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Dominguez-Mompell R, Zhang B, Paredes N, Combs A, Elkenawy I, Sfogliano L, Fijany L, Colak O, Romero-Maroto M, Moon W. Breathing changes following mini-implant-supported maxillary skeletal expander treatment in late adolescent or adult patients : Assessment of objective and subjective functional breathing changes. J Orofac Orthop 2024:10.1007/s00056-024-00521-6. [PMID: 38466417 DOI: 10.1007/s00056-024-00521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The aim of this study was to assess objective and subjective breathing changes in adult patients who underwent maxillary skeletal expansion with the mini-implant-supported maxillary skeletal expander (MSE). METHODS Twenty-nine patients (mean age 18.1 ± 4.3 years) who underwent expansion using the MSE were compared pre- and posttreatment and with a control group (mean age 19.9 ± 2.6 years) to assess objective and subjective functional breathing changes. Objective measurements of the airway including peak nasal inspiratory flow (PNIF) and peak oral inspiratory flow (POIF) were measured utilizing the In-Check medical device (Clement Clarke, Harlow, United Kingdom). Patients reported subjective breathing assessment utilizing the visual analog scale (VAS). Intragroup comparisons were performed with Wilcoxon tests and intergroup comparison with Mann-Whitney U tests. Spearman correlation coefficients were calculated among the studied variables (P < 0.05). RESULTS Following MSE treatment, there were significantly higher values for PNIF total (P < 0.0001), PNIF right (P < 0.0001), PNIF left (P < 0.0001), and POIF (P < 0.01) compared to pretreatment and control group results. Also, patients reported a significant decrease in troubled breathing as measured by the VAS for breathing through the right nostril (P < 0.01), left nostril (P < 0.001), and both nostrils (P < 0.01). Comparing the objective and subjective variables for both the pre-MSE or post-MSE groups, the results indicated no significant correlation between total PNIF and total VAS. However, the values had significant correlations between PNIF and VAS on each side when the patients were asked to block one nostril. CONCLUSIONS Objective functional breathing measurements were increased immediately after treatment with MSE. Subjective functional breathing measurements changes were significantly higher after MSE treatment and compared with the control group. MSE presents a nonsurgical alternative to achieving orthopedic expansion in adult patients which may provide a benefit for patients with nasal airway obstruction.
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Affiliation(s)
| | - Boshi Zhang
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ney Paredes
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA.
| | - Andrew Combs
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Islam Elkenawy
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Luca Sfogliano
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Layla Fijany
- UCLA School of Dentistry, Section of Orthodontics, Center for Health Science, Room 63-082 CHS, 10833 Le Conte Ave, Box 951668, 90095-1668, Los Angeles, CA, USA
| | - Ozge Colak
- Orthodontics Department, State University of New York, 320 Hayes Rd, 14215, Buffalo, NY, USA
| | | | - Won Moon
- Orthodontics and Craniofacial Development Research Forsyth Institute, 245 First Street, 02142, Cambridge, MA, USA.
- Orthodontics Department, AJOU University, Suwon, Korea (Republic of).
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Combs A, Paredes N, Dominguez-Mompell R, Romero-Maroto M, Zhang B, Elkenawy I, Sfogliano L, Fijany L, Colak O, Wu B, Moon W. Long-term effects of maxillary skeletal expander treatment on functional breathing. Korean J Orthod 2024; 54:59-68. [PMID: 38268461 PMCID: PMC10811361 DOI: 10.4041/kjod23.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/26/2024] Open
Abstract
Objective : To investigate the long-term effects of maxillary skeletal expander (MSE) treatment on functional breathing. Methods Objective measures of breathing, the peak nasal inspiratory flow (PNIF), and peak oral inspiratory flow (POIF), and subjective measures of breathing, the visual analog scale (VAS) and nasal obstruction symptom evaluation (NOSE) survey, were used to investigate the long-term effects of MSE in functional breathing. Seventeen patients, mean age 19.4 ± 3.9 years treated at the UCLA Orthodontics Clinic were assessed on their functional breathing at 3 timepoints: pre-expansion (T0), post-expansion (T1), and post-orthodontic treatment (T2). Results : Immediately after expansion (T1), all the objective functional breathing values were significantly increased in comparison to T0 (P < 0.05). The VAS total, VAS right and VAS left were significantly lower at T1 in comparison to T0 (P < 0.05). At 26.8 ± 3.9 months after MSE expansion (T2), PNIF total, PNIF right, PNIF left, and POIF were significantly higher when compared to T0 (P < 0.05). Also, VAS total, VAS right and VAS left were significantly lower at T2 when compared to T0 (P < 0.05). Additionally, there was a positive correlation between PNIF and the magnitude of expansion at anterior nasal spine and zygomaticomaxillary point (ZMA). There was a positive correlation between total VAS and the magnitude of expansion at the ZMA. There were no significant changes for the NOSE subjective breathing measurement at all time comparisons. Conclusions : Overall, MSE treatment produces an increased objective and subjective airway improvement that continues to remain stable in the long-term post expansion.
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Affiliation(s)
- Andrew Combs
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | | | | | | | - Boshi Zhang
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Islam Elkenawy
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Luca Sfogliano
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Layla Fijany
- Center for Health Science, Section of Orthodontics, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Ozge Colak
- Department of Orthodontics, State University of New York, Buffalo, NY, USA
| | - Ben Wu
- Orthodontic and Craniofacial Development Research, Forsyth Institute, Cambridge, MA, USA
| | - Won Moon
- Orthodontic and Craniofacial Development Research, Forsyth Institute, Cambridge, MA, USA
- Department of Orthodontics, Ajou University, School of Medicine, Suwon, Korea
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da Silva AAF, Prado GPR, Pereira MD. Randomized clinical trial of surgically assisted rapid maxillary expansion with two and three segments for nasal breathing. Clin Oral Investig 2023; 27:6209-6219. [PMID: 37632579 DOI: 10.1007/s00784-023-05237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVES To evaluate surgically assisted rapid maxillary expansion (SARME), with osteotomies separating the maxilla into two segments (SARME-2S) and three segments (SARME-3S), on obstruction symptoms and nasal cavity dimensions in patients with maxillary transverse skeletal deficiency (MTSD). MATERIALS AND METHODS Sixteen patients with MTSD of 7 mm or above were evaluated in each group, for a total of 32 patients. All patients were evaluated pre- and postoperatively up to 10 months after the expander activations. The minimum cross-sectional area (MCA) and the volume of the nasal cavities were identified by acoustic rhinometry. The Nasal Obstruction Symptom Evaluation (NOSE) scale questionnaire was applied. The palate surface area (PSA) was measured, via digitized maxillary models, as a criterion for comparison with the other variables studied. RESULTS There was no difference between the groups (p = 0.370) and was verified a significant increase in PSA postoperatively. MCA showed a small increase without statistical significance, and together with the volume of the nasal cavities remained constant during the study. NOSE scale scores decreased significantly in the postoperative periods, implying a decrease in nasal obstruction symptoms in both groups. CONCLUSIONS SARME with two and three segments show similar results, and both may improve nasal obstruction symptoms when present in patients with MTSD. CLINICAL RELEVANCE SARME, regardless of the chosen surgical technique, should follow the recommendation to correct just the MTSD. While an improvement in nasal breathing is expected, this must be understood as likely, but not certain.
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Affiliation(s)
- Alexandre Augusto Ferreira da Silva
- Postgraduate Program in Translational Surgery, Federal University of São Paulo, Rua Botucatu, 740, 2º Andar, Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Gabriela Pereira Ribeiro Prado
- Postgraduate Program in Translational Surgery, Federal University of São Paulo, Rua Botucatu, 740, 2º Andar, Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Max Domingues Pereira
- Postgraduate Program in Translational Surgery, Craniomaxillofacial Surgery Department, Plastic Surgery Division, Federal University of São Paulo, Rua Botucatu, 740, 2º Andar, Vila Clementino, São Paulo, SP, 04023-062, Brazil.
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Zambon C, Cherobin G, Utumi E, Machado G, de Vasconcellos F, Peres M, Pilan R, Voegels R, Pinna F. Computational fluid dynamics and NOSE scale to assess nasal respiratory function, and correlation with linear maxillary measurements after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00422-2. [DOI: 10.1016/j.ijom.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 02/09/2023]
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Alagoz E, Unver T, Seker ED, Kurt G, Senturk E, Ozdem A, Dolanmaz D. EVALUATING CHANGES IN NASAL AIRWAY VOLUME AND NASAL AIRFLOW AFTER SURGICALLY ASSISTED RAPID MAXILLARY EXPANSION. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:533-542. [DOI: 10.1016/j.oooo.2022.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/10/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
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Abstract
Snoring can be harmless (primary) or a symptom of sleep-disordered breathing (secondary) and should alert the physician to evaluate the patient for risks thereof. Phenotypes of snoring and sleep-disordered breathing (SDB) are anatomic and nonanatomic and identifying these phenotypes and their interrelationships are critical to effective therapy. Mouth breathing alerts the physician to nasal airway obstruction, signals orofacial growth changes in children, and heralds the progression of SDB. Systematic evaluation to establish phenotypes includes assessing sleep habits, comorbidities, upper airway examination, polysomnography, and drug-induced sleep endoscopy. Strategies for treatment should be personalized and precise to the phenotype(s) to achieve the most benefit.
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Affiliation(s)
- Yoke-Yeow Yap
- KPJ Johor Specialist Hospital, 39b Jalan Abdul Samad, Johor Bahru 80100, Malaysia.
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Tang H, Liu P, Liu X, Hou Y, Chen W, Zhang L, Guo J. Skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) in young adults. Angle Orthod 2021; 91:301-306. [PMID: 33492395 DOI: 10.2319/052920-491.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To observe skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) and determine the possible factors that may affect the postexpansion changes using cone-beam computed tomography (CBCT) in young adults. MATERIALS AND METHODS Thirty-one patients (mean age 22.14 ± 4.76 years) who were treated with MARME over 1 year were enrolled. Four mini-implants were inserted in the midpalatal region, and the number of activations ranged from 40 to 60 turns (0.13 per turn). CBCT was performed before MARME (T0), after activation (T1), and after 1 year of retention (T2). The mean period between T1 and T0 was 6 ± 1.9 months and between T2 and T1 was 13 ± 2.18 months. A paired t-test was performed to compare T0, T1, and T2. The correlations between the postexpansion changes and possible contributing factors were analyzed by Pearson correlation analysis. RESULTS The widths increased significantly after T1. After T2, the palatal suture width decreased from 2.50 mm to 0.75 mm. From T1 to T2, decreases recorded among skeletal variables varied from 0.13 mm to 0.41 mm. This decrease accounted for 5.75% of the total expansion (2.26 mm) in nasal width (N-N) and 19.75% at the lateral pterygoid plate. A significant correlation was found between postexpansion change and palatal cortical bone thickness and inclination of the palatal plane (ANS-PNS/SN; P < .05). CONCLUSIONS Expanded skeletal width was generally stable after MARME. However, some amount of relapse occurred over time. Patients with thicker cortical bone of the palate and/or flatter palatal planes seemed to demonstrate better stability.
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de Oliveira CB, Ayub P, Ledra IM, Murata WH, Suzuki SS, Ravelli DB, Santos-Pinto A. Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment. Am J Orthod Dentofacial Orthop 2021; 159:733-742. [PMID: 33931257 DOI: 10.1016/j.ajodo.2020.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults. METHODS The sample comprised 17 patients (mean age, 26 ± 11 years) selected for the MARPE group and 15 (mean age, 28.5 ± 10.5 years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups. RESULTS MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE. CONCLUSIONS The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.
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Affiliation(s)
- Cibele Braga de Oliveira
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil.
| | - Priscila Ayub
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Ingrid Müller Ledra
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Wilson Humio Murata
- Department of Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil
| | - Selly Sayuri Suzuki
- Department of Orthodontics, São Leopoldo Mandic Institute and Research Center, Campinas, São Paulo, Brazil
| | - Dirceu Barnabé Ravelli
- Department of Pediatric Dentistry, Area of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
| | - Ary Santos-Pinto
- Department of Orthodontics, Araraquara School of Dentistry, São Paulo State University, School of Dentistry, Araraquara, São Paulo, Brazil
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Calvo-Henriquez C, Megias-Barrera J, Chiesa-Estomba C, Lechien JR, Maldonado Alvarado B, Ibrahim B, Suarez-Quintanilla D, Kahn S, Capasso R. The Impact of Maxillary Expansion on Adults' Nasal Breathing: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2021; 35:923-934. [PMID: 33583193 DOI: 10.1177/1945892421995350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, increases upper airway volume. However, it is yet unclear whether maxillary expansion may improve nasal function.Review Methods: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked by two authors from the Rhinology Study Group of the Young Otolaryngologists section of the International Federation of Otorhinolaryngological Societies. Two authors extracted the data. The main outcome was expressed as the value (in variable units) prior to treatment (T0), after expansion procedures (T1), after the retention period (T2), and after a follow-up period (T3). RESULTS A total of 10 studies (257 patients) met the inclusion criteria. The data pooled in the meta-analysis reveals a statistically significant reduction of 0.27 Pa/cm3/s (CI 95% 0.15, 0.39) in nasal resistance after palatal expansion As far as subjective changes are concerned, the pooled data for the change in the NOSE score shows a statistically significant mean reduction after maxillary expansion of 40.08 points (CI 95% 36.28, 43.89). CONCLUSION The initial available evidence is too limited to suggest maxillary expansion as a primary treatment option to target nasal breathing. However the data is encouraging with regards to the effect of maxillary expansion on nasal function. Further higher quality studies are needed in order to define clearer patient selection criteria, distinguish optimal techniques, and demonstrate long-term efficacy in long term follow up studies.
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Affiliation(s)
| | - Joaquim Megias-Barrera
- Service of Maxillofacial Surgery, Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - Carlos Chiesa-Estomba
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Service of Otolaryngology, Donostia University Hospital, San Sebastian, Spain
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Foch Hospital, University of Paris Saclay, Paris, France
| | - Byron Maldonado Alvarado
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago, Spain.,Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
| | - Badr Ibrahim
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California
| | - David Suarez-Quintanilla
- Orthodontic Private Practice, Santiago de Compostela, Santiago, Spain.,Department of Orthodontics, University of Santiago de Compostela, Santiago, Spain
| | - Sandra Kahn
- Orthodontic Private Practice, San Francisco, California
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California
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Does Nasal Cavity Enlargement Associated With Respiratory Function Improvement After Surgically Assisted Rapid Maxillary Expansion? J Craniofac Surg 2020; 31:829-831. [PMID: 32068729 DOI: 10.1097/scs.0000000000006245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To systematically evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal cavity and its associated respiratory function changes. MATERIAL AND METHODS Multiple electronic databases were searched, authors were contacted as required, and reference lists of potentially relevant studies were screened. Articles that included patients older than 16 who had received SARME were considered. Data extraction and quality assessment were performed independently and in duplicate. RESULTS Eight articles, including 161 patients, were finally selected and analyzed. Nasal cavity significantly augmentation after SARME has been recognized by 7 studies with moderate-quality evidence. Among them, the nasal cavity volume increased <20% in 4 studies, 20% to 40% in 1 study, and >40% in 2 studies. Totally, the range of increasing in nasal cavity volume was 7.6% to 99%. One study had recorded the nasal expiratory and inspiratory flow significantly increased 18.5% and 21.7%, respectively. CONCLUSION SARME was found to produce meaningful volume augmentation in nasal cavity with adult patients. However, the improvement of nasal respiratory function has not been well elucidated; thus, SARME is not yet recommended for the purpose of improving nasal respiratory.
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Ortún-Terrazas J, Fagan MJ, Cegoñino J, Illipronti-Filho E, Pérez Del Palomar A. Towards an early 3D-diagnosis of craniofacial asymmetry by computing the accurate midplane: A PCA-based method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 191:105397. [PMID: 32092615 DOI: 10.1016/j.cmpb.2020.105397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/11/2020] [Accepted: 02/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Craniofacial asymmetry is a common growth disorder often caused by unilateral chewing. Although an early orthodontic treatment would avoid surgical procedures later in life, the uncertainty of defining the accurate sagittal midplane potentially leads to misdiagnosis and therefore inaccurate orthodontic treatment plans. This novel study aims to 3D-diagnose craniofacial complex malformations in children with unilateral crossbite (UXB) considering a midplane which compensates the asymmetric morphology. METHODS The sagittal midplane of 20 children, fifteen of whom exhibited UXB, was computed by a PCA-based method which compensates the asymmetry mirroring the 3D models obtained from cone-beam computed tomography data. Once determined, one side of the data was mirrored using the computed midplane to visualize the malformations on the hard and soft tissues by 3D-computing the distances between both halves. Additionally, 31 skull's landmarks were manually placed in each model to study the principal variation modes and the significant differences in the group of subjects with and without UXB through PCA and Mann-Whitney U test analyses respectively. RESULTS Morphological 3D-analysis showed pronounced deformities and aesthetic implications for patients with severe asymmetry (jaw deviation > 0.8 mm) in whole craniofacial system, while initial signs of asymmetry were found indistinctly in the mandible or maxilla. We detected significant (p < 0.05) malformations for example in mandibular ramus length (0.0086), maxillary palate width (0.0481) and condylar head width (0.0408). Craniofacial malformations increased the landmarks' variability in the group of patients with UXB over the control group requiring 8 variation modes more to define 99% of the sample' variability. CONCLUSIONS Our findings demonstrated the viability of early diagnosis of craniofacial asymmetry through computing the accurate sagittal midplane which compensates the individual's asymmetrical morphology. Furthermore, this study provides important computational insights into the determination of craniofacial deformities which are caused by UXB, following some empirical findings of previous clinical studies. Hence, this computational approach can be useful for the development of new software in craniofacial surgery or for its use in biomedical research and clinical practice.
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Affiliation(s)
- Javier Ortún-Terrazas
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.
| | - Michael J Fagan
- Medical and Biological Engineering, School of Engineering and Computer Science, University of Hull, Hull, United Kingdom
| | - Jose Cegoñino
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Edson Illipronti-Filho
- School of Dentistry, Department of Orthodontics and Pediatric Dentistry, University of São Paulo, São Paulo, Brazil
| | - Amaya Pérez Del Palomar
- Group of Biomaterials, Aragon Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
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How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea? Sleep Breath 2019; 24:287-296. [DOI: 10.1007/s11325-019-01948-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 08/30/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
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13
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Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor. Sleep Med 2019; 65:172-176. [PMID: 31606311 DOI: 10.1016/j.sleep.2019.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study correlates objective and subjective measurements associated with obstructive sleep apnea (OSA) to define the efficacy of Distraction Osteogenesis Maxillary Expansion (DOME) to treat adult OSA patients with narrow maxilla and nasal floor. METHODS This is a retrospective study reviewing cases from September 2014 through April 2018 with 75 eligible subjects. Inclusion criteria required OSA confirmed by attended polysomnography (PSG). Pre- and Post-operative clinical data were measured at the Stanford Sleep Medicine and Stanford Sleep Surgery Clinics. DOME is a two-step process starting with insertion of custom-fabricated maxillary expanders anchored to the hard palate by mini-implants followed by minimally invasive osteotomies. After maxillary expansion was complete, orthodontic treatment to restore normal occlusion was initiated. Perioperative Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Nasal Obstruction Symptom Evaluation (NOSE), and Oxygen Desaturation Index (ODI) were measured for 43, 72, 72, and 34 subjects respectively. Statistical analysis was performed using paired T-test with significance set at p-value < 0.05. RESULTS The mean age of test subjects was 30.5 ± 8.5 years with a gender distribution of 57 males and 18 females. There was a significant reduction in pre and post-operative NOSE score (10.94 ± 5.51 to 3.28 ± 2.89, p < 0.0001), mean ESS score (10.48 ± 5.4 to 6.69 ± 4.75, p < 0.0001), and AHI (17.65 ± 19.30 to 8.17 ± 8.47, p < 0.0001) with an increased percentage of REM sleep (14.4 ± 8.3% to 22.7 ± 6.6%, p = 0.0014). No significant adverse effects were identified. CONCLUSIONS DOME treatment reduced the severity of OSA, refractory nasal obstruction, daytime somnolence, and increased the percentage of REM sleep in this selected cohort of adults OSA patients with narrow maxilla and nasal floor.
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Storto CJ, Garcez AS, Suzuki H, Cusmanich KG, Elkenawy I, Moon W, Suzuki SS. Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion. Angle Orthod 2019; 89:713-720. [PMID: 30896250 DOI: 10.2319/070518-504.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE). MATERIALS AND METHODS Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion. RESULTS There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (P<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (P<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (P<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly. CONCLUSIONS Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.
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Kayalar E, Schauseil M, Hellak A, Emekli U, Fıratlı S, Korbmacher-Steiner H. Nasal soft- and hard-tissue changes following tooth-borne and hybrid surgically assisted rapid maxillary expansion: A randomized clinical cone-beam computed tomography study. J Craniomaxillofac Surg 2019; 47:1190-1197. [PMID: 31307850 DOI: 10.1016/j.jcms.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The aim of this study was to assess the effects of tooth/bone-borne (hybrid) and tooth-borne (TB) surgically assisted rapid maxillary expansion (SARME) on the width of the nasal soft and hard tissue. PATIENTS AND METHODS Twenty skeletally mature patients (nine males and 11 females; mean age 19.4 years) with transverse maxillary hypoplasia were randomly assigned to hybrid or TB devices. The patients had undergone SARME operations, performed by the same surgical team using the same procedure (Le Fort I osteotomy with pterygomaxillary dysjunction, midline osteotomy, and no down-fracture). Nasal soft- and hard-tissue changes were analyzed using CBCT preoperatively (T0), at the end of the active expansion phase (T1), and after 6 months of retention (T2). The study was approved by the relevant ethics committee. RESULTS The skeletal and soft-tissue nasal parameters increased significantly in the T0-T1 and T0-T2 periods in both groups (P < 0.05). No statistically significant differences between the groups were observed. The mean piriform aperture width increased from 1.26 mm in T0-T1 to 0.97 mm in T1-T2 and 2.17 mm in T0-T2 (P < 0.008). In the soft tissue, the alar base width increased to 2.78 mm and the alar width to 2.95 mm in T0-T2 (P = 0.001). There was a positive correlation (63.6%) between the changes in skeletal and soft-tissue values. CONCLUSION The hybrid and TB devices led to similarly significant widening effects in nasal soft and hard tissues in both the short term and 6 months after SARME.
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Affiliation(s)
- Emre Kayalar
- Departments of Orthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey; Private Practice, Orthodontist (PhD), Istanbul, Turkey.
| | - Michael Schauseil
- Department of Orthodontics, University of Marburg, Marburg, Germany.
| | - Andreas Hellak
- Department of Orthodontics, University of Marburg, Marburg, Germany.
| | - Ufuk Emekli
- Department of Oral and Maxillofacial Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Sönmez Fıratlı
- Departments of Orthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
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Effect of rapid maxillary expansion on halitosis. Am J Orthod Dentofacial Orthop 2018; 154:702-707. [PMID: 30384941 DOI: 10.1016/j.ajodo.2018.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the effect of rapid maxillary expansion (RME) on halitosis. METHODS Thirty children (11-15 years old) were randomly divided into RME and control groups. The RME group consisted of 15 children treated with hyrax appliances, and the control group included 15 children without treatment. Halitosis was evaluated with the halimeter and the organoleptic method. Plaque index and gingival index scores were recorded. Acoustic rhinometry was used to measure the nasal volume. Measurements were obtained at 2 times: before RME, and after retention at 4 months. The Wilcoxon signed rank test and the paired t test were used for intragroup comparisons, and the Mann-Whitney U test and the Student t test were used for intergroup comparisons. RESULTS Halitosis (halimeter and organoleptic values) decreased significantly in the RME group (P <0.001). Insignificant changes of halitosis were observed in the control group. Intragroup and intergroup comparisons showed no statistically significant differences for the plaque index. Gingival index values were significantly decreased with RME (P ≤0.05). Nasal cavity volume increased significantly in the RME group (P <0.01). CONCLUSIONS RME was shown to lower halitosis values. RME could be a treatment option for patients with maxillary transverse deficiency and halitosis.
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Facial improvement after mandibular midline distraction and surgically assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2017; 152:523-542. [PMID: 28962738 DOI: 10.1016/j.ajodo.2016.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/22/2022]
Abstract
This case report describes the retreatment of a 49-year-old woman with severe crowding in the mandibular incisor region and tapered maxillary and mandibular arches. Treatment consisted of mandibular midline distraction and surgically assisted rapid maxillary expansion to increase arch length. The need for proper presurgical orthodontics is described, and the complications during treatment are discussed. The results of treatment, including the superimposition of 3-dimensional facial scans, are presented. The treatment approach we used is typically indicated for patients with previous extractions of all first premolars who develop significant crowding after treatment. Surgical planning in 3 dimensions and the use of a 3-dimensional designed surgical osteotomy guiding wafer should improve the predictability of this treatment approach.
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Rômulo de Medeiros J, Ferraro Bezerra M, Gurgel Costa FW, Pinheiro Bezerra T, de Araújo Alencar CR, Studart Soares EC. Does pterygomaxillary disjunction in surgically assisted rapid maxillary expansion influence upper airway volume? A prospective study using Dolphin Imaging 3D. Int J Oral Maxillofac Surg 2017; 46:1094-1101. [PMID: 28521967 DOI: 10.1016/j.ijom.2017.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/21/2016] [Accepted: 04/14/2017] [Indexed: 11/30/2022]
Abstract
Surgically assisted rapid maxillary expansion has been used for the treatment of transverse maxillary deficiency. This prospective study aimed to evaluate the effect of this surgery (with or without pterygomaxillary disjunction) on the upper airway volume. The patients were randomly divided into two groups: without pterygomaxillary disjunction (-PD) and with pterygomaxillary disjunction (+PD). Eleven patients per group were estimated to obtain a representative sample (90% of power and 95% of confidence level). Volumetric images of cone beam computed tomography scans were obtained preoperatively, immediately after Hyrax screw stabilization and 6 months after Hyrax screw stabilization. Volumetric measurements of the nasal cavity, maxillary sinuses, nasopharynx, and oropharynx, and of the minimum oropharynx cross-sectional area were obtained using Dolphin 3D Imaging Software. The final sample consisted of 25 adult individuals (+PD group, n=12; -PD group, n=13). In the +PD group, we observed a statistically significant increase immediately after Hyrax screw stabilization for the nasopharynx volume (P=0.003), oropharynx volume (P=0.007) and oropharynx cross-sectional area (P=0.001). Pterygomaxillary disjunction resulted in a significant (P <0.05) increase in volumetric measurements of the nasopharynx and minimum oropharynx cross-sectional area 6 months after the expander device stabilization.
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Affiliation(s)
- J Rômulo de Medeiros
- Division of Oral and Maxillofacial Surgery, Federal University of Ceará, University of Fortaleza, Fortaleza, Brazil.
| | - M Ferraro Bezerra
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
| | - F W Gurgel Costa
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
| | - T Pinheiro Bezerra
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Unichristus University Center, Fortaleza, Brazil
| | | | - E C Studart Soares
- Division of Oral and Maxillofacial Surgery, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Brazil
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Sakai RHUS, Marson FAL, Sakuma ETI, Ribeiro JD, Sakano E. Correlation between acoustic rhinometry, computed rhinomanometry and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency. Braz J Otorhinolaryngol 2016; 84:S1808-8694(16)30234-8. [PMID: 28017262 PMCID: PMC9442894 DOI: 10.1016/j.bjorl.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/26/2016] [Accepted: 10/30/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To provide clinical information and diagnosis in mouth breathers with transverse maxillary deficiency with posterior crossbite, numerous exams can be performed; however, the correlation among these exams remains unclear. OBJECTIVE To evaluate the correlation between acoustic rhinometry, computed rhinomanometry, and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency. METHODS A cross-sectional study was conducted in 30 mouth breathers with transverse maxillary deficiency (7-13 y.o.) patients with posterior crossbite. The examinations assessed: (i) acoustic rhinometry: nasal volumes (0-5cm and 2-5cm) and minimum cross-sectional areas 1 and 2 of nasal cavity; (ii) computed rhinomanometry: flow and average inspiratory and expiratory resistance; (iii) cone-beam computed tomography: coronal section on the head of inferior turbinate (Widths 1 and 2), middle turbinate (Widths 3 and 4) and maxilla levels (Width 5). Acoustic rhinometry and computed rhinomanometry were evaluated before and after administration of vasoconstrictor. Results were compared by Spearman's correlation and Mann-Whitney tests (α=0.05). RESULTS Positive correlations were observed between: (i) flow evaluated before administration of vasoconstrictor and Width 4 (Rho=0.380) and Width 5 (Rho=0.371); (ii) Width 2 and minimum cross-sectional areas 1 evaluated before administration of vasoconstrictor (Rho=0.380); (iii) flow evaluated before administration of vasoconstrictor and nasal volumes of 0-5cm (Rho=0.421), nasal volumes of 2-5cm (Rho=0.393) and minimum cross-sectional areas 1 (Rho=0.375); (iv) Width 4 and nasal volumes of 0-5cm evaluated before administration of vasoconstrictor (Rho=0.376), nasal volumes of 2-5cm evaluated before administration of vasoconstrictor (Rho=0.376), minimum cross-sectional areas 1 evaluated before administration of vasoconstrictor (Rho=0.410) and minimum cross-sectional areas 1 after administration of vasoconstrictor (Rho=0.426); (v) Width 5 and Width 1 (Rho=0.542), Width 2 (Rho=0.411), and Width 4 (Rho=0.429). Negative correlations were observed between: (i) Width 4 and average inspiratory resistance (Rho=-0.385); (ii) average inspiratory resistance evaluated before administration of vasoconstrictor and nasal volumes of 0-5cm (Rho=-0.382), and average expiratory resistance evaluated before administration of vasoconstrictor and minimum cross-sectional areas 1 (Rho=-0.362). CONCLUSION There were correlations between acoustic rhinometry, computed rhinomanometry, and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency.
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Affiliation(s)
| | - Fernando Augusto Lima Marson
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Genética Médica, Campinas, SP, Brazil
| | - Emerson Taro Inoue Sakuma
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas, SP, Brazil
| | - José Dirceu Ribeiro
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil.
| | - Eulália Sakano
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil
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Jensen T, Rodrigo-Domingo M. Surgically assisted rapid maxillary expansion (SARME) with or without intraoperative releasing of the nasal septum. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:e85-e90. [PMID: 28049609 DOI: 10.1016/j.oooo.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 09/19/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess nasal septum deviation after surgically assisted rapid maxillary expansion (SARME) with or without intraoperative releasing of the nasal septum. STUDY DESIGN A total of 20 consecutive adult patients with transverse maxillary deficiency underwent SARME with intraoperative releasing (n = 10) or nonreleasing (n = 10) of the nasal septum. Cone beam computed tomography scans were obtained immediately after surgery (T1), after the end of distraction (T2), and 6 months after SARME (T3). Deviation of the nasal septum was evaluated by angular measurements on superimposed cone beam computed tomography images from T1 to T3. Moreover, visible nasal septum deviation was assessed by using superimposed clinical photos obtained preoperatively (CP1) and before second-stage surgery (CP2). RESULTS No significant differences were found between releasing and nonreleasing of the nasal septum in angular radiographic measurements from T1 to T3 (0 degrees; 95% confidence interval -0.62 to 0.62; P = .5) or visible nasal deviation from CP1 to CP2 (-0.14 degrees; 95% confidence interval -0.64 to 0.36; P = .28). CONCLUSIONS The results of the present study indicate that there is no need for intraoperative releasing of the nasal septum during SARME. However, further randomized studies based on large patient groups are needed before final conclusions on this topic can be reached.
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Affiliation(s)
- Thomas Jensen
- Consultant, Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark.
| | - Maria Rodrigo-Domingo
- Biostatistician, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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21
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Buck LM, Dalci O, Darendeliler MA, Papadopoulou AK. Effect of Surgically Assisted Rapid Maxillary Expansion on Upper Airway Volume: A Systematic Review. J Oral Maxillofac Surg 2015; 74:1025-43. [PMID: 26778518 DOI: 10.1016/j.joms.2015.11.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/15/2015] [Accepted: 11/30/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Surgically assisted rapid maxillary expansion (SARME) is required in non-growing patients when maturity or resistance precludes desired sutural separation by noninvasive techniques. The aim of this review was to determine what volumetric changes occur in the upper airway spaces after SARME in adults. MATERIALS AND METHODS A systematic review was performed with data assessed for suitability of meta-analysis. The primary outcome measurement of volumetric changes in an upper airway space was sought in non-growing patients undergoing SARME. Electronic database searches were performed for published literature in Medline (by Ovid), Pre-Medline, Old Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) spanning all available years to August 1, 2015. Unpublished literature was searched electronically through ClinicalTrials.gov and the National Research Register. Additional hand searching of reference lists of relevant articles, grey searching, and expert correspondence was conducted for any additional studies. Two authors independently screened search results, extracted data, and assessed the risk of bias of included studies. RESULTS Twenty-one studies were located by initial screening; 10 were excluded after full-text review, leaving 11 studies eligible that met all inclusion criteria for this systematic review. In total, 204 treated patients (mean age, 18 to 31 yr) were included in the qualitative synthesis. Ten studies evaluated nasal cavity volume, 2 evaluated palatal volume, and 1 evaluated oropharyngeal volume. Appliances used included tooth-borne hyrax and transpalatal distractor devices. CONCLUSIONS SARME was found to produce substantial short-term volume increases in the nasal cavity in non-growing patients that were maintained for at least 63 months. Evidence weakly suggested no effect on oropharyngeal volume. However, most studies were evaluated as having a high risk of bias. The effect of such volume changes on respiratory function still needs to be determined; thus, SARME cannot be recommended for respiratory purposes.
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Affiliation(s)
- Lloyd M Buck
- Postgraduate Student, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Oyku Dalci
- Senior Lecturer, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - M Ali Darendeliler
- Professor and Chair, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia
| | - Alexandra K Papadopoulou
- Senior Lecturer, Discipline of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, Australia; Research Associate, Department of Oral Surgery and Implantology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Trefný P, Krajíček V, Velemínská J. Three-dimensional analysis of palatal shape in patients treated with SARME using traditional and geometric morphometrics. Orthod Craniofac Res 2015; 19:18-27. [PMID: 26443465 DOI: 10.1111/ocr.12105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To demonstrate the advantages of dense surface models in the evaluation of surgical-assisted rapid maxillary expansion's effect (SARME) on palatal morphology. Furthermore, we compared the palatal surface before (T1) and after (T2) therapy with controls. SETTING AND SAMPLE POPULATION Surgical-assisted rapid maxillary expansion's effect group of 15 adult patients (Le Fort I and midpalatal sagittal osteotomy, hyrax screw) and 50 adult individuals. Patients were treated in General Faculty Hospital, Prague. MATERIALS AND METHODS Eighty plaster casts were digitized using a three-dimensional laser scanner and evaluated using traditional and geometric morphometrics. RESULTS An unpaired Student's t-test on the controls and the SARME T1 group revealed significant differences in all width measurements. Between the controls and the SARME T2 group, significant differences were only related to the interdental angle between the first molars and particularly to the palatal height. The most remarkable differences between the pre- and post-treatment palatal morphology were a widening of the dental arch and buccal shift of the lateral teeth associated with apparent flattening of the alveolar crest. CONCLUSIONS Dense surface model provided descriptive visualization of the treatment effect and was helpful in the evaluation of palatal shape variability including detection of the most difficult patients. Correction of the dental arch width discrepancy by SARME was successfully achieved. After therapy, palatal shape variability of most of the patients was comparable to the variability of the control group.
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Affiliation(s)
- P Trefný
- 1st Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - V Krajíček
- Department of Software and Computer Science Education, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - J Velemínská
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University in Prague, Prague, Czech Republic
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Menegat F, Monnazzi MS, Silva BN, de Moraes M, Gabrielli MAC, Pereira-Filho VA. Assessment of nasal obstruction symptoms using the NOSE scale after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2015; 44:1346-50. [PMID: 26187045 DOI: 10.1016/j.ijom.2015.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 06/18/2015] [Accepted: 06/25/2015] [Indexed: 11/24/2022]
Abstract
The Nasal Obstruction Symptom Evaluation (NOSE) scale is a reliable and valid instrument used widely in otorhinolaryngology to evaluate nasal obstruction symptoms in patients with nasal disorders. The purpose of this study was to assess nasal obstruction symptoms prospectively in patients undergoing surgically assisted rapid maxillary expansion (SARME) using the NOSE scale. Sixteen patients were studied (mean age 31±7.7 years), 10 women and six men, all with a transverse maxillary deficiency and an indication for SARME. Hyrax type devices were placed preoperatively and SARME was performed using Kraut's technique. The NOSE scale was applied prospectively to assess nasal obstruction symptoms. The results were recorded for each score on a scale ranging from 0 to 4, and these scores were multiplied by 5, generating a balanced scale from 0 to 100. Data were stratified according to NOSE scores, and nasal obstruction was categorized as mild (0-25), moderate (26-50), or severe (>50). The questionnaire was administered twice, first preoperatively and then at 6 months after surgery, and the results compared. Data were analyzed statistically using SAS statistical package software and showed that patients experienced a subjective improvement or did not have a worsening of nasal obstruction symptoms after SARME.
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Affiliation(s)
- F Menegat
- Dental School of Piracicaba, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - M S Monnazzi
- Dental School of Araraquara, FOAR-UNESP, Araraquara, São Paulo, Brazil.
| | - B N Silva
- Dental School of Piracicaba, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - M de Moraes
- Dental School of Piracicaba, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - M A C Gabrielli
- Dental School of Araraquara, FOAR-UNESP, Araraquara, São Paulo, Brazil
| | - V A Pereira-Filho
- Dental School of Araraquara, FOAR-UNESP, Araraquara, São Paulo, Brazil
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