以改良型Bionator功能性矯正裝置治療骨性二級咬合患者於咽呼吸道深度、舌骨位置、及顱顏型態的變化

Treatment Effects of the Modified Bionator on Pharyngeal Airway Depth, Hyoid Bone Position, and Craniofacial Change of Skeletal Class II Patients

林衍君(Yen-Chun Lin)

指導教授 ： 蔡恒惠

臺北醫學大學/口腔醫學院/牙醫學系碩博士班/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00087

摘要

目的:由於不少患有口呼吸，打鼾，或睡眠呼吸中止的患者，顱顏型態特徵皆有下顎後縮之二級異常咬合及舌骨位置較低的狀況，故本研究探討二級異常咬合患者於生長期利用功能性矯正裝置進行齒顎矯正的同時，是否能早期改變氣道之尺寸，控制舌骨高度，進而減少未來發生呼吸道狹窄所引發的打鼾或睡眠呼吸中止症候群。
方法:收集使用改良型Bionator矯正裝置治療骨性二級咬合(且為安格氏二級異常咬合第ㄧ分類)患者為樣本進行回溯性研究，51位男性(平均10.84歲)，35位女性(平均10.3歲)。男性平均治療時間1.75年，女性2.05年。依性別分組，所有樣本皆依標準操作在術前、術後及術後追蹤期拍攝側方測顱X光片，觀察咽呼吸道深度、舌骨位置及顱顏型態的變化。
結果:經功能性矯正器治療後，咽呼吸道深度除鼻咽口咽交界處(PNS-SPU)及男性的喉咽(E-SPLL)有顯著增加外，其餘深度都沒有變化。舌骨位置相對於下顎骨下緣(GoL-Me)及第三頸椎與頦點連線(C3-Me)的垂直高度並沒有隨生長而下降。顱顏型態方面，上下顎齒列關係在治療後有明顯改善。
結論：青少年時期使用功能性矯正裝置對於咽呼吸道深度增加無顯著效果。然而，功能性矯正器促進口腔肌肉及舌頭的運動，使舌骨垂直高度位置維持，可能避免成為打鼾或睡眠呼吸中止症候群的族群。

關鍵字

Bionator功能性矯正裝置 ； 咽呼吸道深度 ； 舌骨位置

並列摘要

Objective: Long time observation of the pharyngeal airway and hyoid bone position changes of class II division I cases following bionator treatment.
Materials and Methods: There were 86 (51 males and 35 females) Angle Class II division I patients diagnosed with mandibular deficiency collected in this study. All of them were treated by the modified bionator with lower incisor resin capping and expansion screw. Lateral cephalometric radiographs were taken before and after bionator treatment. Average treatment time was 1.75 years for males and 2.02 years for females. Five linear items of pharyngeal depths and seven linear items of hyoid bone position were measured. ANOVA was used to compare the four stages (before treatment, after treatment, 2 years follow up, and 4 years follow up) in both gender. The level of significance was set at p＜0.05.
Result: Pharyngeal depths were not changed significantly before and after treatment expect nasopharynx (D1) in both gender and hypopharynx(D5) in male. Hyoid bone position was maintain in the vertical position relate to the mandible (H5 and H6 changed not significantly) in male and female. Horizontally, hyoid bone moved forward immediately after bionator treatment but returned to posterior position later.
Conclusion: Through mandible advancement by bionator for class II treatment in growing patients, the pharyngeal airway depths were not change significantly at sagittal direction. However, after bionator treatment, hyoid bone was maintained in the vertical position related to mandible during growth.

並列關鍵字

Bionator ； pharynx ； hyoid bone position

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