Korean J Orthod.  2023 May;53(3):175-184. 10.4041/kjod22.075.

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

• Liu W
• Zhou S
• Yen E
• Zou B

• KMID: 2542812
• DOI: http://doi.org/10.4041/kjod22.075

Abstract

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).
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).
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; p < 0.05) and throughout the treatment (RPE/FM, 2.4 mm; Alt-RAMEC/FM, 3.7 mm; p < 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.
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.

Keyword

Airway; Class III treatment; Cone-beam computed tomography; Facemask

Figure

• 

  Figure 1 The coronal and mid-sagittal sections on cone-beam computed tomography used to measure the antero-posterior and vertical position of Point A relative to the midline reference point (ML).

• 

  Figure 2 Boundaries and volume measurements used in this study.

Reference

1. Wells AP, Sarver DM, Proffit WR. 2006; Long-term efficacy of reverse pull headgear therapy. Angle Orthod. 76:915–22. https://doi.org/10.2319/091605-328. DOI: 10.2319/091605-328. PMID: 17090164.

2. Souki BQ, Nieri M, Pavoni C, Pavan Barros HM, Junqueira Pereira T, Giuntini V, et al. 2020; Development and validation of a prediction model for long-term unsuccess of early treatment of Class III malocclusion. Eur J Orthod. 42:200–5. https://doi.org/10.1093/ejo/cjz031. DOI: 10.1093/ejo/cjz031. PMID: 31067294.

3. Guyer EC, Ellis EE 3rd, McNamara JA Jr, Behrents RG. 1986; Components of class III malocclusion in juveniles and adolescents. Angle Orthod. 56:7–30. https://pubmed.ncbi.nlm.nih.gov/3485393/. DOI: 10.1043/0003-3219(1986)056<0007:COCIMI>2.0.CO;2. PMID: 3485393.

4. Ngan PW, Hagg U, Yiu C, Wei SH. 1997; Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction. Semin Orthod. 3:255–64. https://doi.org/10.1016/s1073-8746(97)80058-8. DOI: 10.1016/S1073-8746(97)80058-8. PMID: 9573887.

5. Vaughn GA, Mason B, Moon HB, Turley PK. 2005; The effects of maxillary protraction therapy with or without rapid palatal expansion: a prospective, randomized clinical trial. Am J Orthod Dentofacial Orthop. 128:299–309. https://doi.org/10.1016/j.ajodo.2005.04.030. DOI: 10.1016/j.ajodo.2005.04.030. PMID: 16168327.

6. Lee WC, Shieh YS, Liao YF, Lee CH, Huang CS. 2021; Long-term maxillary anteroposterior changes following maxillary protraction with or without expansion: a meta-analysis and meta-regression. PLoS One. 16:e0247027. https://doi.org/10.1371/journal.pone.0247027. DOI: 10.1371/journal.pone.0247027. PMID: 33617540. PMCID: PMC7899359. PMID: 13e2b4f8bda440f4bee127499206d705.

7. Liou EJ, Tsai WC. 2005; A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J. 42:121–7. https://doi.org/10.1597/03-107.1. DOI: 10.1597/03-107.1. PMID: 15748102.

8. Liou EJ. 2005; Effective maxillary orthopedic protraction for growing Class III patients: a clinical application simulates distraction osteogenesis. Prog Orthod. 6:154–71. https://pubmed.ncbi.nlm.nih.gov/16276426/. PMID: 16276426.

9. Isci D, Turk T, Elekdag-Turk S. 2010; Activation-deactivation rapid palatal expansion and reverse headgear in Class III cases. Eur J Orthod. 32:706–15. https://doi.org/10.1093/ejo/cjq006. DOI: 10.1093/ejo/cjq006. PMID: 20457582.

10. Masucci C, Franchi L, Giuntini V, Defraia E. 2014; Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthod Craniofac Res. 17:259–69. https://doi.org/10.1111/ocr.12051. DOI: 10.1111/ocr.12051. PMID: 25041370.

11. Liu Y, Hou R, Jin H, Zhang X, Wu Z, Li Z, et al. 2021; Relative effectiveness of facemask therapy with alternate maxillary expansion and constriction in the early treatment of Class III malocclusion. Am J Orthod Dentofacial Orthop. 159:321–32. https://doi.org/10.1016/j.ajodo.2019.12.028. DOI: 10.1016/j.ajodo.2019.12.028. PMID: 33487499.

12. Liu W, Zhou Y, Wang X, Liu D, Zhou S. 2015; Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients: a single-center, randomized controlled trial. Am J Orthod Dentofacial Orthop. 148:641–51. https://doi.org/10.1016/j.ajodo.2015.04.038. DOI: 10.1016/j.ajodo.2015.04.038. PMID: 26432320.

13. Fischer B, Masucci C, Ruellas A, Cevidanes L, Giuntini V, Nieri M, et al. 2018; Three-dimensional evaluation of the maxillary effects of two orthopaedic protocols for the treatment of Class III malocclusion: a prospective study. Orthod Craniofac Res. 21:248–57. https://doi.org/10.1111/ocr.12247. DOI: 10.1111/ocr.12247. PMID: 30253035.

14. Özbilen EÖ, Yılmaz HN, Acar YB. 2021; Does Alt-RAMEC protocol and facemask treatment affect dentoalveolar structures? Angle Orthod. 91:626–33. https://doi.org/10.2319/111620-940.1. DOI: 10.2319/111620-940.1. PMID: 33843979. PMCID: PMC8376168.

15. Kale B, Buyukcavus MH. 2021; Determining the short-term effects of different maxillary protraction methods on pharyngeal airway dimensions. Orthod Craniofac Res. 24:543–52. https://doi.org/10.1111/ocr.12471. DOI: 10.1111/ocr.12471. PMID: 33506632.

16. Lee JW, Park KH, Kim SH, Park YG, Kim SJ. 2011; Correlation between skeletal changes by maxillary protraction and upper airway dimensions. Angle Orthod. 81:426–32. https://doi.org/10.2319/082610-499.1. DOI: 10.2319/082610-499.1. PMID: 21299388. PMCID: PMC8923552.

17. Pamporakis P, Nevzatoğlu Ş, Küçükkeleş N. 2014; Three-dimensional alterations in pharyngeal airway and maxillary sinus volumes in Class III maxillary deficiency subjects undergoing orthopedic facemask treatment. Angle Orthod. 84:701–7. https://doi.org/10.2319/060513-430.1. DOI: 10.2319/060513-430.1. PMID: 24417494. PMCID: PMC8650436.

18. Iwasaki T, Suga H, Yanagisawa-Minami A, Sato H, Sato-Hashiguchi M, Shirazawa Y, et al. 2019; Relationships among tongue volume, hyoid position, airway volume and maxillofacial form in paediatric patients with Class-I, Class-II and Class-III malocclusions. Orthod Craniofac Res. 22:9–15. https://doi.org/10.1111/ocr.12251. DOI: 10.1111/ocr.12251. PMID: 30421852.

19. Adobes Martin M, Lipani E, Alvarado Lorenzo A, Bernes Martinez L, Aiuto R, Dioguardi M, et al. 2020; The effect of maxillary protraction, with or without rapid palatal expansion, on airway dimensions: a systematic review and meta-analysis. Eur J Paediatr Dent. 21:262–70. https://doi.org/10.23804/ejpd.2020.21.04.2.

20. Yilmaz BS, Kucukkeles N. 2014; Skeletal, soft tissue, and airway changes following the alternate maxillary expansions and constrictions protocol. Angle Orthod. 84:868–77. https://doi.org/10.2319/092713-705.1. DOI: 10.2319/092713-705.1. PMID: 24621102. PMCID: PMC8634817.

21. Onem Ozbilen E, Yilmaz HN, Kucukkeles N. 2019; Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy. Korean J Orthod. 49:49–58. https://doi.org/10.4041/kjod.2019.49.1.49. DOI: 10.4041/kjod.2019.49.1.49. PMID: 30603625. PMCID: PMC6306318.

22. Celikoglu M, Buyukcavus MH. 2017; Changes in pharyngeal airway dimensions and hyoid bone position after maxillary protraction with different alternate rapid maxillary expansion and construction protocols: a prospective clinical study. Angle Orthod. 87:519–25. https://doi.org/10.2319/082316-632.1. DOI: 10.2319/082316-632.1. PMID: 28139938. PMCID: PMC8366701.

23. Garrett BJ, Caruso JM, Rungcharassaeng K, Farrage JR, Kim JS, Taylor GD. 2008; Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 134:8–9. https://doi.org/10.1016/j.ajodo.2008.06.004. DOI: 10.1016/j.ajodo.2008.06.004. PMID: 18617096.

24. Smith T, Ghoneima A, Stewart K, Liu S, Eckert G, Halum S, et al. 2012; Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 141:618–26. https://doi.org/10.1016/j.ajodo.2011.12.017. DOI: 10.1016/j.ajodo.2011.12.017. PMID: 22554756.

25. Dias RR, Takeshita WM, Sverzut AT, Trivellato AE, Sverzut CE. 2021; Linear analysis of the nasal septum in patients treated with surgically assisted rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 159:71–80. https://doi.org/10.1016/j.ajodo.2019.11.021. DOI: 10.1016/j.ajodo.2019.11.021. PMID: 33234461.

26. Abdalla Y, Brown L, Sonnesen L. 2019; Effects of rapid maxillary expansion on upper airway volume: a three-dimensional cone-beam computed tomography study. Angle Orthod. 89:917–23. https://doi.org/10.2319/101218-738.1. DOI: 10.2319/101218-738.1. PMID: 30942607. PMCID: PMC8109167.

27. Zimmerman JN, Vora SR, Pliska BT. 2019; Reliability of upper airway assessment using CBCT. Eur J Orthod. 41:101–8. https://doi.org/10.1093/ejo/cjy058. DOI: 10.1093/ejo/cjy058. PMID: 30184085.

28. da Luz Vieira G, de Menezes LM, de Lima EM, Rizzatto S. 2009; Dentoskeletal effects of maxillary protraction in cleft patients with repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J. 46:391–8. https://doi.org/10.1597/07-144.1. DOI: 10.1597/07-144.1. PMID: 19642763.

29. Çelebi F, Çelikdelen M. 2020; Comparison of the changes following two treatment approaches: rapid maxillary expansion versus alternate rapid maxillary expansion and constriction. Turk J Orthod. 33:1–7. https://doi.org/10.5152/TurkJOrthod.2020.19023. DOI: 10.5152/TurkJOrthod.2020.19023. PMID: 32284892. PMCID: PMC7138235.

30. Lemos Rinaldi MR, Azeredo F, Martinelli de Lima ㄸ, Deon Rizzatto SM, Sameshima G, Macedo de Menezes L. 2018; Cone-beam computed tomography evaluation of bone plate and root length after maxillary expansion using tooth-borne and tooth-tissue-borne banded expanders. Am J Orthod Dentofacial Orthop. 154:504–16. https://doi.org/10.1016/j.ajodo.2017.12.018. DOI: 10.1016/j.ajodo.2017.12.018. PMID: 30268261.

31. Baccetti T, Franchi L, Mucedero M, Cozza P. 2010; Treatment and post-treatment effects of facemask therapy on the sagittal pharyngeal dimensions in Class III subjects. Eur J Orthod. 32:346–50. https://doi.org/10.1093/ejo/cjp092. DOI: 10.1093/ejo/cjp092. PMID: 19752018.

32. Canturk BH, Celikoglu M. 2015; Comparison of the effects of face mask treatment started simultaneously and after the completion of the alternate rapid maxillary expansion and constriction procedure. Angle Orthod. 85:284–91. https://doi.org/10.2319/031114-176.1. DOI: 10.2319/031114-176.1. PMID: 25017013. PMCID: PMC8631883.

33. Yen SL. 2011; Protocols for late maxillary protraction in cleft lip and palate patients at childrens hospital Los Angeles. Semin Orthod. 17:138–48. https://doi.org/10.1053/j.sodo.2011.01.001. DOI: 10.1053/j.sodo.2011.01.001. PMID: 21765629. PMCID: PMC3134380.

34. Almuzian M, Almukhtar A, Ulhaq A, Alharbi F, Darendeliler MA. 2019; 3D effects of a bone-anchored intra-oral protraction in treating class III growing patient: a pilot study. Prog Orthod. 20:37. https://doi.org/10.1186/s40510-019-0290-0. DOI: 10.1186/s40510-019-0290-0. PMID: 31531735. PMCID: PMC6749004. PMID: 41ab6cd5bf5d4a7b8de5fb1e90ebd593.

35. Kaya D, Kocadereli I, Kan B, Tasar F. 2011; Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study. Angle Orthod. 81:639–46. https://doi.org/10.2319/081010-473.1. DOI: 10.2319/081010-473.1. PMID: 21299407. PMCID: PMC8919738.

36. Meazzini MC, Torre C, Cappello A, Tintinelli R, De Ponti E, Mazzoleni F. 2021; Long-term follow-up of late maxillary orthopedic advancement with the Liou-Alternate rapid maxillary expansion-constriction technique in patients with skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop. 160:221–30. https://doi.org/10.1016/j.ajodo.2020.04.027. DOI: 10.1016/j.ajodo.2020.04.027. PMID: 34183222.

37. Niu X, Di Carlo G, Cornelis MA, Cattaneo PM. 2020; Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: a systematic review and meta-analysis. Orthod Craniofac Res. 23:250–76. https://doi.org/10.1111/ocr.12378. DOI: 10.1111/ocr.12378. PMID: 32248642.