Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago, Spain.
Service of Maxillofacial Surgery, Hospital Complex of Santiago de Compostela, Santiago, Spain.
Am J Rhinol Allergy. 2021 Nov;35(6):923-934. doi: 10.1177/1945892421995350. Epub 2021 Feb 14.
Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, increases upper airway volume. However, it is yet unclear whether maxillary expansion may improve nasal function. Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked by two authors from the Rhinology Study Group of the Young Otolaryngologists section of the International Federation of Otorhinolaryngological Societies. Two authors extracted the data. The main outcome was expressed as the value (in variable units) prior to treatment (T0), after expansion procedures (T1), after the retention period (T2), and after a follow-up period (T3).
A total of 10 studies (257 patients) met the inclusion criteria. The data pooled in the meta-analysis reveals a statistically significant reduction of 0.27 Pa/cm/s (CI 95% 0.15, 0.39) in nasal resistance after palatal expansion As far as subjective changes are concerned, the pooled data for the change in the NOSE score shows a statistically significant mean reduction after maxillary expansion of 40.08 points (CI 95% 36.28, 43.89).
The initial available evidence is too limited to suggest maxillary expansion as a primary treatment option to target nasal breathing. However the data is encouraging with regards to the effect of maxillary expansion on nasal function. Further higher quality studies are needed in order to define clearer patient selection criteria, distinguish optimal techniques, and demonstrate long-term efficacy in long term follow up studies.
鼻手术未能恢复一些情况下的鼻呼吸。有人认为上颌骨收缩是失败的主要原因。据认为，上颌骨收缩会导致内外鼻阀关闭。此外，文献中已经充分证实，无论是成人还是儿童，上颌骨扩张都会增加上呼吸道的容积。然而，上颌骨扩张是否能改善鼻功能尚不清楚。两位作者从国际耳鼻喉科学会青年耳鼻喉科分会鼻科研究组对 PubMed（医学索引在线）、Cochrane 图书馆、EMBASE 和 Trip 数据库进行了检索。两位作者提取了数据。主要结果表示为治疗前（T0）、扩张后（T1）、保持期（T2）和随访期（T3）的数值（以变量单位表示）。
共有 10 项研究（257 例患者）符合纳入标准。荟萃分析汇总的数据显示，腭扩张后鼻阻力降低了 0.27 Pa/cm/s（95%CI 0.15，0.39），具有统计学意义。就主观变化而言，NOSE 评分变化的汇总数据显示，上颌骨扩张后平均降低 40.08 分（95%CI 36.28，43.89），具有统计学意义。
目前的证据还不够充分，不能将上颌骨扩张作为改善鼻呼吸的主要治疗选择。然而，上颌骨扩张对鼻功能的影响令人鼓舞。需要进一步开展高质量的研究，以明确患者选择标准，区分最佳技术，并在长期随访研究中证明长期疗效。
