Korean J Orthod.  2020 Jul;50(4):238-248. 10.4041/kjod.2020.50.4.238.

Effects of the long-term use of maxillary protraction facemasks with skeletal anchorage on pharyngeal airway dimensions in growing patients with cleft lip and palate

• Kim JE
• Yim S
• Choi JY
• Kim S
• Kim SJ
• Baek SH

• KMID: 2504141
• DOI: http://doi.org/10.4041/kjod.2020.50.4.238

Abstract

Objective
To investigate the effects of the long-term use of a maxillary protraction facemask with miniplate (FM-MP) on pharyngeal airway dimensions in growing patients with cleft lip and palate (CLP).
Methods
The study included 24 boys with CLP (mean age, 12.2 years; mean duration of FM-MP therapy, 4.9 years), divided into two groups according to the amount of A point advancement to the vertical reference plane (VRP): Group 1, > 4 mm; Group 2, < 2 mm; n = 12/group. After evaluating the skeletodental and airway variables using lateral cephalograms acquired before and after FM-MP therapy, statistical analyses were performed.
Results
Group 1 showed greater forward and downward displacements of the posterior maxilla (posterior nasal spine [PNS]-horizontal reference plane [HRP]; PNSVRP), greater increase in ANB, more forward tongue position (tongue tip-Pt vertical line to Frankfort horizontal plane), and greater increase in the oropharynx (superior posterior airway space [SPAS]; middle airway space [MAS]) and upper nasopharynx (PNS-adenoid2) than did Group 2. While maxillary advancement (A-VRP and PNS-VRP) correlated with increases in SPAS, MAS, and PNS-adenoid2, downward displacement of the PNS (PNS-HRP) correlated with increases in SPAS, MAS, PNSadenoid1, and PNS-adenoid2, and with a decrease in vertical airway length (VAL). Mandibular forward displacement and decrease in mandibular plane correlated with increases in MAS.
Conclusions
FM-MP therapy had positive effects on the oropharyngeal and nasopharyngeal airway spaces without increases in VAL in Group 1 rather than in Group 2. However, further validation using an untreated control group is necessary.

Keyword

Growing patients with cleft lip and palate; Maxillary protraction; Facemask with miniplate; Pharyngeal airway dimension

Figure

• 

  Figure 1 A, An example of facemask with miniplate (FM-MP) therapy. B, Reference lines. The horizontal reference plane (HRP) passes the Sella (S) at an angle of 7 degree clockwise to the Sella-Nasion (SN) plane. The vertical reference plane (VRP) is perpendicular to the HRP passing through the S. A-VRP is the horizontal distance from the VRP to A point.

• 

  Figure 2 Cephalometric landmarks and measurements. A, Landmarks. S, Sella; N, nasion; Ba, basion; Or, orbitale; Po, porion; Pt, pterygoid point; R, midpoint between sella and basion; AD1, adenoid point 1 (adenoid tissue on the PNS-Ba line); AD2, adenoid point 2 (adenoid tissue on the R-PNS line); Co, condylion; Go, gonion; ANS, anterior nasal spine; PNS, posterior nasal spine; A, point A; B, point B; TT, tongue tip; Pog, pogonion; Me, menton; P, tip of the soft palate; Eb, base of the epiglottic fold; H, hyoidale (the most anterosuperior point on the body of the hyoid bone); RGN, retrognathion; Pm, protuberance menti; Xi, geometric center of the ramus; FH, Frankfort horizontal; C3, the third vertebrae. B, Skeletodental variables. 1, SNA; 2, SNB; 3, SN-Pog; 4, ANB; 5, effective maxillary length (EMxL); 6, effective mandibular length (EMnL); 7, ANS-Me; 8, lower facial height (ANS-Xi-Pm); 9, overjet; 10, U1-SN; 11, U1-FH; 12, L1-MP. C, Airway-related variables. hyoid bone 1, H-RGN; 2, MP-H; 3, H-PTV; 4, H-C3Me; tongue 5, TGL; 6, TGH; 7, Td-PP; 8, TT-PTV; soft palate 9, SPL; 10, SPT; 11, SPA; pharyngeal airway 12, SPAS; 13, MAS; 14, IAS; 15, PNS-AD1; 16, PNS-AD2. See Table 2 for definitions of each landmark or measurement.

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