Einfluss der maxillären Mikrognathie auf die Morphologie von PAS und Adenoiden

Abstract

Die wechselseitige Beziehung zwischen Dysgnathien und posterior airway space sowie Weichteilmorphologie der extrathorakalen Luftwege ist bereits lange Diskussionsgegenstand der Forschung und aufgrund ihrer Komplexität noch nicht ausreichend verstanden. In der vorliegenden Untersuchung wurde eine Analyse jener Atemwegscharakteristika von Patienten mit mikrognathem Oberkiefer mittels Fernröntgenseitenbildanalyse und einer aus Patienten der Angle-Klasse II bestehenden Kontrollgruppe durchgeführt. Der Fokus wurde insbesondere auf den Nasenrachenraum sowie mögliche Einflüsse auf das lymphatische Gewebe der Adenoide gelegt. Signifikante Unterschiede konnten bezüglich Luftraumtiefe hierbei nur auf der nasopharyngealen Ebene festgestellt werden, für die am ehesten knöcherne Differenzen, nicht jedoch Differenzen im Volumen des lymphatischen Gewebes ursächlich scheinen.

The aim of the study was to assess influences of presence of maxillary micrognathia on dimensions of the extrathoracic airway space. Furthermore the impact of said dysgnathia on shaping of lymphatic adenoid tissue was investigated. To operationalize this an analysis of pre-treatment lateral cephalograms of orthodontic patients was performed. 73 persons were examined and divided into an experimental group (UG) containing 34 individuals as well as a control group (KG) of 39. The division into these groups was dependent on patients either meeting diagnostic criteria for maxillary micrognathia (UG) or presence of Angle-Class II (KG) respectively. The mean age for UG was 10,55 ± 3,03 years, while including 18 males (52,9%) and 16 females (47,1%). The mean age for KG was 10,93 ± 3,26 years while including 20 males (51,3%) and 19 females (48,7%). The used scheme of analysis is based on a combination of procedures used in earlier investigations of Hourfar et al. (Hourfar, Kinzinger, Meißner, et al., 2017) and Jonas et al. (Jonas et al., 1988). To objectivate the obtained data statistically it was checked on linear correlations with the used diagnostic parameters using regression analysis as well as compared between the two groups using student¶s T-test or Mann-Whitney-U-Test respectively. The results showed a significantly (p=0,034) lower sagittal depth of airway on the palatal level in UG (2,039 mm). Matching this, the bony nasopharynx was also identified as significantly (asymptotic significance = 0,026) narrower in UG (1,647 mm). Regarding all remaining levels of posterior airway space as well as in the comparison of the area of adenoids and nasopharynx no significant differences were detected. Regression analysis showed that depth of the bony Nasopharynx was highly significant (F(2,69) = 6,412, p = 0,003) and moderately dependent (R2 = 0,157, korr. R2 = 0,132) on SNA and age, respectively highly significant (F(2,69) = 6,392, p = 0,003) and moderately (R2 = 0,156, korr. R2 = 0,132) dependent on ANB and age. Furthermore the sagittal area of adenoids was identified as significantly (F(1,70) = 6,003, p = 0,017) yet weakly (R2 = 0,079, korr. R2 = 0,066) influenced by SNA, respectively influenced significantly (F(2,69) = 3,464, p = 0,037) yet weakly (R2 = 0,091, korr. R2 = 0,065) by ANB and SNB. Also ratio of adenoid to nasopharynx area was shown to be influenced highly signifcantly (F(2,70) = 5,722, p = 0,005) yet weakly (R2 = 0,141, korr. R2 = 0,116) by SNA and age, respectively to be influenced highly significantly (F(3,69) = 4,453, p = 0,006) and moderately (R2 = 0,162, korr. R2 = 0,126) by ANB and upper to lower jaw ratio. Hence, the results indicate significant bony constriction in the sagittal plane of the nasopharynx of indivduals with micrognathic maxilla when compared to Angle-class II patients. Regarding nasopharyngeal soft tissue, there might be a slight tendency of Angle-class II individuals to develop larger adenoids.