CHANGES IN ORO-PHARYNGEAL AIRWAY DIMENSIONS AFTER TREATMENT WITH FUNCTIONAL APPLIANCE IN CLASS II SKELETAL PATTERN
Abstract
Background: Functional appliances have been used since many decades for the correction of mandibular retrognathism. Similar oral appliances are a treatment modality for patients with Obstructive sleep apnea. Hence, interception at the right age with these growth modification appliances might benefit a child from developing long term respiratory insufficiency. Therefore, the purpose of our study was to assess the short term effects of Twin block appliance (CTB) on pharyngeal airway size in subjects with skeletal Class II pattern in a sample of Pakistani population. Methods: A retrospective study was conducted from orthodontic records of 62 children (31 males, 31 females) with retrognathic mandibles using lateral cephalograms obtained at initial visit and after CTB treatment. Paired t-test was used to compare the pre-functional and post-functional treatment airway size. Independent sample t-test was used for comparison between the genders and statistical significance was kept at ‰¤0.05. Results: The upper airway width (p<0.001), nasopharyngeal depth (p=0.03) and upper airway thickness (p=0.008) was substantially improved after CTB treatment. Males showed a greater increase in upper airway width (p= 0.03) and nasopharyngeal depth (p=0.01) in comparison to the females. Conclusion: Functional appliance therapy can improve the narrow pharyngeal airway of growing children presenting with deficient mandibles having Class II skeletal pattern.
References
Hamid WM, Asad S. Prevalence of skeletal components of malocclusion using composite cephalometric analysis. Pak Oral Dental J 2003;23:137-44.
Rosenberger HC. Growth and development of naso-respiratory area in childhood. Am Otolaryng 1934;43:495-512.
Linder-Aronson S, Leighton BC. A longitudinal study of the development of the posterior nasopharyngeal wall between 3 and 16 years of age. Eur J Orthod 1983;5:47-58.
Ceylan I, Oktay H. A study on the pharyngeal size in different skeletal patterns. Am J Orthod Dentofacial Orthop 1995;108(1):69-75.
Lowe AA, Fleetham JA, Adachi S, Ryan CF. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop 1995;107(6):589-95.
Lowe AA, Ozbek MM, Miyamoto K, Pae EK, Fleetham JA. Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis. Angle Orthod 1997;67(2):143-53.
Memon S, Fida M, Shaikh A. Comparison of different craniofacial patterns with pharyngeal widths. J Coll Physicians Surg Pak 2012;22(5):302-6.
Pae EK, Lowe AA, Sasaki K, Price C, Tsuchiya M, Fleetham JA. A cephalometric and electromyographic study of upper airway structures in the upright and supine positions. Am J Orthod Dentofacial Orthop 1994;106(1):52-9.
Morrison DL, Launois SH, Isono S, Feroah TR, Whitelaw WA, Remmers JE. Pharyngeal narrowing and closing pressures in patients with obstructive sleep apnea. Am Rev Respir Dis 1993;148(3):606-11.
Späth-Schwalbe E, Hundenborn C, Kern W, Fehm HL, Born J. Nocturnal wakefulness inhibits growth hormone (GH)-releasing hormone-induced GH secretion. J Clin Endocrinol Metab 1995;80(1):214-9.
Born J, Muth S, Fehm HL. The significance of sleep onset and slow wave sleep for nocturnal release of growth hormone (GH) and cortisol. Psychoneuroendocrinology 1988;13(3):233-43.
Agren K, Nordlander B, Linder-Aronsson S, Zettergren-Wijk L, Svanborg E. Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement. Acta Otolaryngol 1998;118(4):581-7.
Jena AK, Singh SP, Utreja AK. Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible. Angle Orthod 2013;83(4):728-34.
Bacetti T, Franchi L, McNamra JA. The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopaedics. Semin Orthod. 2005;11:119-29.
Ozbek MM, Memikoglu TU, Gogen H, Lowe AA, Baspinar E. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal Class II cases. Angle Orthod 1998;68(4):327-36.
Kirjavainen M, Kirjavainen T. Upper airway dimensions in Class II malocclusion. Effects of headgear treatment. Angle Orthod 2007;77(6):1046-53.
Zhang C, He H, Ngan P. Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study. Sleep Breath 2013;17(4):1309-14.
Hänggi MP, Teuscher UM, Roos M, Peltomaki TA. Long-term changes in pharyngeal airway dimensions following activator-headgear and fixed appliance treatment. Eur J Orthod 2008;30(6):598-605.
Han S, Choi YJ, Chung CJ, Kim JY, Kim KH. Long-term pharyngeal airway changes after bionator treatment in adolescents with skeletal Class II malocclusions. Korean J Orthod 2014;44(1):13-9.
Fransson AM, Tegelberg A, Svenson BA, Lennartsson B, Isacsson G. Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring. Am J Orthod Dentofacial Orthop 2003;122(4):371-9.
Bonham PE, Currier GF, Orr WC, Othman J, Nanda RS. The effect of a modified functional appliance on obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1988;94(5):384-92.
Jena AK, Duggal R. Treatment effects of twin-block and Mandibular Protraction Appliance-IV (MPA-IV) in the correction of Class II malocclusion. Angle Orthod 2010;80(3):485-91.
Liu Y, Park YC, Lowe AA, Fleetham JA. Supine cephalometric analyses of an adjustable oral appliance used in the treatment of obstructive sleep apnea. Sleep Breath 2000;4(2):59-66.
Vinoth SK, Thomas AV, Nethravathy R. Cephalometric changes in airway dimensions with twin block therapy in growing class II patients. J Pharm Bioallied Sci 2013;5(Suppl 1):S25-9.
Restrepo C, Santamarı´a A, Pela´ez S, Tapias A. Oropharyngeal airway dimensions after treatment with functional appliances in Class II retrognathic children. J Oral Rehabil 2011;38(8):588-94.
Erbas B, Kocadereli I. Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography. Angle Orthod 2014;84(4):693-700.
Ghodke S, Utreja AK, Singh SP, Jena AK. Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in Class II malocclusion subjects. Prog Orthod 2014;15:68.
Abu Allhaija ES, Al-Khateeb SN. Uvulo-glosso-pharyngeal dimensions in different antero-posterior skeletal patterns. Angle Orthod 2005;75(6):1012-18.
Battagel JM, Johal A, Kotecha B. A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. Eur J Orthod. 2000;22(2):353-65.
Johnston CD, Richardson A. Cephalometric changes in adult pharyngeal morphology. Eur J Orthod 1999;21(4):357-62.
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