儿童腺样体肥大、上颌窦黏膜增厚与牙颌面发育的相关性分析

doi:10.19439/j.sjos.2019.05.016

摘要/Abstract

摘要： 目的探讨腺样体肥大、上颌窦黏膜增厚对儿童牙颌面软、硬组织发育的影响。方法筛选治疗前患儿80例,分为A组（腺样体肥大伴上颌窦黏膜增厚）、B组（腺样体肥大而上颌窦黏膜未增厚）、C组（无腺样体肥大而上颌窦黏膜增厚）、D组（无腺样体肥大且上颌窦黏膜未增厚）,每组各20例,年龄12~14岁。进行头影测量和双侧上颌窦体积测量。采用SPSS 24.0软件包比较4组各参数之间的差异。结果 B、C 2组与D组相比,均只有ANB角增大,差异具有统计学意义（P<0.05）;A组与D组相比,SNB角、ANB角、Wits值、颌凸角、下颌平面角、前面高、后前面高比、前上面高、三角之和、Y轴角、下颌支高度、上唇审美平面距等多项参数有显著差异（P<0.05）。结论腺样体肥大、上颌窦黏膜增厚对牙颌面的发育存在影响;两者同时存在时,可能有叠加作用,对牙颌面发育有更大的影响。

关键词: 腺样体肥大, 上颌窦, 黏膜增厚, 气化, 牙颌面发育

Abstract: PURPOSE: To investigate the effects of adenoid hypertrophy and maxillary sinus mucosal thickening on dentofacial development. METHODS: The selected subjects were divided into 4 groups according to the inclusion criteria: group A (adenoid hypertrophy with maxillary sinus mucosal thickening), group B (adenoid hypertrophy without maxillary sinus mucosal thickening), group C (normal adenoid with maxillary sinus mucosal thickening), and group D (normal adenoid without maxillary sinus mucosal thickening). There were 20 subjects in each group, aging from 12 to 14 years old. The volume of maxillary sinus was measured by Mimics software. The adenoid, dental arch width, basal bone width and palatal height were measured by Dolphin software and dentofacial measurements were performed in the lateral cephalograms derived from cone-beam CT (CBCT). The data were analyzed with SPSS 24.0 software package. RESULTS: There was no significant difference in dentofacial measurements between group B and group D or group C and group D,except for ANB angle (P<0.05). Compared with group D, SNB, ANB, Wits appraisal, NA-APo, MP-HP, N-Me, S-Go/N-Me, N-ANS (perp HP), sum of three angles, Ar-Go of group A were significantly different (P<0.05). Neither left nor right maxillary sinus bony volume had significant difference between group B and D or group C and D. CONCLUSIONS: Both adenoid hypertrophy and maxillary sinus mucosal thickening have impact on dentofacial development. Moderate or more severe adenoid hypertrophy with maxillary sinus mucosal thickening has greater impact on dentofacial development over adenoid hypertrophy or maxillary sinus mucosal thickening alone.

Key words: Adenoid hypertrophy, Maxillary sinus, Pneumatization, Mucosal thickening, Dentofacial development

中图分类号:

R782.1

许雅芬, 许一力, 李浙杭, 雷勇华. 儿童腺样体肥大、上颌窦黏膜增厚与牙颌面发育的相关性分析[J]. 上海口腔医学, 2019, 28(5): 529-535.

XU Ya-fen, XU Yi-li, LI Zhe-hang, LEI Yong-hua. Correlation between adenoid hypertrophy, maxillary sinus mucosal thickening and dentofacial development in children[J]. Shanghai Journal of Stomatology, 2019, 28(5): 529-535.

参考文献

[1] 田勇泉. 耳鼻喉头颈外科学[M]. 北京: 人民卫生出版社, 2013.
[2] Sousa JB, Anselmo-Lima WT, Valera FC, et al.Cephalometric assessment of the mandibular growth pattern in mouth-breathing children[J]. Int J Pediatr Otorhinolaryngol, 2005, 69(3): 311-317.
[3] 张虹, 李晓明, 裴士庚, 等. 腺样体肥大所致鼻气道阻塞对儿童颅面发育的影响[J]. 中国耳鼻咽喉头颈外科, 2010, 17(2): 88-90.
[4] Mahony D, Karsten A, Linder-Aronson S.Effects of adenoidectomy and changed mode of breathing on incisor and molar dentoalveolar heights and anterior face heights[J]. Aust Orthod J, 2004, 20(2): 93-98.
[5] Ozdemir H, Altin R, Sogut A, et al.Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients[J]. Pediatr Radiol, 2004, 34(5): 393-399.
[6] Raffat A, ul Hamid W. Cephalometric assessment of patients with adenoidal faces[J]. J Pak Med Assoc, 2009, 59(11): 747-752.
[7] Zettergren-Wijk L, Forsberg CM, Linder-Aronson S.Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea-a 5-year follow-up study[J]. Eur J Orthod, 2006, 28(4): 319-326.
[8] Yamaguchi H, Sueishi K.Malocclusion associated with abnormal posture[J]. Bull Tokyo Dent Coll, 2003, 44(2): 43-54.
[9] Peltomaki T.The effect of mode of breathing on craniofacial growth-revisited[J]. Eur J Orthod, 2007, 29(5): 426-429.
[10] 唐珊. 儿童腺样体肥大与牙颌面部畸形的相关性[D]. 大连:大连医科大学, 2011.
[11] 郝峪. 腺样体肥大患儿的上气道结构分析及其对颌面部发育的影响[D]. 太原: 山西医科大学, 2015.
[12] Koca CF, Erdem T, Bayindir T.The effect of adenoid hypertrophy on maxillofacial development: an objective photographic analysis[J]. J Otolaryngol Head Neck Surg, 2016, 45(1): 48-56.
[13] Farid M, Metwalli N.Computed tomographic evaluation of mouth breathers among paediatric patients[J]. Dentomaxillofac Radiol, 2010, 39(1): 1-10.
[14] Lopatiene K, Babarskas A.Malocclusion and upper airway obstruction[J]. Medicina (Kaunas), 2002, 38(3): 277-283.
[15] 朱习文, 陆汉强, 李月峰, 等. 上颌窦气化与上颌窦炎关系的CT影像学分析[J]. 中国医药指南, 2010, 8(34): 24-25.
[16] Cho SH, Kim TH, Kim KR, et al.Factors for maxillary sinus volume and craniofacial anatomical features in adults with chronic rhinosinusitis[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(6): 610-615.
[17] Sanchez Fernandez JM, Anta Escuredo JA, Sanchez Del Rey A, et al. Morphometric study of the paranasal sinuses in normal and pathological conditions[J]. Acta Ot olaryngol, 2000, 120(2): 273-278.
[18] 尚红坤, 阮标, 李斯斯, 等. 上颌窦三维立体形态与上颌窦炎关系的研究[J]. 临床耳鼻咽喉头颈外科杂志, 2012, 26(20): 921-925.
[19] 张铁松, 石浩, 林建云, 等. 云南地区正常儿童与鼻窦炎患儿鼻窦发育情况比较[J]. 临床耳鼻咽喉头颈外科杂志, 2010, 24(11): 511-513.
[20] Rak KM, Newell JD 2nd, Yakes WF, et al. Paranasal sinuses on MR images of the brain: significance of mucosal thickening[J]. AJR Am J Roentgenol, 1991, 156(2): 381-384.
[21] Karatas D, Koc A, Yuksel F, et al.The effect of nasal septal deviation on frontal and maxillary sinus volumes and development of sinusitis[J]. J Craniofac Surg, 2015, 26(5): 1508-1512.
[22] Behlfelt K, Linder-Aronson S, McWilliam J, et al. Dentition in children with enlarged tonsils compared to control children[J]. Eur J Orthod, 1989, 11(4): 416-429.
[23] Principato JJ.Upper airway obstruction and craniofacial morphology[J]. Otolaryngol Head Neck Surg, 1991, 104(6): 881-890.
[24] Defabjanis P.Impact of nasal airway obstruction on dentofacial development and sleep disturbances in children: preliminary notes[J]. J Clin Pediatr Dent, 2003, 27(2): 95-100.
[25] Oulis CJ, Vadiakas GP, Ekonomides J, et al.The effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits[J]. J Clin Pediatr Dent, 1994, 18(3): 197-201.
[26] Sosa FA, Graber TM, Muller TP.Postpharyngeal lymphoid tissue in Angle Class Ⅰ and Class Ⅱ malocclusions[J]. Am J Orthod, 1982, 81(4): 299-309.
[27] Gois EG, Ribeiro-Junior HC, Vale MP, et al.Influence of nonnutritive sucking habits, breathing pattern and adenoid size on the development of malocclusion[J]. Angle Orthod, 2008, 78(4): 647-654.
[28] Hultcrantz E, Larson M, Hellquist R, et al.The influence of tonsillar obstruction and tonsillectomy on facial growth and dental arch morphology[J]. Int J Pediatr Otorhinolaryngol, 1991, 22(2): 125-134.
[29] Weider DJ, Baker GL, Salvatoriello FW.Dental malocclusion and upper airway obstruction, an otolaryngologist's perspective[J]. Int J Pediatr Otorhinolaryngol, 2003, 67(4): 323-331.
[30] Wysocki J, Krasny M, Skarzynski PH.Patency of nasopharynx and a cephalometric image in the children with orthodontic problems[J]. Int J Pediatr Otorhinolaryngol, 2009, 73(12): 1803-1809.
[31] Souki BQ, Pimenta GB, Souki MQ, et al.Prevalence of malocclusion among mouth breathing children: do expectations meet reality?[J]. Int J Pediatr Otorhinolaryngol, 2009, 73(5): 767-773.
[32] Lofstrand-Tidestrom B, Hultcrantz E.Development of craniofacial and dental arch morphology in relation to sleep disordered breathing from 4 to 12 years. Effects of adenotonsillar surgery[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(2): 137-143.
[33] Hultcrantz E, Lofstrand Tidestrom B.The development of sleep disordered breathing from 4 to 12 years and dental arch morphology[J]. Int J Pediatr Otorhinolaryngol, 2009, 73(9): 1234-1241.
[34] 张虹. 儿童腺样体肥大对下颌骨发育的影响[J]. 临床耳鼻咽喉头颈外科杂志, 2013, 27(17): 955-958.
[35] 邹明舜. 儿童增殖腺-鼻咽腔比率测定的临床价值[J]. 中华放射学杂志, 1997, 31(3): 43-45.