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Effects of maxillary expansion and protraction on pharyngeal airway dimensions in relation to changes in head posture and hyoid position

A retrospective cohort study

Auswirkungen einer Oberkieferexpansion und -protraktion auf die Dimensionen der pharyngealen Atemwege in Abhängigkeit von Änderungen in der Kopfhaltung und der Hyoidposition

Eine retrospektive Kohortenstudie

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Abstract

Purpose

To assess changes in pharyngeal airway dimensions, head posture and hyoid position after maxillary expansion and face mask (FM) treatment compared to untreated class III patients.

Methods

This study examined 24 class III patients (10 girls, 14 boys, mean age: 10.97 ± 0.88 years) treated with expansion and a petit-type FM appliance and 24 untreated class III patients (16 girls, 8 boys, mean age: 10.50 ± 1.06 years). Pre- and posttreatment cephalometric radiographs were digitally analysed. Parametric data were analysed with paired and independent-samples t‑tests, nonparametric data were analysed with Wilcoxon signed-rank and Mann–Whitney U tests. Spearman’s correlation analysis was used to examine the relationship between dental/skeletal treatment changes and those of craniocervical postural position, pharyngeal airway dimension and hyoid position.

Results

With respect to the hypopharyngeal airway dimension, the hypopharyngeal sagittal length (CV3’-LPW), velar angle (HRL/U-PNS) and velar length (U-PNS) significantly increased in the treatment group. All the parameters describing head posture and those describing the distances of the hyoid bone to the HRL changed significantly after treatment, but these changes were not significantly different from the control group. In the treatment group, there also occurred a significant increase in the sagittal growth of the maxilla (SNA, Co‑A, Na-Perp A, Wits), vertical growth of the maxillomandibular complex (SN-GoGN, N‑ANS, N‑Me), counterclockwise rotation of the maxilla (SN-PP) and overjet, while a clockwise rotation (y-axis) and a nonsignificant inhibition of the sagittal growth (Co-Gn) of the mandible were observed. The treatment induced increases of hypopharyngeal sagittal length (CV3’-LPW), soft palate thickness and anteroposterior movement of hyoid bone (H-CV3) demonstrated a positive correlation with changes of craniocervical angles (NSL/OPT, NSL/CVT) and a negative correlation with craniohorizontal angles (OPT/HOR, CVT/HOR). The change of the anteroposterior movement of hyoid bone (H-CV3) was also positively correlated with oropharyngeal sagittal length (CV2’-MPW), the hypopharyngeal sagittal length (CV3’-LPW) and the minimal dimension of the pharyngeal airway space (PASmin).

Conclusion

While expansion and FM treatment did not affect the head posture and hyoid bone position, positive effects were observed in the hypopharyngeal airway region.

Zusammenfassung

Zielsetzung

Untersucht werden sollten die Veränderungen der pharyngealen Atemwegsdimensionen, der Kopfhaltung und der Hyoidposition nach einer Oberkieferexpansion und einer Gesichtsmaskenbehandlung (FM) im Vergleich zu nichtbehandelten Klasse-III-Patienten.

Methoden

In dieser Studie wurden 24 Klasse-III-Patienten (10 Mädchen, 14 Jungen, Durchschnittsalter: 10,97 ± 0,88 Jahre), die mit einer Expansion und einer FM-Apparatur vom Petit-Typ behandelt wurden, und 24 unbehandelte Klasse-III-Patienten (16 Mädchen, 8 Jungen, Durchschnittsalter: 10,50 ± 1,06 Jahre) untersucht. Die kephalometrischen Röntgenbilder vor und nach der Behandlung wurden digital analysiert. Parametrische Daten wurden mit t‑Tests für gepaarte und unabhängige Stichproben analysiert, nichtparametrische Daten mit dem Wilcoxon-Signed-Rank- und dem Mann-Whitney-U-Test. Die Spearman-Korrelationsanalyse wurde verwendet, um die Beziehung zwischen zahnmedizinischen/skelettalen Behandlungsveränderungen und den Veränderungen der kraniozervikalen Haltungsposition, der pharyngealen Atemwegsdimension und der Hyoidposition zu untersuchen.

Ergebnisse

In Bezug auf die hypopharyngeale Atemwegsdimension nahmen die hypopharyngeale sagittale Länge (CV3’-LPW), der velare Winkel (HRL/U-PNS) und die velare Länge (U-PNS) in der Behandlungsgruppe signifikant zu. Alle Parameter, welche die Kopfhaltung beschreiben, ebenso wie diejenigen, welche die Abstände zwischen Os hyoideum und HRL beschreiben, veränderten sich nach der Behandlung signifikant, unterschieden sich aber nicht von der Kontrollgruppe. In der Behandlungsgruppe kam es auch zu einer signifikanten Zunahme des sagittalen Wachstums der Maxilla (SNA, Co‑A, Na-Perp A, Wits), des vertikalen Wachstums des maxillomandibulären Komplexes (SN-GoGN, N‑ANS, N‑Me), der Rotation der Maxilla gegen den Uhrzeigersinn (SN-PP) und des Overjet, während eine Rotation im Uhrzeigersinn (Y-Achse) und eine nicht-signifikante Hemmung des sagittalen Wachstums (Co-Gn) der Mandibula beobachtet wurden. Die behandlungsbedingte Zunahme der hypopharyngealen sagittalen Länge (CV3’-LPW), der Dicke des weichen Gaumens und der anteroposterioren Bewegung des Os hyoideum (H-CV3) zeigte eine positive Korrelation mit den Veränderungen der kraniozervikalen Winkel (NSL/OPT, NSL/CVT) und eine negative Korrelation mit den kraniohorizontalen Winkeln (OPT/HOR, CVT/HOR). Die Veränderung der anteroposterioren Bewegung des Zungenbeins (H-CV3) korrelierte ebenfalls positiv mit der sagittalen Länge des Oropharynx (CV2’-MPW), der sagittalen Länge des Hypopharynx (CV3’-LPW) und der minimalen Dimension des pharyngealen Atemwegsraums (PASmin).

Schlussfolgerung

Während sich die Expansions- und FM-Behandlung nicht auf die Kopfhaltung und die Position des Os hyoideum auswirkte, wurden positive Effekte im Bereich der hypopharyngealen Atemwege beobachtet.

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References

  1. Toffol LD, Pavoni C, Baccetti T, Franchi L, Cozza P (2008) Orthopedic treatment outcomes in Class III malocclusion: a systematic review. Angle Orthod 78:561–573. https://doi.org/10.2319/030207-108.1

    Article  PubMed  Google Scholar 

  2. Kilinc AS, Arslan SG, Kama JD, Özer T, Dari O (2008) Effects on the sagittal pharyngeal dimensions of protraction and rapid palatal expansion in Class III malocclusion subjects. Eur J Orthod 30:61–66. https://doi.org/10.1093/ejo/cjm076

    Article  PubMed  Google Scholar 

  3. Ellis E III, McNamara JA Jr (1984) Components of adult Class III malocclusion. J Oral Maxillofac Surg 42:295–305. https://doi.org/10.1016/0278-2391(84)90109-5

    Article  PubMed  Google Scholar 

  4. Sayin MO, Türkkahraman H (2004) Malocclusion and crowding in an orthodontically referred Turkish population. Angle Orthod 74:635–639. https://doi.org/10.1043/0003-3219(2004)074%3C0635:maciao%3E2.0.co;2

    Article  PubMed  Google Scholar 

  5. Liang S, Wang F, Chang Q, Bai Y (2021) Three-dimensional comparative evaluation of customized bone-anchored vs tooth-borne maxillary protraction in patients with skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop 160:374–394. https://doi.org/10.1016/j.ajodo.2020.04.034

    Article  PubMed  Google Scholar 

  6. Niu X, Madhan S, Cornelis MA, Cattaneo PM (2021) Novel three-dimensional methods to analyze the morphology of the nasal cavity and pharyngeal airway. Angle Orthod 91:320–328. https://doi.org/10.2319/070620-610.1

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee J‑W, Park K‑H, Kim S‑H, Park Y‑G, Kim S‑J (2011) Correlation between skeletal changes by maxillary protraction and upper airway dimensions. Angle Orthod 81:426–432. https://doi.org/10.2319/082610-499.1

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yagci A, Uysal T, Usumez S, Orhan M (2011) Effects of modified and conventional facemask therapies with expansion on dynamic measurement of natural head position in Class III patients. Am J Orthod Dentofacial Orthop 140:e223–e231. https://doi.org/10.1016/j.ajodo.2011.05.018

    Article  PubMed  Google Scholar 

  9. Sayınsu K, Isik F, Arun T (2006) Sagittal airway dimensions following maxillary protraction: a pilot study. Eur J Orthod 28:184–189. https://doi.org/10.1093/ejo/cji095

    Article  PubMed  Google Scholar 

  10. Aksu M, Gorucu-Coskuner H, Taner T (2017) Assessment of upper airway size after orthopedic treatment for maxillary protrusion or mandibular retrusion. Am J Orthod Dentofacial Orthop 152:364–370. https://doi.org/10.1016/j.ajodo.2016.12.027

    Article  PubMed  Google Scholar 

  11. Celikoglu M, Buyukcavus MH (2017) Changes in pharyngeal airway dimensions and hyoid bone position after maxillary protraction with different alternate rapid maxillary expansion and construction protocols: a prospective clinical study. Angle Orthod 87:519–525. https://doi.org/10.2319/082316-632.1

    Article  PubMed  Google Scholar 

  12. Akin M, Ucar FI, Chousein C, Sari Z (2015) Effects of chincup or facemask therapies on the orofacial airway and hyoid position in Class III subjects. J Orofac Orthop 76:520–530. https://doi.org/10.1007/s00056-015-0315-3

    Article  PubMed  Google Scholar 

  13. Gul Amuk N, Kurt G, Baysal A, Turker G (2019) Changes in pharyngeal airway dimensions following incremental and maximum bite advancement during Herbst-rapid palatal expander appliance therapy in late adolescent and young adult patients: a randomized non-controlled prospective clinical study. Eur J Orthod 41:322–330. https://doi.org/10.1093/ejo/cjz011

    Article  PubMed  Google Scholar 

  14. Cistulli PA, Palmisano RG, Poole MD (1998) Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 21:831–835. https://doi.org/10.1093/sleep/21.8.831

    Article  PubMed  Google Scholar 

  15. Quo S, Lo LF, Guilleminault C (2019) Maxillary protraction to treat pediatric obstructive sleep apnea and maxillary retrusion: a preliminary report. Sleep Med 60:60–68. https://doi.org/10.1016/j.sleep.2018.12.005

    Article  PubMed  Google Scholar 

  16. Auvenshine RC, Pettit NJ (2020) The hyoid bone: an overview. Cranio 38:6–14. https://doi.org/10.1080/08869634.2018.1487501

    Article  PubMed  Google Scholar 

  17. Aydemir H, Memikoğlu U, Karasu H (2012) Pharyngeal airway space, hyoid bone position and head posture after orthognathic surgery in Class III patients. Angle Orthod 82:993–1000. https://doi.org/10.2319/091911-597.1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hwang D‑M, Lee J‑Y, Choi YJ, Hwang C‑J (2019) Evaluations of the tongue and hyoid bone positions and pharyngeal airway dimensions after maxillary protraction treatment. Cranio 37:214–222. https://doi.org/10.1080/08869634.2017.1418644

    Article  PubMed  Google Scholar 

  19. Tallgren A, Solow B (1987) Hyoid bone position, facial morphology and head posture in adults. Eur J Orthod 9:1–8. https://doi.org/10.1093/ejo/9.1.1

    Article  PubMed  Google Scholar 

  20. Durão AR, Alqerban A, Ferreira AP, Jacobs R (2015) Influence of lateral cephalometric radiography in orthodontic diagnosis and treatment planning. Angle Orthod 85:206–210. https://doi.org/10.2319/011214-41.1

    Article  PubMed  Google Scholar 

  21. Liu Y, Hou R, Jin H, Zhang X, Wu Z, Li Z, Guo J (2021) Relative effectiveness of facemask therapy with alternate maxillary expansion and constriction in the early treatment of Class III malocclusion. Am J Orthod Dentofacial Orthop 159:321–332. https://doi.org/10.1016/j.ajodo.2019.12.028

    Article  PubMed  Google Scholar 

  22. Baccetti T, Franchi L, McNamara JA Jr (2002) An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod 72:316–323. https://doi.org/10.1043/0003-3219(2002)072%3C0316:aivotc%3E2.0.co;2

    Article  PubMed  Google Scholar 

  23. Cevidanes L, Baccetti T, Franchi L, McNamara JA Jr, De Clerck H (2010) Comparison of two protocols for maxillary protraction: bone anchors versus face mask with rapid maxillary expansion. Angle Orthod 80:799–806. https://doi.org/10.2319/111709-651.1

    Article  PubMed  PubMed Central  Google Scholar 

  24. Seker ED, Yagci A, Kurt Demirsoy K (2019) Dental root development associated with treatments by rapid maxillary expansion/reverse headgear and slow maxillary expansion. Eur J Orthod 41:544–550. https://doi.org/10.1093/ejo/cjz010

    Article  PubMed  Google Scholar 

  25. Solow B, Sandham A (2002) Cranio-cervical posture: a factor in the development and function of the dentofacial structures. Eur J Orthod 24:447–456. https://doi.org/10.1093/ejo/24.5.447

    Article  PubMed  Google Scholar 

  26. Pracharktam N, Hans MG, Strohl KP, Redline S (1994) Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects. Angle Orthod 64:63–74. https://doi.org/10.1043/0003-3219(1994)064%3C0063:uasceo%3E2.0.co;2

    Article  PubMed  Google Scholar 

  27. Takada K, Petdachai S, Sakuda M (1993) Changes in dentofacial morphology in skeletal Class III children treated by a modified maxillary protraction headgear and a chin cup: a longitudinal cephalometric appraisal. Eur J Orthod 15:211–221. https://doi.org/10.1093/ejo/15.3.211

    Article  PubMed  Google Scholar 

  28. Tuncer BB, Kaygisiz E, Tuncer C, Yüksel S (2009) Pharyngeal airway dimensions after chin cup treatment in Class III malocclusion subjects. J Oral Rehabil 36:110–117. https://doi.org/10.1111/j.1365-2842.2008.01910.x

    Article  PubMed  Google Scholar 

  29. Lee N‑K, Cha B‑K (2006) A cephalometric study on the velopharyngeal changes after maxillary protraction. Korean J Orthod 36:161–169

    Google Scholar 

  30. Turley PK (2002) Managing the developing Class III malocclusion with palatal expansion and facemask therapy. Am J Orthod Dentofacial Orthop 122:349–352. https://doi.org/10.1067/mod.2002.127295

    Article  PubMed  Google Scholar 

  31. Harada K, Ishii Y, Ishii M, Imaizumi H, Mibu M, Omura K (2002) Effect of maxillary distraction osteogenesis on velopharyngeal function: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:538–543. https://doi.org/10.1067/moe.2002.123827

    Article  PubMed  Google Scholar 

  32. Ko EW, Figueroa AA, Guyette TW, Polley JW, Law WR (1999) Velopharyngeal changes after maxillary advancement in cleft patients with distraction osteogenesis using a rigid external distraction device: a 1-year cephalometric follow-up. J Craniofac Surg 10:312–320. https://doi.org/10.1097/00001665-199907000-00005

    Article  PubMed  Google Scholar 

  33. Ceylan I, Oktay H (1995) A study on the pharyngeal size in different skeletal patterns. Am J Orthod Dentofacial Orthop 108:69–75. https://doi.org/10.1016/s0889-5406(95)70068-4

    Article  PubMed  Google Scholar 

  34. Hiyama S, Suda N, Ishii-Suzuki M, Tsuiki S, Ogawa M, Suzuki S, Kuroda T (2002) Effects of maxillary protraction on craniofacial structures and upper-airway dimension. Angle Orthod 72:43–77. https://doi.org/10.1043/0003-3219(2002)072%3C0043:eompoc%3E2.0.co;2

    Article  PubMed  Google Scholar 

  35. Oktay H, Ulukaya E (2008) Maxillary protraction appliance effect on the size of the upper airway passage. Angle Orthod 78:209–214. https://doi.org/10.2319/122806-535.1

    Article  PubMed  Google Scholar 

  36. Mucedero M, Baccetti T, Franchi L, Cozza P (2009) Effects of maxillary protraction with or without expansion on the sagittal pharyngeal dimensions in Class III subjects. Am J Orthod Dentofacial Orthop 135:777–781. https://doi.org/10.1016/j.ajodo.2008.11.021

    Article  PubMed  Google Scholar 

  37. Baccetti T, Franchi L, Mucedero M, Cozza P (2010) Treatment and post-treatment effects of facemask therapy on the sagittal pharyngeal dimensions in Class III subjects. Eur J Orthod 32:346–350. https://doi.org/10.1093/ejo/cjp092

    Article  PubMed  Google Scholar 

  38. Bibby R, Preston CB (1981) The hyoid triangle. Am J Orthod 80:92–97. https://doi.org/10.1016/0002-9416(81)90199-8

    Article  PubMed  Google Scholar 

  39. Tselnik M, Pogrel MA (2000) Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg 58:282–285. https://doi.org/10.1016/s0278-2391(00)90053-3

    Article  PubMed  Google Scholar 

  40. Tecco S, Festa F, Tete S, Longhi V, D’Attilio M (2005) Changes in head posture after rapid maxillary expansion in mouth-breathing girls: a controlled study. Angle Orthod 75:171–176. https://doi.org/10.1043/0003-3219(2005)075%3C0167:cihpar%3E2.0.co;2

    Article  PubMed  Google Scholar 

  41. Kim M‑A, Kim B‑R, Youn J‑K, Kim Y‑JR, Park Y‑H (2014) Head posture and pharyngeal airway volume changes after bimaxillary surgery for mandibular prognathism. J Craniomaxillofac Surg 42:531–535. https://doi.org/10.1016/j.jcms.2013.07.022

    Article  PubMed  Google Scholar 

  42. Achilleos S, Krogstad O, Lyberg T (2000) Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males. Eur J Orthod 22:383–394. https://doi.org/10.1093/ejo/22.4.383

    Article  PubMed  Google Scholar 

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthodontics, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Türkiye

    Gökhan Çoban, Taner Öztürk DDS, MDS, Merve Ece Erdem & Ahmet Yağcı

  2. Department of Orthodontics, Faculty of Dentistry, Tokat Gaziosmanpasa University, 60030, Tokat, Türkiye

    Hatice Cansu Kış

Authors
  1. Gökhan Çoban
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  2. Taner Öztürk DDS, MDS
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  3. Merve Ece Erdem
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  4. Hatice Cansu Kış
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Correspondence to Taner Öztürk DDS, MDS.

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Conflict of interest

G. Çoban, T. Öztürk, M.E. Erdem, H.C. Kış and A. Yağcı declare that they have no competing interests.

Ethical standards

This retrospective cohort study was approved by the Erciyes University Clinical Research Ethics Committee (approval code: 2019/669) and registered with the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov; registration number NCT05114642). A written informed consent form was obtained from the patients’ parents before all treatment procedures.

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Çoban, G., Öztürk, T., Erdem, M.E. et al. Effects of maxillary expansion and protraction on pharyngeal airway dimensions in relation to changes in head posture and hyoid position. J Orofac Orthop 84 (Suppl 3), 172–185 (2023). https://doi.org/10.1007/s00056-022-00426-2

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