eur J Oral Sci 2013;121:450-6.
- Zhao Y, Nguyen M, Gohl E, Mah JK, Sameshima G, Enciso R. Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2010;137:S71-8.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Diş Hekimliği |
| Bölüm | Özgün Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 37 Sayı: 3 |