Farengeal Havayolu Ölçümlerinde Toplam Havayolu Hacmi İle Bölgesel Havayolları Arasındaki Korelasyonun Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, dentofasiyal anomali tanılı hastaların total farengeal havayolu hacimleri ile nazofarengeal, retropalatal ve retroglossal havayolu hacimleri arasındaki korelasyonu değerlendirmektir.

Materyal ve Metod: Yaşları 9.1 ile 13.8 aralığında olan 26 kız ve 34 erkek olmak üzere toplam 60 dentofasiyal deformite tanısı konulmuş bireyin CBCT kayıtları çalışma kapsamına alınmıştır. Kayıtlar üzerinden hastaların yaş, cinsiyet, nazofarengeal, retropalatal, retroglossal ve total havayolu hacimleri kaydedilmiştir. Solunum yolları ile ilgili ölçümler hacimsel parametreler kullanılarak karşılaştırılmıştır. Hasta verileri cinsiyetler üzerinden ve cinsiyetten bağımsız olarak iki aşamada istatistik analiz programı ile yapılmıştır.

Bulgular: Nazofarenks, retropalatal, retroglossal hacimler ile total hacim değişkenleri arasında istatistiksel olarak anlamlı ilişkiler bulunmaktadır (p<0.05).Sonuçlar incelendiğinde, nazofarengeal hacim ile total hacim arasında %59,9 retropalatal hacim ile total hacim arasında yaklaşık %84,2 ve retroglossal hacim ile total hacim arasında %73,1 düzeyinde aynı yönlü ilişki bulunmaktadır. Ayrıca nazofarengeal hacim ile retropalatal hacim arasında yaklaşık %27,1; retropalatal hacim ile retroglossal hacim arasında %48,7 düzeyinde aynı yönlü ilişki mevcuttur. Korelasyon fark testi bulgularına göre, kızlarda retropalatal-total hacim arasında ilişki erkeklere göre yaklaşık %13 oranında daha fazladır. Cinsiyet değerlendirmeye alınmadan yapılan korelasyon değerlendirilmesinde ise total hacim ile nazofarenks, retropalatal ve retroglossal hacimler arasında güçlü korelasyon varlığı saptanmıştır. Bu kolerasyonların içinde en güçlü ilişki total hacim ile  retropalatal hacim arasında bulunmuştur (%84,2).

Sonuç: Çalışmamız sonucunda, her üç anatomik bölgenin de total havayolu hacmi için önemli olduğu, klinik olarak önemli bulunmasa da nazofarengeal havayolu ölçümlerinin de total havayolu hacmi ile güçlü bir kolerasyon gösterdiği, retropalatal havayolu hacminin total havayolu hacmi ile en güçlü korelasyonu gösterdiği ve cinsiyetler arası segmental ve total havayolu hacimleri arasında retropalatal-total hacim hariç istatistiksel olarak anlamlı bir fark bulunmadığı sonuçları kaydedilmiştir

Anahtar Kelimeler

• Havayolu hacmi,Segmentasyon,Dentofasiyal deformiteler

Evaluation of Correlation Between Total Airway Volume and Regional Airway Volumes in Pharyngeal Airway Measurements

Öz

Background: The aim of this study was to evaluate the correlation between total pharyngeal airway volumes and nasopharyngeal, retro-palatinal and retro-glossal airway volumes of patients with dentofacial anomaly.

Materials and Methods: CBCT records of 60 dentofacial deformities, 26 females and 34 males aged between 9.1-13.8, were included in the study. Age, sex, nasopharyngeal, retropalatal, retroglossal and total nasopharyngeal airway volumes of the patients were recorded. respiratory tract measurements were compared using volumetric parameters. The patients were evaluated in two stages according to gender and independent of gender and statistical analyzes were performed with R project (R Core Team, 2019) statistical analysis program.

Results: There are statistically significant relationships between nasopharynx, retropalatal, retroglossal volumes and total volume variables (p<0.05). When the results were examined, there was a same-way relationship between nasopharyngeal volume and total volume at 59.9% retropalatal volume and total volume at approximately 84.2% and between retroglossal volume and total volume at 73.1%. In addition, the same directional relationship exists between nasopharyngeal volume and retropalatal volume at approximately 27.1%; and between retropalatal volume and retroglossal volume at 48.7%. According to the correlation difference test findings, the association between retropalatal-total volume in girls was approximately 13% greater than in boys. The correlation between the total volume and the nasopharynx, retropalatal and retroglossal volumes was determined. Among these cholerations, the strongest relationship was found between total volume and retropalatal volume (84.2%).

Conclusion: As a result of our study, it was found that all three anatomic regions were important for total airway volume, although it is not clinically important nasopharyngeal airway measurements showed a strong correlation with total airway volume, retropalatal airway volume showed the strongest correlation with total airway volume and no statistically significant difference was found between segmental and total airway volumes except for retropalatal and total airway volume between genders.

Anahtar Kelimeler

• Airway volume,Segmentation,Dentofacial deformities

Kaynakça

1. [1] Li L, Liu H, Cheng H, Han Y, Wang C, Chen Y, 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. PLoS One. 2014;9(4):e94378.
2. [2] Baker TL. Sleep apnea disorders. Introduction to sleep and sleep disorders. Med Clin North Am. 1985;69(6):1123-52.
3. [3] Şenol TH. Hacettepe Anatomi Ders Notları. Saray Medikal Yayıncılık. 1996:103-5.
4. [4] Klinik Baş Boyun Anatomisi. Ulusal Tıp Kitapevi- İstanbul. 1996;1. Cilt.
5. [5] Baumrind S, Korn EL, Ben-Bassat Y, West E. Quantitation of maxillary remodeling: a description of osseous changes relative to superimposition on metallic implants. Am J Orthod Dentofac Orthop 1987;91:29-41
6. [6] Montgomery WM, Vig PS, Staab EV, Matteson SR. Computed tomography: a three-dimensional study of the nasal airway. Am J Orthod. 1979;76(4):363-75.
7. [7] Enöz M. Yanardağ, H., Güven, M. (2006) OSAS'lı Hastaların Üst Solunum Yollarının Değerlendirilmesinde Kullanılan Teknikler. KBB Forum, 5 (3), 133- 137.
8. [8] Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72(1):75-80.

9. [9] El H, Palomo JM. Measuring the airway in 3 dimensions: a reliability and accuracy study. Am J Orthod Dentofacial Orthop. 2010;137(4 Suppl):S50 e1-9; discussion S-2.
10. [10] Battagel JM, Johal A, Smith AM, Kotecha B. Postural variation in oropharyngeal dimensions in subjects with sleep disordered breathing: a cephalometric study. Eur J Orthod. 2002;24(3):263-76.
11. [11] Subtelny JD. The significance of adenoid tissue in orthodontia. Angle Orthod 1954;24:59-69.
12. [12] Bhattacharyya N, Blake SP, Fried MP. Assessment of the airway in obstructive sleep apnea syndrome with 3-dimensional airway computed tomography. Otolaryngol Head Neck Surg. 2000;123(4):444-9.
13. [13] Pliska BT, Tam IT, Lowe AA, Madson AM, Almeida FR. Effect of orthodontic treatment on the upper airway volume in adults. Am J Orthod Dentofacial Orthop. 2016;150(6):937-44.
14. [14] Schendel S, Powell N, Jacobson R. Maxillary, mandibular, and chin advancement: treatment planning based on airway anatomy in obstructive sleep apnea. J Oral Maxillofac Surg. 2011;69(3):663-76.
15. [15] Lee JW, Park KH, Kim SH, Park YG, Kim SJ. Correlation between skeletal changes by maxillary protraction and upper airway dimensions. Angle Orthod. 2011;81(3):426-32.
16. [16] Li YM, Liu JL, Zhao JL, Dai J, Wang L, Chen JW. Morphological changes in the pharyngeal airway of female skeletal class III patients following bimaxillary surgery: a cone beam computed tomography evaluation. Int J Oral Maxillofac Surg. 2014;43(7):862-7.
17. [17] Palomo JM, Rao PS, Hans MG. Influence of CBCT exposure conditions on radiation dose. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105(6):773-82.
18. [18] Kim YJ, Hong JS, Hwang YI, Park YH. Three-dimensional analysis of pharyngeal airway in preadolescent children with different anteroposterior skeletal patterns. Am J Orthod Dentofacial Orthop. 2010;137(3):306 e1-11; discussion -7.
19. [19] Tso HH, Lee JS, Huang JC, Maki K, Hatcher D, Miller AJ. Evaluation of the human airway using cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):768-76.
20. [20] Yamashina A, Tanimoto K, Sutthiprapaporn P, Hayakawa Y. The reliability of computed tomography (CT) values and dimensional measurements of the oropharyngeal region using cone beam CT: comparison with multidetector CT. Dentomaxillofac Radiol. 2008;37(5):245-51.
21. [21] Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2009;135(4):468-79.
22. [22] Kapila S, Conley RS, Harrell WE, Jr. The current status of cone beam computed tomography imaging in orthodontics. Dentomaxillofac Radiol. 2011;40(1):24-34.
23. [23] Weissheimer A, Menezes LM, Sameshima GT, Enciso R, Pham J, Grauer D. Imaging software accuracy for 3-dimensional analysis of the upper airway. Am J Orthod Dentofacial Orthop. 2012;142(6):801-13.
24. [24] Panou E, Motro M, Ates M, Acar A, Erverdi N. Dimensional changes of maxillary sinuses and pharyngeal airway in Class III patients undergoing bimaxillary orthognathic surgery. Angle Orthod, 2013, 83: 824-831.
25. [25] Raffaini M, Pisani C. Clinical and cone-beam computed tomography evaluation of the three-dimensional increase in pharyngeal airway space following maxillo-mandibular rotationadvancement for Class II-correction in patients without sleep apnoea (OSA). J Craniomaxillofac Surg, 2013, 41: 552-557.
26. [26] Park SB, Kim YI, Son WS, Hwang DS, Cho BH. Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with Class III skeletal deformities: bimaxillary surgery and mandibular setback surgery. Int J Oral Maxillofac Surg, 2012, 41: 87-93.
27. [27] Hong JS, Park YH, Kim YJ, Hong SM, Oh KM. Three-dimensional changes in pharyngeal airway in skeletal class III patients undergoing orthognathic surgery. J Oral Maxillofac Surg, 2011, 69: e401-408.
28. [28] Goncales ES, Duarte MA, Palmieri C, Jr., Zakhary GM, Ghali GE. Retrospective analysis of the effects of orthognathic surgery on the pharyngeal airway space. J Oral Maxillofac Surg, 2014, 72: 2227-2240.
29. [29] de Souza Carvalho AC, Magro Filho O, Garcia IR, Jr., Araujo PM, Nogueira RL. Cephalometric and three-dimensional assessment of superior posterior airway space after maxillomandibular advancement. Int J Oral Maxillofac Surg, 2012, 41: 1102-1111.
30. [30] Boudewyns AN, Van de Heyning PH, De Backer WA. Site of upper airway obstruction in obstructive apnoea and influence of sleep stage. Eur Respir J, 1997, 10: 2566-2572.
31. [31] Shin JH, Kim MA, Park IY, Park YH. A 2-year follow-up of changes after bimaxillary surgery in patients with mandibular prognathism: 3-dimensional analysis of pharyngeal airway volume and hyoid bone position. J Oral Maxillofac Surg, 2015, 73: 340 e341-349.
32. [32] Kim H-S, Kim G-T, Kim S, Lee J-W, Kim E-C, Kwon Y-D. Three-dimensional evaluation of the pharyngeal airway using cone-beam computed tomography following bimaxillary orthognathic surgery in skeletal class III patients. Clinical oral investigations, 2016: 1-8.
33. [33] Lee Y, Chun YS, Kang N, Kim M. Volumetric changes in the upper airway after bimaxillary surgery for skeletal class III malocclusions: a case series study using 3-dimensional cone-beam computed tomography. J Oral Maxillofac Surg, 2012, 70: 2867-2875.
34. [34] Sears CR, Miller AJ, Chang MK, Huang JC, Lee JS. Comparison of pharyngeal airway changes on plain radiography and cone-beam computed tomography after orthognathic surgery. J Oral Maxillofac Surg, 2011, 69: e385-394.
35. [35] Brunetto DP, Velasco L, Koerich L, Araujo MT. Prediction of 3-dimensional pharyngeal airway changes after orthognathic surgery: a preliminary study. Am J Orthod Dentofacial Orthop, 2014, 146: 299-309.