Division of Allergy, Clinical Immunology and Rherumatology - Federal University of São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil.
Department of Otorhinolaryngology, UNIFESP-EPM, São Paulo, Brazil.
Allergol Immunopathol (Madr). 2023 Jul 1;51(4):55-62. doi: 10.15586/aei.v51i4.853. eCollection 2023.
To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma.
Fifty-three MB children/adolescents (aged 7-14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance).
A significant reduction in the CARATkids score occurred in the RAD (-4.06; < 0.05), similarly when patient and parent/guardian scores were evaluated (-3.28 and -3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them.
In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.
评估快速上颌扩张（RME）对上颌骨闭锁的口呼吸（MB）儿童鼻气道通畅性的影响，这些儿童的上颌骨闭锁是由于或不由于与哮喘相关的变应性鼻炎（AR）引起的。
53 名 MB 儿童/青少年（年龄 7-14 岁）患有混合或恒牙列和上颌骨闭锁，伴或不伴有单侧或双侧反颌。他们形成了以下组：RAD（AR + 哮喘；临床治疗，RME）；RAC（AR + 哮喘；临床治疗，不进行 RME）；和 D（口呼吸者；仅进行 RME）。RAD 和 RAC 患者接受局部鼻皮质类固醇和/或全身 H1 抗组胺药（持续使用）和环境暴露控制。所有患者在 RME 前（T1）和 6 个月后（T2）均接受 CARATkids 评分、声鼻测量和鼻腔计算机断层扫描（CT）评估。RAD 和 D 患者接受了 RME（Hyrax®矫形器）。
RAD 组的 CARATkids 评分显著降低（-4.06；<0.05），患者和家长/监护人评分也有类似的降低（-3.28 和-3.16）。声鼻测量（V5）显示所有组的鼻腔体积均增加，RAD 患者的鼻腔体积增加显著高于 RAC 和 D 组（分别为 0.99×0.71×0.69cm）。鼻腔 CT 显示所有三组的鼻腔体积均增加，三组之间无显著差异。
在上颌骨闭锁的 MB 患者中，AR、哮喘和 AR 伴哮喘的患者中，RME 增加了鼻腔体积并改善了呼吸症状。然而，它不应该作为管理患有呼吸道过敏患者的唯一治疗方法。
