2つのプロトコールによる拡張および上顎前突後の鼻腔、咽頭気道、上顎洞容積の変化の比較：急速口蓋拡張と急速上顎拡張・収縮の交互併用

Comparison of changes in the nasal cavity, pharyngeal airway, and maxillary sinus volumes after expansion and maxillary protraction with two protocols: Rapid palatal expansion versus alternate rapid maxillary expansion and constriction.

抄録

目的:

成長期のクラスIII患者において、急速口蓋拡張（RPE）または交互急速上顎拡張収縮（Alt-RAMEC）後にフェイスマスク（FM）療法を行った後の鼻腔（NC）、上咽頭、口腔咽頭、上顎洞（MS）の一連の容積変化を、コーンビームCT（CBCT）を用いて評価し比較すること。

OBJECTIVE: To evaluate and compare a series of volume changes in the nasal cavity (NC), nasopharynx, oropharynx, and maxillary sinuses (MS) in growing Class III patients after either rapid palatal expansion (RPE) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy, by using conebeam computed tomography (CBCT).

方法:

40名の成長期III級患者をレトロスペクティブに選択し、2つのマッチさせたグループに分けた：RPE/FM群（女性14名、男性6名、平均年齢9.66±1.23歳）とAlt-RAMEC/FM群（女性14名、男性6名、平均年齢10.28±1.45歳）である。A点の前後・上下変位、NC、上咽頭、中咽頭、MSの体積を、治療前（T1）、拡大後（T2）、後引き込み（T3）の各時点で測定した。

METHODS: Forty growing Class III patients were retrospectively selected and divided into two matched groups: RPE/FM (14 females, 6 males; mean age, 9.66 ± 1.23 years) and Alt-RAMEC/FM groups (14 females, 6 males; mean age, 10.28 ± 1.45 years). The anteroposterior and vertical displacements of Point A, the volumes of the NC, nasopharyngeal, oropharyngeal, and MS were measured at different time points: pretreatment (T1), postexpansion (T2), and postprotraction (T3).

結果:

両群とも、拡大時には有意な上顎前方移動（1.3mm）を示し、前突時（RPE/FM, 1.1mm; Alt-RAMEC/FM, 2.4mm; < 0.05）および治療期間中（RPE/FM, 2.4mm; Alt-RAMEC/FM, 3.7mm; < 0.05）には統計学的に有意な群間差がみられた。NCおよび上咽頭気道容積は、拡張、伸展および治療後、両群で有意に増加した。口腔咽頭およびMSの容積は、両群とも伸展後および治療後に増加した。しかし、両群間に容積差は認められなかった。

RESULTS: Both groups demonstrated significant maxilla advancement (by 1.3 mm) during expansion, with a statistically significant intergroup difference during protraction (RPE/FM, 1.1 mm; Alt-RAMEC/FM, 2.4 mm; < 0.05) and throughout the treatment (RPE/FM, 2.4 mm; Alt-RAMEC/FM, 3.7 mm; < 0.05). NC and nasopharyngeal airway volumes increased significantly in both groups after expansion, protraction, and treatment. The oropharyngeal and MS volumes increased in both groups after protraction and post-treatment. However, no volumetric differences were observed between the two groups.

結論:

RPE/FM群とAlt-RAMEC/FM群では、NC、鼻咽頭、口腔咽頭、MSを含む気道容積の変化に、各時点で有意差は認められなかった。Alt-RAMEC/FM群では、プロトラクション後の前方への移動が有意に多かったが、その差は臨床的に関連するには小さすぎると考えられた。

CONCLUSIONS: There was no significant difference in airway volume changes, including NC, nasopharyngeal, oropharyngeal airway, and MS, between RPE/FM and Alt-RAMEC/FM groups at different time points. Although there was significantly more forward movement after protraction in the Alt-RAMEC/FM group, the difference was deemed too small to be clinically relevant.