Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion

Three-dimensional image study of accelerated maxillary expansion in oral breathing kids

OBJECTIVE

To evaluate, by a three-dimensional study, the volumetric and integumentary effects of rapid maxillary expansion on the nose, in mouth breathing kids with maxillary hypoplasia, in the short term, assessing the possible interference of gender, growth and age on the results achieved.

METHODS

120 mouth breathing patients with maxilla hypoplasia were divided into an Experimental Group treated by rapid maxillary expansion (n = 104, 62 males and 42 females, mean age 10.1 years, SD = 2.10, ranging from 5.1 to 13.9 years); and Control Group, constituted by 16 patients (9 males and 7 females, mean age 9.3 years, SD = 2.1 years, ranging from 6.1 to 13.2 years). Patients in the experimental group underwent multislice computed tomography examinations at two different times: (T1) pre-expansion and (T2) post-expansion. The control group was submitted to the same tests at the same time intervals. Six soft tissue variables of the nose were studied, besides the volume and area of the nasal cavity, and the measurement and comparison of data between T1 and T2 were performed using the Dolphin Imaging 11.7 Premium software.

RESULTS

The experimental group showed significant mean increases in all soft tissue variables studied (p < 0.005), yet there were no significant changes in the control group. In the comparison between groups, only inclination of the nasal dorsum did not present any significant change.

CONCLUSION

Rapid maxillary expansion may alter the nasal shape and physiology, by anatomical changes in the nose soft tissues, making it an important aid in the treatment of mouth breathing in childhood.

LEVEL OF EVIDENCE

The soft tissues of the nose play an important role in nasal shape and physiology and facial esthetics, and since they are directly related to the nasal valves, they are fundamental for maintenance and stability of the nasal breathing pattern.

Long-term assessment of conventional and mini-screw-assisted rapid palatal expansion on the nasal cavity

OBJECTIVES

To evaluate the long-term effects of mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls on the nasal cavity with cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 180 CBCT scans that were part of a previous randomized trial were evaluated retrospectively for 60 patients at pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were randomly assigned into 3 groups: MARPE, RPE, and controls (time period T1 to T3; MARPE: 2 years 8 months; RPE: 2 years 9 months; control: 2 years 7 months). Nasal height, nasal length, nasion-ANS height, ANS-PNS length, pyriform height, and nasal septal deviation angle were measured. The changes in alar width, alar base width, anterior nasal cavity width, posterior nasal cavity width, maxillary intermolar width, and maxillary intercanine width were also evaluated.

RESULTS

The alar base width, posterior nasal cavity width, anterior nasal cavity width, maxillary intercanine width, and maxillary intermolar width significantly increased (P < .05), and the nasal septal deviation angle significantly decreased (P < .05) in both the MARPE and RPE groups as compared with controls in the short term. In the long term, the nasal septal deviation angle was significantly decreased (P < .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P < .05) in the MARPE group compared with the RPE group and controls.

CONCLUSIONS

MARPE and RPE led to a significant increase in the nasal cavity and alar base width compared with controls in the short term. In the long term, a significant increase was observed only in the posterior nasal cavity width with MARPE. Both MARPE and RPE led to a minimal decrease in nasal septal deviation angle in comparison with controls.

Short-term and long-term effects of rapid maxillary expansion on the nasal soft and hard tissue

OBJECTIVES

To evaluate nasal soft and hard tissue changes immediately post-rapid maxillary expansion (RME) and to assess the stability of these changes using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 35 treatment group (TG) patients (18 girls, 17 boys; 9.39 ± 1.4) had a pre-RME CBCT and a post-RME CBCT approximately 66 days after expansion, and 25 patients had a follow-up CBCT 2.84 years later. A total of 28 control group (CG; no RME) patients (16 girls, 12 boys; 8.81 ± 1.6) had an initial CBCT and a CBCT an average of 2.25 years later. Soft and hard tissue nasal landmarks were measured in transverse, sagittal, and coronal planes of space on CBCT scans. Differences within the same group were evaluated by paired t-tests or Wilcoxon signed-rank tests. Long-term comparisons between TG and CG were evaluated by independent-sample t-tests or Wilcoxon rank-sum tests.

RESULTS

Immediately post-RME, there were statistically significant mean increases of 1.6 mm of alar base width, 1.77 mm of pyriform height, and 3.57 mm of pyriform width (P < .05). CG showed the significant increases over 2.25 years (P < .001). Compared with CG, the long-term evaluation of TG demonstrated only pyriform height and pyriform width showed a statistically significant difference (P < .01).

CONCLUSIONS

Although RME produced some significant increase on the nasal soft tissue immediately after expansion, it regressed to the mean of normal growth and development over time. However, long-term evaluation of TG compared with CG showed only pyriform height and pyriform width to be affected by RME.

Facial soft tissue changes after nonsurgical rapid maxillary expansion: a systematic review and meta-analysis

Background

The present systematic review and meta-analysis aimed to test the hypothesis that no facial soft tissue changes occur after nonsurgical rapid maxillary expansion (RME), in order to provide a reference for orthodontists.

Methods

PubMed, EMBASE, Cochrane Library, OVID, MEDLINE, CINAHL, Scopus, and ScienceDirect databases were electronically and manually searched up to December 2017, and randomized controlled, clinical controlled trials, cohort studies and retrospective studies where soft tissue changes were measured before and after nonsurgical RME were identified. Study appraisal and synthesis were performed by two reviewers who completed the study selection and quality assessment procedures independently and in duplicate. Data from the involved studies were pooled using Revman 5.3.

Results

A total of 1762 articles were identified after the removal of duplicates. After selection and quality assessment, 15 studies met the inclusion criteria for the systematic review, and 13 articles were ultimately included in the meta-analysis. The quality of the involved studies was relatively moderate. Pre-expansion, postexpansion, and postretention data were pooled. The nasal width, alar base width, and distances from the lower lips to the E line showed significant changes after expansion. Moreover, after retention, the nasal width, mouth width, upper philtrum width, and distance from the lower lip to the E line showed significant increases relative to the baseline values. Limitations of the present study included the moderate quality of the included studies and the fact that the results were based on short-term observations of patients in the growth phase.

Conclusion

Our findings suggest that RME results in a significantly increased nasal width, mouth width, upper philtrum width, and distance from the lower lip to the E line after the retention phase. However, the clinical importance of these findings is questionable.

Electronic supplementary material

The online version of this article (10.1186/s13005-018-0162-8) contains supplementary material, which is available to authorized users.