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The relationship between upper airway width and facial growth changes in orthodontic treatment of growing children

교정치료에 따른 사춘기 성장 아동의 상기도 폭경과 안면 성장 변화와의 관계 연구

  • Kim, Yoon-Ji (Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Bok, Gyoo-Suk (Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Lee, Kyu-Hong (Public Health Doctor) ;
  • Hwang, Yong-In (Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Park, Yang-Ho (Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center)
  • 김윤지 (한림대학교 의료원 강동성심병원 치과교정과) ;
  • 복규석 (한림대학교 의료원 강동성심병원 치과교정과) ;
  • 이규홍 (공중보건의) ;
  • 황용인 (한림대학교 의료원 강동성심병원 치과교정과) ;
  • 박양호 (한림대학교 의료원 강동성심병원 치과교정과)
  • Published : 2009.06.30

Abstract

Objective: The purpose of this study was to evaluate how airway changes influence facial growth during puberty in Korean children. Methods: Thirty-six patients aged 9 to 11 (mean age: 10.7 years) were selected. Cephalograms and hand-wrist x-rays were taken at pre-treatment (T1) and post-treatment (T2). The sample was divided into narrow (5.2 - 8.6 mm, AW-Narrow), medium (8.9 - 11.5 mm, AW-Medium), and wide (11.7 - 16.0 mm, AW-Wide) groups according to the airway width at T1. Cephalometric measurements at T1, T2 and growth from T1 to T2 were compared between groups. Results: The degree of increase in airway size in each group was 4.55 mm, 3.84 mm and 1.94 mm in the AW-Narrow, AW-Medium, and AW-Wide groups, respectively. Moreover, the differences were statistically significant. The significant smallest posterior facial height was found in the AW-Narrow group at T1. For the growth values from T1 to T2, the AW-Narrow group showed significantly larger values of PFH/AFH, facial axis, ANS (T1 - T2), and Gn (T1 - T2) than the AW-Medium group. Conclusions: The compensational changes in the airway width and facial growth were found in the narrow group. Surgical approach of the airway to prevent unfavorable facial growth in these years of age should be carried out, but with careful deliberation because these problems may be improved naturally.

본 연구의 목적은 아동에서 사춘기 성장 동안 기도의 변화가 안면 성장에 미치는 영향을 평가하는 것이었다. 9 - 11세(평균 10.7세)의 교정환자 36명을 대상으로 하여 초진 시(T1)와 치료 종료 시(T2)에 각각 측모두부방사선사진과 수완부 방사선 사진을 촬영하였다. 측모두부방사선사진상의 기도 폭경을 기준으로 하여 대상을 세 그룹으로 나누었다; 폭경이 좁은 그룹(AW-Narrow: 5.2 - 8.6 mm), 중간 그룹(AW-Medium: 8.9 - 11.5 mm), 넓은 그룹(AW-Wide: 11.7 - 16.0 mm). T1과 T2시기에 각 그룹 간의 안면 계측치의 차이를 비교하였으며 T1 - T2 사이의 계측치의 변화량을 각 그룹별로 비교하여 성장을 평가하였다. 각 그룹의 기도 폭경 증가량은 AW-Narrow, AW-Medium, AW-Wide group에서 각각 4.55 mm, 3.84 mm, 1.94 mm였으며 통계적으로 유의한 차이를 보였다. T1시기의 각 그룹 간의 비교에서 AW-Narrow group에서 다른 그룹에 비해 PFH가 유의하게 작은 값을 나타냈다. T1 - T2 사이의 성장 평가에서는 AW-Narrow group에서 다른 그룹에 비해 PFH/AFH, facial axis, ANS (T1 - T2), and Gn (T1 - T2)의 변화가 유의하게 큰 값을 보였다. 이 시기의 안면 성장 기간 동안 기도 폭경이 좁은 그룹에서 기도 폭경 및 안면 성장의 보상성 변화가 일어난 것으로 생각된다. 바람직하지 않은 안면 성장을 예방하기 위한 외과적 기도 처치를 고려할 때 자발적인 개선 가능성을 고려하여 좀 더 신중한 평가가 필요할 것으로 생각된다.

Keywords

References

  1. Moyers RE. Etiology of malocclusion, in Handbook of orthodontics. Chicago: Year Book Medical Publishers, Inc.; 1988. p. 21
  2. Behlfelt K, Linder-Aronson S, McWilliam J, Neander P, Laage-Hellman J. Cranio-facial morphology in children with and without enlarged tonsils. Eur J Orthod 1990;12:233-43 https://doi.org/10.1093/ejo/12.3.233
  3. Subtelny JD, Sakuda M. Open-bite: diagnosis and treatment. Am J Orthod 1964;50:337-58 https://doi.org/10.1016/0002-9416(64)90175-7
  4. Proffit WR, Fields HW Jr, Sarver DM. Contemporary orthodontics. 4th ed. St. Louis: Mosby Year Book Inc.; 2007. p. 154-8
  5. Cheng MC, Enlow DH, Papsidero M, Broadbent BH Jr, Oyen O, Sabat M. Developmental effects of impaired breathing in the face of the growing child. Angle Orthod 1988;58:309-20
  6. de Freitas MR, Alcazar NM, Janson G, de Freitas KM, Henriques JF. Upper and lower pharyngeal airways in subjects with Class I and Class II malocclusions and different growth patterns. Am J Orthod Dentofacial Orthop 2006;130:742-5 https://doi.org/10.1016/j.ajodo.2005.01.033
  7. Hwang YI, Lee KH, Lee KJ, Kim SC, Cho HJ, Cheon SH, et al. Effect of airway and tongue in facial morphology of prepubertal Class I, II children. Korean J Orthod 2008;38:74-82 https://doi.org/10.4041/kjod.2008.38.2.74
  8. Lessa FC, Enoki C, Feres MF, Valera FC, Lima WT, Matsumoto MA. Breathing mode influence in craniofacial development. Braz J Otorhinolaryngol 2005;71:156-60 https://doi.org/10.1016/S1808-8694(15)31304-5
  9. Linder-Aronson S. Effects of adenoidectomy on mode of breathing, size of adenoids and nasal airflow. ORL J Otorhinolaryngol Relat Spec 1973;35:283-302 https://doi.org/10.1159/000275131
  10. McNamara JA Jr. Influence of respiratory pattern on craniofacial growth. Angle Orthod 1981;51:269-300
  11. Tourne LP. The long face syndrome and impairment of the nasopharyngeal airway. Angle Orthod 1990;60:167-76
  12. Vig KW. Nasal obstruction and facial growth: the strength of evidence for clinical assumptions. Am J Orthod Dentofacial Orthop 1998;113:603-11 https://doi.org/10.1016/S0889-5406(98)70219-7
  13. Handelman CS, Osborne G. Growth of the nasopharynx and adenoid development from one to eighteeen years. Angle Orthod 1976;46:243-59
  14. Jaw TS, Sheu RS, Liu GC, Lin WC. Development of adenoids: a study by measurement with MR images. Kaohsiung J Med Sci 1999;15:12-8
  15. Vilella Bde S, Vilella Ode V, Koch HA. Growth of the nasopharynx and adenoidal development in Brazilian subjects. Braz Oral Res 2006;20:70-5 https://doi.org/10.1590/S1806-83242006000100013
  16. Woodside DG, Linder-Aronson S, Lundstrom A, McWilliam J. Mandibular and maxillary growth after changed mode of breathing. Am J Orthod Dentofacial Orthop 1991;100:1-18 https://doi.org/10.1016/0889-5406(91)70044-W
  17. 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. Eur J Orthod 2006;28:319-26 https://doi.org/10.1093/ejo/cji119
  18. Fishman LS. Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand-wrist films. Angle Orthod 1982;52:88-112
  19. Lee KH, Hwang YI, Kim YJ, Park YH, Baek SH, Cha KS. Skeletal maturation associated with the fourth cervical vertebra and menarcheal timing. Korean J Orthod 2008;38:52-9 https://doi.org/10.4041/kjod.2008.38.1.52
  20. Houston WJ, The analysis of errors in orthodontic measurements. Am J Orthod 1983;83:382–90 https://doi.org/10.1016/0002-9416(83)90322-6
  21. Dahlberg G. Statistical methods for medical and biological students. New York: Interscience; 1940. p. 1-140
  22. Major MP, Flores-Mir C, Major PW. Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review. Am J Orthod Dentofacial Orthop 2006;130:700-8 https://doi.org/10.1016/j.ajodo.2005.05.050
  23. Apaydin FD, Ozg$\ddot{u}$r A, Yildiz A, Kuyucu S, Duce MN, Ozer C, et al. Open-mouth versus closed-mouth radiographs of the nasopharynx in the evaluation of nasopharyngeal airway obstruction. Clin Imaging 2003;27:382-5 https://doi.org/10.1016/S0899-7071(03)00014-7

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