Abstract:

Objective　To explore the effects of upper airway obstruction on the prevalence of malocclusion in children，and use the cephalometrics to study the effects of upper airway obstruction on craniomaxillofacial growth and development. Methods　（1）Prevalence of malocclusion：craniomaxillofacial examination was carried out respectively on 176 children with upper airway obstruction in ENT Department（Group ENT） and on 485 primary and middle school students（Group GS）. The total prevalence of malocclusion and the prevalence of malocclusion of different dental stages were compared between two groups of children. Then count the malocclusion constitute ratio on Angel，s classification. （2）Cephalometric analysis：there were 32 patients with upper airway obstruction from ENT department as orthodontic treatment group（Group H）and 32 patients without the upper airway obstruction as orthodontic clinic group（Group N）. Measure the cephalometrics of craniomaxillofacial soft and hard tissue，upper airway sagittal dimension and hyoid bone position，then statistical analysis was done by independent-sample t-test. Results　The prevalence of malocclusion of primary dentition period，mixed dentition period and total prevalence of malocclusion in Group ENT were higher than Group GS with statistical significance（P＜0.001）. There was no significant difference between the two groups in permanent dentition period（P＞0.05）. Between Group H and Group N，in craniomaxillofacial soft and hard tissue measurements，only SNGoGn had statistical difference（P＜0.05）；there were significant differences in three parameters of upper airway：posterior nasal spine point to the pharyngeal wall （PNS-UPW），middle soft palate to the posterior pharyngeal wall（SPP-SPPW）and narrowest airway clearance（Mc1-Mc2）（P＜0.05）；the measurements of H-PP，H-PNS，H-MP and H-C3（V） representing the vertical position of the hyoid bone had statistically significant differences （P＜0.05）while no other measurements were statistically significant. Conclusion　The prevalence of malocclusion in children with upper airway obstruction is significantly higher than that of the normal population. Children with upper airway obstruction during their growth and development are prone to have vertical mandibular growth，a reduction in the upper pharyngeal sagittal dimension and lower hyoid position.

Key words: upper airway obstruction, malocclusion prevalence, craniomaxillofacial development, airway, hyoid bone

摘要：

目的　研究上呼吸道阻塞患儿错牙合畸形的患病率情况，并利用头影测量分析上呼吸道阻塞对颅颌面生长发育的影响。方法　（1）错牙合畸形患病率调查：选取2017年5—9月于中国医科大学附属盛京医院耳鼻喉科门诊就诊的上呼吸道阻塞患儿176例为病例组（ENT组），另选取2017年6月于辽宁省沈阳市光明中学七年级和塔湾小学三年级进行口颌面错牙合畸形普查的中小学生485名为对照组（GS组）。比较两组人群不同牙合期和整体错牙合畸形的患病率，并统计不同牙合期错牙合畸形的安氏分类构成比。（2）头影测量分析：选取2017年5—9月于中国医科大学附属盛京医院耳鼻喉科门诊就诊的上呼吸道阻塞并进行正畸治疗的患儿32例为病例组（H组），另选取2016年1月至2017年12月于中国医科大学附属口腔医院正畸科就诊的上呼吸道通畅并进行正畸治疗的患儿32例为对照组（N组）。分别对两组患儿的颅颌面软硬组织、气道矢状径间隙和舌骨位置进行测量，采用独立样本t检验对两组测量值进行统计学分析。结果　（1）ENT组患儿替牙牙合期、乳牙牙合期以及整体错牙合畸形的患病率均高于GS组，差异有统计学意义（P＜0.001），但恒牙牙合期两组患病率的差异无统计学意义（P＞0.05）。（2）H组和N组患儿，在颅颌面软硬组织测量指标中，仅下颌平面角（SNGoGn）测量结果差异具有统计学意义（P＜0.05）；在气道间隙矢状径测量中，软腭上后气道间隙（PNS-UPW）、软腭中后气道间隙（SPP-SPPW）、气道间隙最窄处距离（Mc1-Mc2）3项指标测量结果差异具有统计学意义（P＜0.05）；在舌骨垂直向位置测量中，H点到腭平面的距离（H-PP）、H点与后鼻棘点的距离（H-PNS）、H点到下颌平面的距离（H-MP）和H点与第三颈椎垂直距离［H-C3（V）］4项指标测量结果差异具有统计学意义（P＜0.05）。结论　上呼吸道阻塞患儿的错牙合畸形患病率明显高于普通人群。在生长发育期，上呼吸道阻塞易导致下颌骨的垂直向生长、咽腔上部矢状间隙的减小和舌骨位置下降改变。

关键词: 上呼吸道阻塞, 错牙合畸形患病率, 颅颌面生长发育, 气道, 舌骨