The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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Effects of the long-term use of maxillary protraction facemasks with skeletal anchorage on pharyngeal airway dimensions in growing patients with cleft lip and palate

  • Kim, Jung-Eun (Department of Dentistry, Graduate School, Kyung Hee University) ;
  • Yim, Sunjin (Department of Dentistry, Graduate School, Seoul National University) ;
  • Choi, Jin-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Kim, Sukwha (Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University) ;
  • Kim, Su-Jung (Department of Orthodontics, School of Dentistry, Kyung Hee University) ;
  • Baek, Seung-Hak (Department of Orthodontics, School of Dentistry, Seoul National University)
  • Received : 2019.10.21
  • Accepted : 2020.03.03
  • Published : 2020.07.25
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Abstract

Objective: To investigate the effects of the long-term use of a maxillary protraction facemask with miniplate (FM-MP) on pharyngeal airway dimensions in growing patients with cleft lip and palate (CLP). Methods: The study included 24 boys with CLP (mean age, 12.2 years; mean duration of FM-MP therapy, 4.9 years), divided into two groups according to the amount of A point advancement to the vertical reference plane (VRP): Group 1, > 4 mm; Group 2, < 2 mm; n = 12/group. After evaluating the skeletodental and airway variables using lateral cephalograms acquired before and after FM-MP therapy, statistical analyses were performed. Results: Group 1 showed greater forward and downward displacements of the posterior maxilla (posterior nasal spine [PNS]-horizontal reference plane [HRP]; PNS-VRP), greater increase in ANB, more forward tongue position (tongue tip-Pt vertical line to Frankfort horizontal plane), and greater increase in the oropharynx (superior posterior airway space [SPAS]; middle airway space [MAS]) and upper nasopharynx (PNS-adenoid2) than did Group 2. While maxillary advancement (A-VRP and PNS-VRP) correlated with increases in SPAS, MAS, and PNS-adenoid2, downward displacement of the PNS (PNS-HRP) correlated with increases in SPAS, MAS, PNS-adenoid1, and PNS-adenoid2, and with a decrease in vertical airway length (VAL). Mandibular forward displacement and decrease in mandibular plane correlated with increases in MAS. Conclusions: FM-MP therapy had positive effects on the oropharyngeal and nasopharyngeal airway spaces without increases in VAL in Group 1 rather than in Group 2. However, further validation using an untreated control group is necessary.

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References

  1. Celikoglu M, Buyuk SK, Sekerci AE, Ucar FI, Cantekin K. Three-dimensional evaluation of the pharyngeal airway volumes in patients affected by unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop 2014;145:780-6. https://doi.org/10.1016/j.ajodo.2014.02.008
  2. Satoh K, Wada T, Tachimura T, Sakoda S, Shiba R. A cephalometric study by multivariate analysis of growth of the bony nasopharynx in patients with clefts and non-cleft controls. J Craniomaxillofac Surg 1998;26:394-9. https://doi.org/10.1016/S1010-5182(98)80074-7
  3. Jolleys A. A review of the results of operations on cleft palates with reference to maxillary growth and speech function. Br J Plast Surg 1954;7:229-41. https://doi.org/10.1016/S0007-1226(54)80027-0
  4. Shibasaki Y, Ross RB. Facial growth in children with isolated cleft palate. Cleft Palate J 1969;6:290-302.
  5. Hermann NV, Jensen BL, Dahl E, Bolund S, Kreiborg S. A comparison of the craniofacial morphology in 2-month-old unoperated infants with unilateral complete cleft lip and palate, and unilateral incomplete cleft lip. J Craniofac Genet Dev Biol 1999;19:80-93.
  6. Karia H, Shrivastav S, Karia AK. Three-dimensional evaluation of the airway spaces in patients with and without cleft lip and palate: a digital volume tomographic study. Am J Orthod Dentofacial Orthop 2017;152:371-81. https://doi.org/10.1016/j.ajodo.2016.12.026
  7. Akarsu-Guven B, Karakaya J, Ozgur F, Aksu M. Growth-related changes of skeletal and upper-airway features in bilateral cleft lip and palate patients. Am J Orthod Dentofacial Orthop 2015;148:576-86. https://doi.org/10.1016/j.ajodo.2015.02.031
  8. Kunkel M, Wahlmann U, Wagner W. Nasal airway in cleft-palate patients: acoustic rhinometric data. J Craniomaxillofac Surg 1997;25:270-4. https://doi.org/10.1016/S1010-5182(97)80065-0
  9. Muntz H, Wilson M, Park A, Smith M, Grimmer JF. Sleep disordered breathing and obstructive sleep apnea in the cleft population. Laryngoscope 2008;118:348-53. https://doi.org/10.1097/MLG.0b013e318158195e
  10. Robison JG, Otteson TD. Increased prevalence of obstructive sleep apnea in patients with cleft palate. Arch Otolaryngol Head Neck Surg 2011;137:269-74. https://doi.org/10.1001/archoto.2011.8
  11. Cordasco G, Matarese G, Rustico L, Fastuca S, Caprioglio A, Lindauer SJ, et al. Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res 2014;17:133-43. https://doi.org/10.1111/ocr.12040
  12. Baccetti T, McGill JS, Franchi L, McNamara JA Jr, Tollaro I. Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop 1998;113:333-43. https://doi.org/10.1016/S0889-5406(98)70306-3
  13. Kaygisiz E, Tuncer BB, Yuksel S, Tuncer C, Yildiz C. Effects of maxillary protraction and fixed appliance therapy on the pharyngeal airway. Angle Orthod 2009;79:660-7. https://doi.org/10.2319/072408-391.1
  14. Oktay H, Ulukaya E. Maxillary protraction appliance effect on the size of the upper airway passage. Angle Orthod 2008;78:209-14. https://doi.org/10.2319/122806-535.1
  15. Sayinsu K, Isik F, Arun T. Sagittal airway dimensions following maxillary protraction: a pilot study. Eur J Orthod 2006;28:184-9. https://doi.org/10.1093/ejo/cji095
  16. Cevidanes L, Baccetti T, Franchi L, McNamara JA Jr, De Clerck H. Comparison of two protocols for maxillary protraction: bone anchors versus face mask with rapid maxillary expansion. Angle Orthod 2010;80:799-806. https://doi.org/10.2319/111709-651.1
  17. Baek SH, Kim KW, Choi JY. New treatment modality for maxillary hypoplasia in cleft patients. Protraction facemask with miniplate anchorage. Angle Orthod 2010;80:783-91. https://doi.org/10.2319/073009-435.1
  18. Ahn HW, Kim KW, Yang IH, Choi JY, Baek SH. Comparison of the effects of maxillary protraction using facemask and miniplate anchorage between unilateral and bilateral cleft lip and palate patients. Angle Orthod 2012;82:935-41. https://doi.org/10.2319/010112-1.1
  19. On SW, Baek SH, Choi JY. Effect of long-term use of facemask with miniplate on maxillary protraction in patients with cleft lip and palate. J Craniofac Surg 2018;29:309-14. https://doi.org/10.1097/SCS.0000000000004122
  20. Fishman LS. Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand-wrist films. Angle Orthod 1982;52:88-112.
  21. Zhang Y, Jia H, Fu Z, Huang Y, Wang Z, Guo R, et al. Dentoskeletal effects of facemask therapy in skeletal Class III cleft patients with or without bone graft. Am J Orthod Dentofacial Orthop 2018;153:542-9. https://doi.org/10.1016/j.ajodo.2017.07.024
  22. Li HY, Chen NH, Wang CR, Shu YH, Wang PC. Use of 3-dimensional computed tomography scan to evaluate upper airway patency for patients undergoing sleep-disordered breathing surgery. Otolaryngol Head Neck Surg 2003;129:336-42. https://doi.org/10.1016/S0194-5998(03)00629-6
  23. Ngan P, Wilmes B, Drescher D, Martin C, Weaver B, Gunel E. Comparison of two maxillary protraction protocols: tooth-borne versus bone-anchored protraction facemask treatment. Prog Orthod 2015;16:26. https://doi.org/10.1186/s40510-015-0096-7
  24. Ozbek MM, Memikoglu TU, Gogen H, Lowe AA, Baspinar E. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal Class II cases. Angle Orthod 1998;68:327-36.
  25. Akcam MO, Toygar TU, Wada T. Longitudinal investigation of soft palate and nasopharyngeal airway relations in different rotation types. Angle Orthod 2002;72:521-6.
  26. van den Dungen GM, Ongkosuwito EM, Aartman IH, Prahl-Andersen B. Craniofacial morphology of Dutch patients with bilateral cleft lip and palate and noncleft controls at the age of 15 years. Cleft Palate Craniofac J 2008;45:661-6. https://doi.org/10.1597/07-166.1
  27. Lee JW, Park KH, Kim SH, Park YG, Kim SJ. Correlation between skeletal changes by maxillary protraction and upper airway dimensions. Angle Orthod 2011;81:426-32. https://doi.org/10.2319/082610-499.1
  28. Xu Y, Zhao S, Shi J, Wang Y, Shi B, Zheng Q, et al. 3-dimensional computed tomographic analysis of the pharynx in adult patients with unrepaired isolated cleft palate. J Oral Maxillofac Surg 2013;71:1424-34. https://doi.org/10.1016/j.joms.2013.01.022
  29. McNamara JA Jr. An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod 1987;21:598-608.
  30. Kapust AJ, Sinclair PM, Turley PK. Cephalometric effects of face mask/expansion therapy in Class III children: a comparison of three age groups. Am J Orthod Dentofacial Orthop 1998;113:204-12. https://doi.org/10.1016/S0889-5406(98)70141-6