Abdullah EKİZER, Sabri İlhan RAMOĞLU, Faruk İzzet UÇAR, Gökmen KURT

Hızlı üst çene genişletmesi sonucu oluşan hava yolu değişikliklerinin değerlendirilmesi

Bu çalışmanın amacı hızlı üst çene genişletmesi yapılan hastalarda hava yolu değişikliklerinin incelenmesidir.Çalışmanın materyalini hızlı üst çene genişletmesi endikasyonu konulan 25 hastadan 10erkek ve 15 kız oluşmaktadır. Ortalama yaş 14,64± 2,26 yıldır max: 18,64 ve min: 8,98 . Tedaviöncesi SNA: 79,52 ± 3,37º ve SNB: 77,51 ± 3,66ºdir.Tedavi öncesi T1 ve tedavi sonrası T2 alındansefalometrik filmlerde 14 hava yolu ölçümüyapılmıştır ANS-PNS-SPT, PNS-SPT, SPC-SPD,SPT-SPpp, PNS-PPW1, SPT-PPW2, SPL/SPS,SPL/IPS, sbti-phwl, PNS-Eb, Eb-Tt, GoGn-Hy,psp-phws ve sbtn-phwn . T1 ve T2 de oluşandeğişikler eşleştirilmiş-t testi karşılaştırılmıştır.Herhangi bir hava yolu ölçümünde anlamlıbir fark görülmemiştir P>0.05 . Ancak alt faringeal boşluğu gösteren SPT-PPW2 ve uvulaboyutlarını gösteren SPC-SPD ve PNS-SPT değerlerinde artış vardır. Hızlı üst çene genişletmesininnazal direnci azaltarak, nazal kapasiteyi arttırdığı,dolayısıyla solunumu rahatlattığı gösterilmiştirancak bu çalışmanın bulguları, hızlı maksilergenişletmenin havayolunda aynı etkiyi göstermediğini ortaya koymuştur.Sonuç olarak modifiye akrilik bonded hızlırapid maksillar ekspansiyon apareyi ile yapılanhızlı üst çene genişletmesinin, havayolu boyutlarında anlamlı bir değişiklik sağlamadığı tespitedilmiştir

Anahtar Kelimeler:

Maksiller darlık, rapidmaksillar ekspansiyon, nazofaringeal havayolu

Evaluation of AirwayChanges After Rapid Maxillary Expansion

The aim of this study to evaluate airwaychanges in patients who had undergone rapid maxillary expansion therapy.Material and method is consist of twenty-fivepatients 10 boys and 15 girls who were indicatedrapid maxillary expansion were included in thestudy. The mean age was 14,64 ± 2,26 years max:18,64 and min: 8,98 . Pretreatment SNA value was79,52 ± 3,37° and SNB value was 77,51 ± 3,66°.Fourteen airway measurements ANS-PNS-SPT,PNS-SPT, SPC-SPD, SPT-SPpp, PNS-PPW1, SPTPPW2, SPL/SPS, SPL/IPS, sbti-phwl, PNS-Eb, EbTt, GoGn-Hy, psp-phws ve sbtn-phwn were madeon cephalometric radiographs which had beentaken before T1 and after T2 treatment. Pairedt-test was used to compare changes in T1 and T2. There were no statistically significant difference in any airway measurements P>0.05 .However, there were increase in SPT-PPW2 indicates lower pharyngeal cavity and SPC-SPD, PNSSPT indicates soft palate dimensions . It wasshown that rapid maxillary expansion had increased nasal capacity by reducing nasal resistanceand therefore had facilitated respiration. But results of this study showed that rapid maxillary expansion did not produce the same effect in airway. In conclusion, it is determined that rapid maxillary expansion which was achieved with modifiedacrylic bonded rapid maxillary expansion appliance showed no significant changes in airwaydimensions

Keywords:

Maxillary constriction, rapidmaxillary expansion, nasopharyngeal airway,

PDF

___

Ceylan I, Oktay H, Demirci M. The effect of rapid maxillary expansion on conductive hearing loss. Angle Orthod 1996; 66: 301-7.
Angell EH. Treatment of irregularity of the permanent or adulth teeth. Dental Cosmos 1860;1:540-544,599-600.
Warren DW, Hershey GH, Turvey TA, Hinton VA, Hairfield WM. The nasal airway follo- wing maxillary expansion. Am J Orthod Dentofacial Orthop 1987; 91: 111-6.
Schwarz GM, Thrash Wm J, Byrd L, Jacobs JD. Tomoghraphic assessment of nasal septal changes following surgical-orthodontic rapid maxil- lary expansion. Am J Orthod Dentofacial Orthop 1985; 87: 39-45.
Özgen M, Aksoy AÜ, Tezcan Ş, Tosun Y. Rapid maksiller ekspansiyonun transversal etki- lerinin frontal sefalometrik incelenmesi. TOD 1994; 7: 26-7.
Hartgering DV, Vig PS, Abbott DW. The effect of rapid maxillary expansion. Am J Ortod Dentofacial Orthop 1987; 92: 381-9.
Thuer U,Kuster R, Ingervall BA. A compar- sion between anamnestic rhinomanometric and ra- diological methods of diagnosing mouthbreathing. Eur J Orthod 1989; 11: 161-8.
Brown GIV. The application of orthodontic principles to the prevention of nasal disease. Dent Cosmos 1903; 45: 765-75.
Pullen HA. Expansion of the dental arch and opening the maxillary suture in relation to the deve- lopment of the internal and external face. Dent Cosmos 1912; 54: 509-27.
İşeri H, Tekkaya AE, Öztan O, Bilgiç S. Biomechanical effects of rapid maxillary expansion on the craniofacial skeleton, studied by the finite ele- ment method. Eur J Orthod 1998; 20: 347-56.
Ceylan İ. Hızlı üst çene genişletmesi sonu- cu meydana gelen dişsel ve iskeletsel değişimlerin sefalometrik olarak incelenmesi. At Ün Diş Hek Fak Derg 1995; 5: 5-13.
Basciftci FA, Mutlu N, Karaman AI, Malkoç S, Kücükkolbası 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.
Ramoglu SI, Sari Z. Maxillary expansion in the mixed dentition: rapid or semi-rapid? Eur J Orthod. 2009 Oct 1. [baskıda]
Orhan M, Üşümez S. A new method for the assessment of changes in molar inclination during RME. Virt J Orthod 2001; 15: 4. Available at: http://www.vjo.it/042/molar.htm.
Malkoç S, Uşümez S and İşeri H. Long- term effects of symphyseal distraction and rapid maxillary expansion on pharyngeal airway dimen- sions, tongue, and hyoid position. Am J Orthod Dentofacial Orthop 2007; 132: 769-75.
Usumez S, Iseri H, Orhan M, Basciftci FA. Effect of rapid maxillary expansion on nocturnal enuresis. Angle Orthod 2003; 73: 532–8.
Basciftci FA, Karaman AI. Effects of a modified acrylic bonded rapid maxillary expansion appliance and vertical chin cap on dentofacial struc- tures. Angle Orthod 2002; 72: 61–71.
Warren DW, Hairfield WM, Seaton D, Morr KE, Smith LR. The relationship between nasal airway size and nasal-oral breathing. Am J Orthod 1988; 93:287-93.
Orhan M ,Üsümez S, Malkoc S. Modified bonded rapid maxillary expansion appliance. World J Orthod 2003; 4: 119-25.
Kurtulmuş H, Çötert S, Tuncer AV.Obstrüktif uyku apnesinin tanısında lateral sefalometrik yaklaşım ve mandibular ilerletici splint ile tedavisi. E Ü Diş Hek Fak Derg 2007; 28: 113-22.
Sforza E. et al. Upper Airway Collapsibility and Cephalometric Variables in Patients with Obstructive Sleep Apnea. Am J Respir Crit Care Med 2000; 161: 347–52.
Akcam MO, Toygar U, Wada Takeshi. Longitudinal investigation of soft palate and nasopharyngeal airway relations in different rotation types. Angle Orthod 2002; 72: 521–6.
Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the mid- palatal suture. Angle Orthod 1961; 31: 73-90.
Starnbach HK, Cleall JF. The effects of splitting the midpalatal suture on the surrounding structures. Am J Orthod 1964; 50: 923-4.
Sarver DM, Johnston MW. Skeletal changes in vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appli- ances. Am J Orthod Dentofac Orthop 1988; 95: 462- 6.
Sarı Z, Uysal T, Üşümez S, Başçiftçi FA. Rapid maxillary expansion. Is it better in the mixed or permament dentition? Angle Orthod 2003; 73: 654-61.
Baccetti T, Franchi L, Cameron CG, McNamara JA. Treatment Timing for Rapid Maxillary Expansion. Angle Orthod 2001; 71: 343–50.
Silva Filho OG, Prado Montes LA, Torelly LF. Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis. Am J Orthod Dentofac Orthop 1995; 107: 268-75.
Bishara SE, Staley RN. Maxillary expan- sion: clinical implications. Am J Orthod Dentofac Orthop 1987; 91: 3-14.
Melsen B. The postnatal development of the palatomaxillary region studied on human autopsy material.. Am J Orthod 1982; 82: 329-42.
Moss JP. Rapid expansion of the maxillary arch. JCO 1968; 5: 215-33.
Persson M, Thilander B. Palatal suture clo- sure in man from 15-35 years of age. Am J Orthod 1977; 72: 42-52.
Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod 1970; 58: 41-66.
Aras A, Sürücü R. Oklüzal ısırma düzlemi taşıyan modifiye Haas apareyi ile hızlı üst çene genişletmesi etkilerinin karşılaştırılmalı incelenmesi. TOD 1990; 3: 14-20.
Aras K, Ünlü B, Küçükkeleş N. Rapid mak- siller ekspansiyon sonrası nazofarinksde oluşan sefalometrik değişiklikler. TOD 1998; 11: 26-9.
Pavlin D, Vukicevik D. Mechanical reac- tions of facial skeleton to maxillary expansion deter- mined by laser holography. Am J Orthod 1984; 84: 498-7.
Velazquez P, Benito E, Bravo LA. Rapid maxillary expansion. A study of the long-term effects. Am J Orthod Dentofac Orthop 1996; 109: 361-7.
Warren DW, Hershey HG, Turvey TA, Hinton VA, Hairfield WM. The nasal airway follo- wing maxillary expansion. Am J Orthod Dentofac Orthod 1987; 91: 111-6.
Altuğ-Ataç AT, Kurt G. İskeletsel Sınıf III maloklüzyonun alt gruplarında yumuşak damak mor- folojisi ve nazofarengeal havayolu. TOD 2006; 19: 209-18.
Oliveira De Felippe NL, Silveira AC, Viana G, Kusnoto B, Smith B, Evans CA. Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: Short- and long-term effects. Am J Orthod Dentofacial Orthop 2008; 134: 370-82.
Doruk C, Sökücü O, Sezer H, Canbay EI. Evaluation of nasal airway resistance during rapid maxillary expansion using acoustic rhinometry. Eur J Orthod 2004; 26: 397-401.
Palaisa J, Ngan P, Martin C and Razmus T. Use of conventional tomography to evaluate changes in the nasal cavity with rapid palatal expansion. Am J Orthod Dentofac Orthop 2007; 132: 458-66.
Tsai HH, Ho CY, Lee PL, Tan CT. Cephalometric analysis of nonobese snorers either with or without obstructive sleep apnea syndrome. Angle Orthod 2007; 77: 1054-61.
Malkoc S, Usumez S, Nur M, Donaghy CE. Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms. Am J Orthod Dentofac Orthop 2005; 128: 513-6.
Lowe AA. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea Am J Orthod Dentofac Orthop 1996; 110: 653- 64.
Johal A, Conaghan C. Maxillary morpho- logy in obstructive sleep apnea: a cephalometric and model study. Angle Orthod 2004; 74: 648–56.
Hartgering DV, Vig PS, Abbott DW. The effect of rapid maxillary expansion on nasal airway resistance. Am J Orthod Dentofac Orthop 1987; 92: 381-9.
Linder-Aronson S. Adenoids: their effect on mode of breathing and nasal airflow and their rela- tionship to characteristics of the facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryng 1970; 265: 1- 132.
Preston CB, Lampasso JD, Tobias PV. Cephalometric evaluation and measurement of upper airway. Semin Orthod 2004; 10: 3-15.