Effects of mouth opening breathing for different reasons on maxillofacial development in children
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摘要: 目的 探究不同原因张口呼吸对儿童颌面部发育的影响。方法 选择151例患儿作为研究对象。依据不同病因将其分为49例腺样体肥大组(A组)、52例扁桃体肥大组(B组)、50例腺样体伴扁桃体肥大组(C组)。选择同期的健康儿童作为本次试验的对照组,共45例。分析A组、B组、C组与对照组的反射鼻咽腔测量参数、面部发育指标及头影参数,研究A组、B组、C组安氏Ⅱ类、安氏Ⅲ类的发生率。结果 A组、B组、C组的反射鼻咽腔测量参数与对照组比较,差异有统计学意义(P < 0.05),头影参数发生改变且各组间不同(P < 0.05)。A组和C组的安氏Ⅱ类发生率较高,B组和C组的安氏Ⅲ类发生率较高(P < 0.05)。结论 腺样体肥大会导致下颌骨后缩,扁桃体肥大会造成下颌前伸,腺样体肥大及扁桃体肥大均容易导致下颌骨出现顺时针旋转的状态。为避免患儿发育不协调,临床应尽早对患儿的颌面部情况进行纠正。Abstract: Objective To explore the effects of mouth opening breathing for different reasons on children's maxillofacial development.Methods One hundred and fifty-one children were selected as the research objects of this experiment. They were divided into 49 cases of adenoid hypertrophy group(group A), 52 cases of tonsillar hypertrophy group(group B) and 50 cases of adenoid with tonsillar hypertrophy group(Group C). Healthy children in the same period were selected as the control group, a total of 45 cases. The reflex nasopharyngeal measurement parameters, facial development indexes and cephalometric parameters of group A, group B, group C and control group were analyzed, and the incidence of Angle ClassⅡand Angle Class Ⅲ in group A, group B and group C were studied.Results Compared with the control group, the reflex nasopharyngeal measurement parameters in group A, group B and group C was significantly different(P < 0.05), and the cephalometric parameters changed with variation in groups(P < 0.05). The incidence of Angle Class Ⅱ facial pattern in group A and group C was higher, but the incidence of Angle Class Ⅲ facial pattern in group B and group C was higher(P < 0.05).Conclusion Adenoid hypertrophy leads to mandibular retraction; tonsil hypertrophy leads to anterior mandibular arch; adenoid hypertrophy and tonsil hypertrophy are easy to lead to clockwise rotation of the mandible. In clinical practice, to avoid children's uncoordinated maxillofacial development, we should correct the maxillofacial situation of children as soon as possible.
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表 1 头影参数指标意义
头影参数 定义 临床意义 SNA角 由蝶鞍中心、鼻根点及上牙槽座点所构成的角 反映上颌相对于颅部的前后位置关系;当此角过大时,上颌前突、面部侧貌可呈凸面型,反之上颌后缩面部呈凹面型 SNB角 由蝶鞍中心、鼻根点及下牙槽座点所构成的角 反映下颌相对于颅部的前后位置关系;此角过大时,下颌呈前突,反之下颌呈后缩 MP-FH角 由下颌平面(MP)与眼耳平面(FH)的交角 代表下颌体的陡度,下颌角的大小,也反映面部的高度 NP-FH角 面平面(NP)与眼耳平面(FH)相交的后下角 反映下颌的突缩程度;此角越大表示下颌越前突,反之则表示下颌后缩 Y轴角 蝶鞍中心与颏顶点连线(SGn)与眼耳平面(FH)相交的下前角 此角反映颏部的突缩;此角越小则表示颏部越突,反之则表示颏部越缩 OP-FH角 合平面(OP)与眼耳平面(FH)的交角 此角代表合平面的斜度;此角越大代表合平面越陡,为安氏Ⅱ类面型倾向;反之此角越小代表合平面越平,为安氏Ⅲ类面型倾向 U1-SN角 上中切牙长轴与SN平面相交的下内角 反映上切牙对于前颅底的相对斜度;此角过大表示上颌中切牙唇倾,反之为舌倾 L1-MP角 下中切牙长轴与MP平面相交的上内角 反映下切牙对于下颌平面的倾斜度;此角过大表示下颌中切牙唇倾,反之为舌倾 上下中切牙角 上中切牙长轴与下中切牙长轴的交角 反映上下中切牙特别是上下前部牙弓的突度;此角越小突度越大,反之突度越小 表 2 4组一般资料的比较
X±S 一般资料 A组(n=49) B组(n=52) C组(n=50) 对照组(n=45) t/χ2 P 年龄/岁 6.33±1.26 6.29±1.22 6.32±1.25 6.31±1.11 0.01 0.998 身高/cm 106.33±2.11 105.69±2.30 105.89±2.13 106.74±2.22 2.19 0.090 BMI/(kg/m2) 19.98±1.46 20.05±1.22 19.88±1.52 20.56±1.45 2.47 0.088 性别/例(%) 2.019 0.568 男 29(59.18) 33(63.46) 25(50.00) 25(55.55) 女 20(40.81) 19(36.53) 25(50.00) 20(44.45) 头围/cm 51.33±1.36 51.13±1.69 50.99±1.58 51.46±1.58 0.86 0.464 表 3 4组声反射鼻咽腔测量参数比较
X±S 组别 例数 NAR/(cmH2O/L·min) NPV/cm3 A组 49 6.66±3.451)2) 16.44±6.121)2) B组 52 5.39±4.261)2) 15.46±5.121)2) C组 50 8.32±4.221) 13.52±4.331) 对照组 45 2.06±1.22 22.46±5.01 t 20.08 25.80 P < 0.001 < 0.001 与对照组比较,1) P < 0.05;与C组比较,2) P < 0.05。 表 4 4组头影参数比较
X±S 头影参数 A组(n=49) B组(n=52) C组(n=50) 对照组(n=45) F P SNA角 77.63±3.12 78.22±2.96 78.45±2.45 77.38±3.16 1.39 0.245 SNB角 74.13±2.151) 76.45±2.852) 78.92±3.461)2)3) 75.66±2.49 25.40 < 0.001 MP-FH角 34.22±4.261) 30.15±5.62 38.99±5.221)2)3) 28.56±4.05 44.78 < 0.001 NP-FH角 79.42±2.951) 83.45±3.662) 87.62±3.241)2)3) 84.27±3.52 49.88 < 0.001 Y轴角 67.59±3.281) 66.68±3.41 69.48±3.691)2)3) 65.49±3.51 4.49 < 0.001 OP-FH角 18.66±5.44 15.88±5.212) 20.36±4.682)3) 16.45±4.38 3.85 < 0.001 U1-SN角 80.95±6.861) 85.46±7.562) 88.76±4.661)2)3) 85.44±8.92 16.04 < 0.001 L1-MP角 86.79±7.01 89.25±8.45 88.49±6.99 89.11±9.26 0.99 0.400 上下中切牙角 143.62±11.68 137.45±12.64 149.86±15.421)2)3) 142.01±14.33 7.25 < 0.001 与对照组比较,1) P < 0.05;与A组比较,2) P < 0.05;与B组比较,3) P < 0.05。 表 5 3组间安氏Ⅱ类、Ⅲ类发生率比较
例(%) A组 B组 C组 安氏Ⅰ类 20a(40.8) 19a(36.5) 6b(12.0) 安氏Ⅱ类 24a(49.0) 6b(11.5) 20a(40.0) 安氏Ⅲ类 5a(10.2) 27b(51.9) 24b(48.0) a,b表示在0.05层次上2组间比较差异无统计学意义。 -
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