济南地区儿童上气道及舌骨位置正常参考值的研究

目的建立济南市11～13岁儿童上气道大小及舌骨位置的正常参考值范围。方法选择无阻塞性睡眠呼吸暂停综合征临床症状的儿童208名,男性71名,女性137名,年龄11～13岁,拍摄X线数字头颅侧位片,测量其骨面型、上气道形态及舌骨位置,使用SPSS 13.0软件对测量值进行统计学分析,建立上气道及舌骨正常参考值范围。结果恒牙列初期儿童上气道大小和舌骨位置存在性别差异,女性上气道SPP-SPPW平面的矢状径比男性大（P〈0.05）;女性软腭中后气道间隙较男性大;男性比女性的舌骨位置低且靠前。结论建立了济南市恒牙初期儿童上气道及舌骨位置的正常参考值范围。     

正常骨面型儿童、成人舌骨位置的X线头影测量分析

目的对正常骨面型儿童、成人的舌骨位置进行测量及相应的比较。方法采用计算机辅助X线头影测量技术,对120名正常骨面型儿童、成人的X线头颅定位侧位片进行测量研究,对舌骨位置测量值进行统计学分析。结果男、女性之间舌骨位置均存在性别差异,男性较女性舌骨位置偏下偏前。儿童与成人之间的比较表明,从替牙期、恒牙早期到恒牙期,男性舌骨垂直位置逐渐降低,水平位置从替牙期到恒牙早期逐渐前移,而从恒牙早期到恒牙期变化不显著。女性舌骨垂直位置和水平位置从替牙期到恒牙早期逐渐下降和前移,而从恒牙早期到恒牙期变化不显著。结论应该按照性别和年龄的不同建立舌骨位置的正常参考值。     

正颌手术前后舌骨位置和咽下气道变化及相关性研究

目的　通过X线头影测量分析了解颌骨后退与前徙对舌骨位置及咽下气道变化的影响情况,为临床治疗提供参数。方法　下颌前突患者23例与小颌畸形患者9例,分别行双侧矢状劈开后退或前徙下颌,手术前后拍摄X线头颅定位侧位片,进行头影测量,测量项目13项,测量数值配对t检验,并将下颌后退距离与各测量项目变化值作相关分析。结果　各测量项目显著差异的有:(1)下颌前突组,下咽腔矢状面积(PSA),舌骨垂直向变化,舌根后缘至咽后壁距离(TBPW),舌背高点至FH平面距离(DTFH),会厌谷至咽后壁距离(VPW),悬雍垂尖点至后咽壁距离(UPW),下颌颏部水平、垂直向变化(PogPTV,MeFH)。舌骨垂直向变化与下颌颏部垂直向变化显著相关。(2)小颌畸形组,舌骨垂直向变化显著。结论　下颌前突组,(1)舌骨向下移位,舌背上抬,舌根向后移动。(2)咽腔气道空间缩小可表现为永久性,但后气道间隙接近正常人,不会发生通气阻塞,更未出现OSAS。舌骨与下颌前部垂直向变化呈负相关。(3)小颌畸形组,舌骨垂直向显著变化,舌骨因颏舌骨肌牵拉而上移。舌骨水平向无显著移位。除会厌谷前移外,舌体无显著移位,说明颌骨前徙对舌体形态没有大的影响。颌骨前徙对后气道无明显影响。从临床病例来看,小颌畸形愈重,前徙颌骨手术对周围组织结构的影响愈大。     

颌骨后退术后舌骨位置和后气道间隙变化的相关性研究

目的　通过X线头影测量分析下颌后退手术对舌骨位置和后气道间隙 (PAS)变化的影响 ,为临床治疗提供依据。方法　下颌前突畸形患者 18例 ,均接受经口内下颌骨升支垂直截骨术 ,术前和术后 1个月拍摄标准颅颌侧位片进行头影测量 ,测量项目 6项 ,测量数值配对t检验 ,并将下颌骨后退距离与各测量项目变化作相关分析。结果　术后下颌骨后退的平均值是 (10 .2 0± 1.31)mm。各测量项目显著差异的有 :舌骨垂直方向变化 ,舌根后缘至咽后壁的距离 ,后气道间隙面积。下颌骨后退距离与PAS面积的减小值和舌骨垂直方向变化密切相关 ,与PAS宽度减小值和舌骨水平方向变化没有密切相关。结论　双侧下颌升支垂直截骨后退术后近期 ,舌骨向下移位 ,舌根后移 ,咽腔气道缩小 ,如果患者同时具有超重、短颈、舌体大等其他危险因素 ,下颌骨后退手术可能导致睡眠呼吸暂停综合征的发生。下颌骨后退距离与后气道间隙面积的减小值和舌骨垂直方向变化呈正相关。     

舌骨位置与口腔正畸Ⅲ．Angle各类错合早期恒牙合儿童舌骨位置的X线头影测量研

本文对１４３例早期恒牙各类错患者的舌骨位置，通过Ｘ线头影测量方法进行了研究。并对各类错之间及其与正常之间的舌骨位置加以对比观察。结果表明：各种错畸形中舌骨位置变化在一定范围内是较明显的，然而又存在一定的规律性。提示舌骨位置与错畸形有关。此外，舌骨位置与下颌骨升枝，下颌颏部以及颈椎之间保持一定的协调关系，表明在错形成过程中机体内存在着一定程度的生理补偿机制。     

骨性Ⅱ类患者上气道形态及舌骨位置与颅颌面骨形态的相关性研究

目的　通过锥形束CT（CBCT）探究骨性Ⅱ类患者上气道形态及舌骨位置与颅颌面骨形态的相关性。方法  按纳入标准选取2016—2019年就诊于山西医科大学第一医院口腔科的60例患者的CBCT影像资料,并将其分为骨性Ⅰ类组、骨性Ⅱ类上颌前突组和骨性Ⅱ类下颌后缩组,每组20例。应用Dolphin11.95软件进行上气道的三维重建,测量颌骨形态、上气道形态及舌骨位置,对数据进行统计学分析。结果　上气道鼻咽段和腭咽段的容积及最小横截面积与SNA（蝶鞍中心、鼻根点及下齿槽座点所构成角）、ANS-PNS距（前后鼻棘点间距）呈正相关,骨性Ⅱ类上颌越前突上气道鼻咽段和腭咽段的容积及最小横截面积越大。上气道舌咽段和喉咽段的容积及最小横截面积与SNB（蝶鞍中心、鼻根点及下齿槽座点所构成角）、Go-Gn（下颌体长度）呈正相关,骨性Ⅱ类下颌越后缩上气道舌咽段和喉咽段的容积及最小横截面积越小。舌骨位置的测量指标H-VPS三组之间比较差异有统计学意义（P＜0.05）。结论　上气道各段的形态与其周围的颅颌面骨形态有着紧密的关联,上气道、颌骨及舌骨之间的关系密不可分。     

呼吸方式与舌骨位置关系的研究

目的：揭示呼吸方式与舌骨位置的关系。方法：通过口鼻气流同步测定系统的随机检测，选择鼻呼吸比例≤70％(口呼吸组)及鼻呼吸比例≥95％(鼻呼吸组)的11～14岁儿童各34人，比较其头颅定位侧位片中舌骨位置的差异，及与13呼吸比例的相关关系。结果：13呼吸与鼻呼吸儿童除H—RGn(P＜0．05)外，舌骨位置无统计学差异，单因素相关分析未发现呼吸时口气流所占的比例与舌骨位置存在相关关系(P＞0．05)。结论：呼吸方式与舌骨位置无明显关系。     

口呼吸青少年儿童上气道形态与舌骨位置的特征研究

目的    应用锥形束CT（CBCT）评估口呼吸患者与鼻呼吸患者上气道形态以及舌骨位置的差异。方法    按照纳入标准选取2018—2021年就诊于山西医科大学第一医院口腔正畸科的青少年儿童骨性Ⅰ类均角患者78例,根据呼吸方式分为口呼吸组（39例）与鼻呼吸组（39例）并拍摄CBCT。应用Dolphin11.95软件进行上气道的三维重建,分别测量上气道各段容积、矢状面表面积、最小横截面积、气道三维结构表面积及舌骨位置,对数据进行统计学分析。结果    口呼吸组上气道腭咽段和舌咽段的容积、矢状面表面积、最小横截面积以及气道三维结构表面积均小于鼻呼吸组,差异有统计学意义（P < 0.05）;口呼吸组与鼻呼吸组的上气道鼻咽段与喉咽段测量项目差异均无统计学意义（P > 0.05）;舌骨相对于前颅底平面的垂直向距离和水平向距离在两组之间的差异均无统计学意义（P > 0.05）。结论    青少年儿童口呼吸骨性Ⅰ类均角患者的上气道明显较鼻呼吸患者狭窄,但口呼吸对舌骨位置的影响不显著。     

成人前牙开(牙合)患者舌骨位置的研究

目的 探讨开(牙合)患者舌骨位置特征.方法 60例患者分为两组,开验组30例,对照组30例.通过头颅侧位X线片研究两组患者舌骨位置的差异.结果 与对照组比较,开(牙合)组舌骨位置在垂直向上无差异.矢状向上,开(牙合)患者舌骨前上点HA与第三颈椎前下点C3的距离(HA-C3)为(31.10±4.27) mm,舌骨前上点HA与颈椎前平面的距离(HA-CVP)为(30.30±4.70) mm;对照组HA-C3和HA-CVP分别为(33.66±4.50) mm和(32.95±4.27) mm,开(牙合)组的HA-C3和HA-CVP小于对照组,差异均有统计学意义(P＜0.05).结论 开(牙合)患者舌骨位置矢状向上较对照组正常(牙合)群体相对颈椎更靠后.     

31例儿童及青少年期含牙囊肿保守治疗临床观察

目的 通过对31例儿童及青少年含牙囊肿的诊治,总结其发病特点及治疗经验.方法 收集北京儿童医院2008 ～ 2012年31例颌骨含牙囊肿病例,回顾性分析囊肿的部位、原因,根据囊肿部位及大小,结合恒牙胚的位置采取拔除病灶牙的一次性开窗治疗或进行开窗减压长期冲洗治疗,并对部分病例采用保留恒牙胚的囊肿刮除手术治疗,观察治疗结果.结果 儿童及青少年颌骨囊肿好发牙位为下颌前磨牙区,其次是上颌尖牙区及上颌中切牙区.前牙区发病多与乳牙龋坏及外伤有关,后牙区发病多与乳牙龋坏有关.通过以上保守治疗可以最大程度保留囊腔内继承恒牙,部分位置异常的牙齿需要进一步辅助正畸治疗.结论 儿童及青少年含牙囊肿,根据囊肿的大小和部位选择适合的保留恒牙胚的治疗方法,可以达到较好的效果,部分病例需要进一步正畸治疗.     

Midfacial fractures in children and adolescents: a review of 492 cases

We studied the records of children and adolescents admitted to our hospital with facial fractures between 1993 and 2002. During the 10-year period, 492 patients with 555 midfacial fractures were treated. Their ages ranged from 1 to 18 years, the peak incidence being between 16 and 18. Three-hundred and eighty (77%) were boys. The zygoma was the most commonly fractured bone (n = 286), and the hard palate the least commonly fractured (n = 6). Motor-vehicles were responsible for 272 (55%) of all fractures. Most fractures were treated by closed reduction, and only 139 (25%) were treated by observation. Complications, including unsatisfactory fracture repair and infection, were recorded in 18 (4%) and the overall mortality was 1% (n = 8).     

不同垂直骨面型成年患者上气道形态和舌骨位置差异的研究

目的:比较不同垂直骨面型成年患者上气道形态和舌骨位置的差异,为临床诊疗和颅面部生长发育的研究提供一定参考依据。方法:采用计算机辅助X线头影测量技术,对120名不同垂直骨面型成年患者的X线头颅定位侧位片进行测量,比较不同性别、不同垂直骨面型组间上气道矢状径和舌骨位置的差异。结果:上气道各段矢状径男性大于女性,但除V-LPW外无统计学差异;不同垂直骨面型组间存在显著差异,高角组<均角组<低角组。舌骨位置存在性别差异,AH-SN,AH-FH男性大于女性(P<0.01),AH-C3男性大于女性(P<0.001),舌骨位置男性比女性偏前下。不同垂直骨面型组间舌骨垂直向位置无显著差异(P>0.05),水平向从高角、均角到低角组AH-O逐渐减小,AH-C3逐渐增大,舌骨位置在水平向逐渐前移。结论:不同垂直骨面型成年患者上气道形态、舌骨位置存在差异,这可能与不同垂直骨面型下颌骨的旋转方式有关。     

Effectiveness of aspartate aminotransferase as a marker of periodontal disease in children and adolescents

BackgroundBiochemical markers from saliva and gingival crevicular fluid are of interest in preventing periodontal disease. We investigated the possibility of detecting aspartate aminotransferase (AST) levels in children and teenagers, as well as the usefulness of the addition of measurements of N-bezyoyl-DL-arginine-2-naphthylamide (BANA) activity and AST release during regular oral check-ups.Subjects and methodsFifty-four children (33 males; 8–15 years) from the pediatric dental clinic of Hiroshima University Hospital were enrolled. Periodontal conditions were investigated using scores of the community periodontal index (CPI), BANA and AST. Bacterial species were also identified.ResultsIn 51 eligible subjects, 64.7% were CPI 1 and 35.3% were CPI 2, and these subjects were diagnosed as having gingivitis. A high BANA score was increased in the CPI 2 group (p = 0.022) and the AST score showed a similar trend. All scores of BANA and AST were found in the same CPI. The number of subjects with higher scores of BANA and/or AST increased with increasing age.ConclusionsIt was possible to measure AST levels in children and teenagers. It is suggested that we provide more specific information to children and their guardian using BANA and AST. Measuring biomarkers during regular oral check-ups could lead to an early diagnosis and intervention to avoid the progression of periodontitis during the childhood and teenage years.     

Radiographic evaluation in three dimensions of condylar fractures with closed treatment in children and adolescents

The study aimed at investigating a new three-dimensional classification of healing morphology in condylar fractures in children and adolescents after closed treatment, and establish its association with fracture type and clinical outcomes.The medical records of children and adolescents with condylar fracture were reviewed, retrospectively. The clinical outcomes were assessed by mandibular deviation during mouth opening, Helkimo anamnestic index (Ai), and Helkimo clinical dysfunction index (Di). The condylar healing morphology was evaluated through three-dimensional CT images after 1–2 years of follow-up.In total, 96 patients with 142 condylar fracture sites were included in the study. Condylar healing morphology was classified into three main patterns: unchanged (21.13%), spherical (62.68%), and irregular (16.19% — including the three subtypes triangular, L-shaped, and Y-shaped). There was a significant difference in the distribution of the three main healing patterns among various fracture types (p = 0.0227). Irregular patterns occurred more frequently in adolescents than in children. In unilateral fractures, no obvious association was found between condylar healing morphology and clinical outcomes, including mandibular deviation during mouth opening (p = 0.162), Ai (p = 0.0991) and Di (p = 0.25). Most patients healing in different condylar patterns reached a good clinical outcome after 1–2 years.Although the healing morphology of condylar fractures in children and adolescents remained abnormal, good clinical outcome was achieved over the 2-year follow-up. Therefore, closed treatment remains a good approach.     

Analysis of three dimensional oropharyngeal airway and hyoid position in retrognathic adolescent patients

ObjectiveTo test the null hypotheses that there is no significant difference in the three-dimensional size of the oropharyngeal space or hyoid position when comparing individuals with a normal jaw relationship with individuals with retrognathic mandibles.MethodsIn total, 226 skeletal class I (0.7° ≤ ANB < 4.7°) or class II (ANB > = 4.7°) adolescent patients were examined and categorized into two groups: normal group and retrognathic group. Group classifications were made based on SNA angle, SNB angle, ANB angle, and maxillary length (Ptm-ANS). From the total available cases, 60 subjects met the above classification criteria and had a normo-divergent facial pattern, with 30 cases in each group. Cone beam computed tomography (CBCT) images were collected for each participant and InVivoDental (Anatomage, San Jose, Calif) software was used to analyze 60 CBCT scans. Mimics 17.0 software was used to reconstruct the upper airway, and indices of oropharyngeal airway dimensions and hyoid position were calculated.ResultsThe oropharyngeal airway dimensions of adolescent patients in the retrognathic group were smaller than adolescent patients in the normal group. The hyoid was positioned more superior and posterior in the retrognathic group. With decreases in mandibular length and SNB angle, oropharyngeal space volume tended to decrease, the hyoid tended to be more superior and posterior.ConclusionThe null hypotheses were rejected. Significant differences in the three-dimensional size of the oropharyngeal space or hyoid position when comparing individuals with a normal jaw relationship with individuals with retrognathic mandibles.     

Study on self-assessment regarding knowledge of temporomandibular disorders in children/adolescents by Swedish and Saudi Arabian dentists

Abstract

Objective. To estimate the degree of self-assessed knowledge among dentists in Sweden and Saudi Arabia regarding temporomandibular disorders (TMD) in children and adolescents using a summative form of assessment and further to investigate the possible factors that may influence the self-assessed knowledge. Materials and methods. A questionnaire survey covering four domains (Etiology; Diagnosis and classification; Chronic pain and pain behavior; Treatment and prognosis) regarding TMD knowledge was used. Out of 250 questionnaires (125 in each country) a total of 65 (52%) were returned in Sweden and 104 (83%) in Saudi Arabia. Results. Self-assessed individual knowledge was significantly associated to the level of actual knowledge among the Swedish groups in the domains Etiology; Diagnosis and classification and Treatment and prognosis (p < 0.05). However, in the Saudi Arabian groups a corresponding significant association was only found in the domain Diagnosis and classification (p < 0.05). Conclusions. This study showed that there is a difference in the accuracy of self-assessment of own knowledge between the dentists in Sweden and Saudi Arabia. The Swedish dentists have a better ability to assess their level of knowledge compared to Saudi Arabian dentists regarding TMD in children and adolescents. This difference could be related to several factors such as motivation, positive feedback, reflection, psychomotor, and interpersonal skills, which all are more dominant in the Swedish educational tradition.     

穿刺活检在儿童及青少年颌面部肿瘤中的诊断价值

目的:探讨穿刺活检诊断儿童及青少年颌面部肿瘤的准确性和安全性。方法:收集2017年1月—2018年7月上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科门诊收治的18岁以下颌面部肿瘤病例共10例,其中男6例,女4例,平均年龄12岁（8~18岁）,所有患者均采用穿刺活检进行诊断。粗针穿刺：使用16G穿刺针取3~5条组织;细针穿刺：用10 mL针筒吸取细胞。对比穿刺病理及术后病理诊断,并记录穿刺后并发症情况。结果:粗针穿刺共4例,3例接受手术治疗。1例穿刺病理为纤维母细胞/肌纤维细胞性肿瘤。2例为横纹肌肉瘤,1例诊断为非肿瘤性病变。细针穿刺共6例,5例接受手术治疗。1例穿刺病理为朗格汉斯细胞组织细胞增生症或巨细胞肉芽肿待排;1例穿刺见大量血液;1例为小圆细胞肿瘤;1例为左下颌下淋巴结穿刺见大量炎症细胞;1例为上皮性恶性肿瘤;1例为横纹肌肉瘤。粗针及细针穿刺后进行手术的患者,大体标本病理诊断与穿刺病理诊断结果均一致。穿刺后均未发生大出血、伤口感染、肿瘤穿刺通道种植转移等并发症。结论:穿刺活检诊断儿童及青少年颌面部肿瘤安全、准确。     

Change of hyoid bone position in patients treated for and resolved of myofascial pain

ABSTRACT

Objective: The purpose of this study was to investigate change in hyoid bone position for patients suffering from myofascial pain and to evaluate the modified hyoid triangle as a three-dimensional cephalometric modality for measuring hyoid position.

Methods: Pre- and post-treatment CBCT scans for 30 female patients resolved of myofascial pain were reviewed by a blinded investigator using the modified hyoid triangle. Changes in dimensions of the hyoid triangle were analyzed with the t-test for paired comparisons.

Results: Statistical analysis showed a drawing nearer of the chin to the third cervical vertebra (–2.0 mm, p = 0.026) and a release of the hyoid bone away from the floor of the mouth (1.5 mm, p = 0.011).

Discussion: These findings suggest resolution of myofascial pain may correlate with decreased forward head posture and relaxation of suprahyoid musculature. The potential for change in oropharyngeal dimension and airway is evident.     

Correlation between the position of hyoid bone and subregions of the pharyngeal airway space in lateral cephalometry and cone beam computed tomography

Objective: To correlate the pharyngeal airway subregions with the positioning of the hyoid bone.Material and Methods: The study examined 107 lateral cephalometric (LC) and cone beam computed tomography (CBCT) images. Linear and volumetric measurements of the pharyngeal subregions were made and correlated to linear measurements using hyoid triangle analysis on images of LC and multiplanar (MPR) and three-dimensional (3D) reconstructions of CBCT.Results: There was significant correlation between linear measurements of the pharyngeal subregions and hyoid bone position in LC images and in MPR and 3D reconstructions of the CBCT. Correlations were more frequent in the oropharynx and hypopharynx, especially for LC images. No correlations were observed between LC images or CBCT reconstructions and the volumetric measurements of the pharyngeal subregions and the position of the hyoid bone.Conclusion: The hyoid bone position showed more correlations with oropharynx and hypopharynx airway measurements. The hyoid triangle method was not applicable to 3D images, since it showed a smaller number of measures correlated to the hyoid bone position.