| Objective:To investigate the effect of RW-Splint on the upper airway in patients with temporomandibular joint disease,so as to provide guidance for clinical application of RW-SplintMethods:1 subjects:This study selected 17 TMD patients in Orthodontics Department of Stomatological Hospital of Guangdong Province from 2011 to 2015.There were 2 male patients and 15 female patients aged 16-24 years(average 20.5 years old).The treatment time was 6-21 months(average 11.9 months).Inclusion criteria:(1)meets the diagnostic criteria for TMD research(rdc/tmd);(2)imaging confirmed bilateral posterior condylar displacement;(3)permanent dentition,at the end of growth peak;(4)complete and clear image data before and after treatment.Exclusion criteria:(1)on chronic respiratory diseases such as nasopharyngeal carcinoma,adenoid or tonsil hypertrophy;(2)with sleep apnea syndrome.(3)with cleft lip and palate or cleft lip and palate history;(4)history of facial trauma;(5)history of orthognathic surgery;(6)mental or psychological problems.(7)obesity.2 Research contents:all patients were treated with CBCT(NewTomQ.Rsrl Italy)in accordance with the uniform shooting conditions before and after Rw-Splint treatment,respectively.The skull and face were scanned in a position of upright and relaxed head and neck.The Frankfort plane was parallel to the ground,and the lips was closed naturally.The patients before treatment were scanned with the maximum intercuspal position,and those after treatment with posterior teeth just contact.Swallowing and breathing were inhibited when scanning.The scan parameters:current of 3.34ma,voltage of 110KV,visual range of 15cm*15cm,axial spacing of 0.3mm,axial width of 0.3mm,scanning time of 18S,exposure time of 3.6s.The scanned CBCT data were imported into the 3D reconstruction software dolphin imaging 11.8 for reconstruction.The median sagittal plane and axial plane of each patient were adjusted in three-dimensional space of the coronal,sagittal and axial plane.2.1 Measurements of the upper airway volume and minimum cross-sectional areaThe upper airway morphology was analyzed under the sinus/airway measurement module of dolphin software.The upper boundary of airway is defined as the plane that Connects two points from the midpoint between cranial base point(BA)and sella turcica(s)to the posterior nasal spinous point(PNS),and is perpendicular to the sagittal plane.The lower boundary of airway is defined as the plane that is through the point of vertex of epiglottis(ET)and is perpendicular to the sagittal plane.The airway is divided into nasopharynx,palatopharynx,glossopharyngeal as the boundary of the posterior nasal spine plane and tip of the uvula plane.Oropharynx contains pharyngeal and glossopharyngeal.The changes of airway volume and minimal sectional area before and after treatment were evaluated.2.2 The measurements of The cross-sectional area and the sagittal and coronal diameter of the interface of the airwayIn the axial interface of dolphin software,the cross-sectional area was measured when the scroll bar was tuned to the interface of the pharynx.That is,the cross sectional area of each interface.In the 3D view of software,the sagittal and coronal diameter of the upper airway was measured.The changes before and after treatment were compared.2.3 Evaluation of the Changes in airway morphologyWe evaluated the morphological changes before and after treatment through analyzing the sagittal and coronal diameter ratio of the upper airway.The sagittal and coronal diameter ratio of the upper airway can well describe the morphological changes of the airway.When the ratio is greater than 1,it is suggested that the upper airway is a ellipse that the sagittal diameter is greater than the coronal diameter.Conversely,the upper airway is a ellipse that the coronal diameter is greater than the sagittal diameter when the ratio is less than 1.Results:1 compared with before treatment,the total volume of the upper airway,pharyngeal,glossopharyngeal and oropharyngeal volume decreased after treatment.The glossopharyngeal volume was significantly reduced.The differences were statistically significant(p<0.05).The volume of nasopharynx slightly increased.But the differences were not statistically significant(p>0.05)except glossopharyngeal.The smallest cross-sectional area of the upper airway was reduced,but there was no significant difference(p>0.05).2 compared with before treatment,the interface of the cross-sectional area decreased after treatment,but the difference was not statistically significant(p>0.05).The sagittal and coronal diameter of each interface decreased.The sagittal diameter of the cross section of the tip of the uvula plane decreased from 10.5 ± 2.5(mm)to 9.2±3.1(mm),which was statistically significant.The coronal diameter of the cross section of top of the epiglottis plane decreased from 26.9 ± 3.9(mm)to 24.6 ±4.5(mm),whose difference was statistically significant(p<0.05),while the changes of other indexes were not significantly different(p>0.05).3 the sagittal and coronal diameter ratio of each cross section of the upper airway was smaller than 1 before and after the treatment.The ratio gradually decreaseed according to the order of PNSP,UTP and ETP,whichsuggests that the shape of the upper airway is flat,and becomesflatter from top to bottom.The ratio of the upper airway interface decreased after treatment,but the difference was not statistically significant(p>0.05).The results indicate that the upper airway become flatter after treatment.Conclusion:1 The volume of upper airway of the patients with temporomandibular joint disease is reduced after Rw-Splint treatment.The effect is the most obvious on the glossopharyngeal segment.2 The tip of the uvula plane and the top of the epiglottis plane are the upper and lower boundary of glossopharyngeal segment,respectively.Accordingly,the main effect of the Rw-Splint treatment on the upper airway is on the glossopharyngeal segment.3 The morphology of upper airway of the patients with temporomandibular joint disease has a tendency to flatten after Rw-Splint treatment,but this change is not obvious. |
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