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Three-dimensional computed tomographic analysis of changes to the external features of the nose after Surgically Assisted Rapid Maxillary Expansion and orthodontic treatment: A prospective longitudinal study
Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
Harvard University, USA .
Institute Postgrad Dent Educ, Sweden .
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2013 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: The aim of this prospective, longitudinal study was toe valuate changes to the external shape and form of the nose after Surgically Assisted Rapid Maxillary Expansion (SARME) and orthodontic treatment. The changes were registered using a three-dimensional (3-D) computer tomography technique, based on superimposition on the anterior base of the skull.

Method: The subjects comprised 35 patients, mean age 19.7 years (16.1-43.9). Lowdose, helical Computerized Tomography (CT) was taken at treatment start and after completed orthodontic treatment, about 18months post-surgery. The 3-D models were registered and superimposed on the anterior cranial base.

Results: There was in general significant widening and overall anterior and inferior displacement of the nasal soft tissue. The changes varied in size and direction. No correlation was found between the initial and final widths of the nose, or between the initial and final widths of the nostrils.

Conclusion: After SARME, the most obvious changes to the external features of the nose  are at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. Patients with narrow and constrained nostrils can benefit from these changes. The 3-D superimposition applied in this study is a reliable method, circumventing projection and measurement errors.

Place, publisher, year, edition, pages
2013.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-91699DOI: 10.1016/j.ajodo.2013.04.013OAI: oai:DiVA.org:liu-91699DiVA: diva2:618620
Available from: 2013-04-29 Created: 2013-04-29 Last updated: 2014-11-19
In thesis
1. Evaluation of surgically assisted rapid maxillary expansion and orthodontic treatment: Effects on dental, skeletal and nasal structures and rhinological findings
Open this publication in new window or tab >>Evaluation of surgically assisted rapid maxillary expansion and orthodontic treatment: Effects on dental, skeletal and nasal structures and rhinological findings
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Surgically Assisted Rapid Maxillary Expansion (SARME) is frequently used to treat skeletal maxillary transverse deficiency (MTD) in skeletally mature and non-growing individuals. Despite previous research in the field, questions remain with respect to the long-term stability of SARME and its effects on hard and soft tissue.

The overall aim of the present doctoral work was to achieve a greater understanding of SARME, using modern image technology and a multidisciplinary approach, with special reference to effects on the hard and soft tissues and respiration. A more specific aim was to evaluate the long-term stability in a retrospective sample of patients treated with SARME and orthodontic treatment and to compare the results with a matched, untreated control group. The studies in this doctoral project are thus based on two different samples and study designs.

The first sample, Study I (Paper I), is a retrospective, consecutive, long-term follow-up material of study models from 31 patients (17 males and 14 females) treated with SARME and orthodontic treatment between 1991 and 2000. The mean pre-treatment age was 25.9 years (SD 9.6) with a mean follow-up time of 6.4 years (SD 3.3). Direct measurements on study models were made with a digital sliding caliper at reference points on molars and canines. To evaluate treatment outcome and long-term stability, the results were compared with study models from an untreated control group, matched for age, gender and follow-up time.

The second sample, Study II (Papers II-IV), is a prospective consecutive, longitudinal material of 40 patients scheduled to undergo SARME and orthodontic treatment between 2006 and 2009.

In Paper II, one patient was excluded because of a planned adenoidectomy. The final sample comprised 39 patients (16 males and 23 females). The mean age at treatment start was 19.9 years (range 15.9 – 43.9). Acoustic rhinometry, rhinomanometry and a questionnaire were used to assess the degree of nasal obstruction at three time-points; pre-treatment, three months after expansion and after completed treatment (mean 18 months).

In Papers III–IV, three patients declined to participate and two had to be excluded because their CT-records were incomplete. The final sample comprised 35 patients (14 males and 21 females). The mean age at treatment start was 19.7 years (range 16.1 – 43.9). Helical CT-images were taken pre-treatment and eighteen months’ post-expansion. 3D models were registered and superimposed at the anterior cranial base. The automated voxel-based image registration method allows precise, accurate measurements in all areas of the maxilla. In Papers II–IV, the treatment groups constituted their own control groups.

The main findings in the retrospective, long-term follow-up study were that SARME and orthodontic treatment normalized the transverse discrepancy and was stable for a mean of 6 years post-treatment. Pterygoid detachment did not entirely eliminate the side effect of buccal tipping of the posterior molars. Relapse is time-related and is most pronounced during the first 3 years after treatment. Thus the retention period should be extended and should be considered for this period. The main rhinological findings in the prospective longitudinal study were that SARME had a shortterm, favourable effect on nasal respiration, but the effect did not persist in the long-term. However, subjects with pre-treatment nasal obstruction reported a lasting sensation of improved nasal function.

SARME and orthodontic treatment had a significant but non-uniform skeletal treatment effect, with significantly greater expansion posteriorly than anteriorly. The expansion was parallel anteriorly but not posteriorly. The lateral tipping of the posterior segment was significant, despite careful surgical separation. No correlation was found between tipping and the patient's age. Furthermore, SARME and orthodontic treatment significantly affected all dimensions of the external features of the nose. The most obvious changes were at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. There were no predictive correlations between the changes. Patients with narrow and constrained nostrils can benefit from these changes with respect to the subjective experience of nasal obstruction. It is questionable whether an alar-cinch suture will prevent widening at the alar-base.

The 3D superimposition applied in Study II is a reliable method, circumventing projection and measurement errors. In conclusion, SARME and orthodontic treatment normalize the transverse deficiency, with long-term stability. SARME has a favourable effect on the subjective perception of nasal respiration. SARME significantly affects dental, skeletal and nasal structures.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 104 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1359
Series
Swedish Dental Journal Supplement, ISSN 0348-6672 ; 229
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91700 (URN)978-91-7519-666-4 (ISBN)
Public defence
2013-05-31, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-29 Created: 2013-04-29 Last updated: 2013-04-29Bibliographically approved

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