Yoon Su-Ji, Yang Il-Hyung, Kim Su-Jung, Baek Seung-Hak
Department of Orthodontics, School of Dentistry, Seoul National University, Seoul, Korea.
Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Korea.
Korean J Orthod. 2025 Mar 25;55(2):105-119. doi: 10.4041/kjod24.190. Epub 2024 Nov 14.
This study aimed to evaluate the changes in upper airway (UA) dimensions in growing patients with Pierre-Robin sequence (PRS).
The subjects were 23 PRS patients who had not undergone growth modification therapy or surgical intervention. Their lateral cephalograms were obtained longitudinally at mean ages of 8.81 (T0) and 14.05 (T1). Patients were categorized based on their SNB value at T0 (Criteria: -2 SD): Group-1 (very retrusive mandible, n = 13) and Group-2 (moderately retrusive mandible, n = 10). Skeletal and UA variables at T0 and T1, as well as ΔT0-T1, were statistically analyzed.
At T0, Group-1 exhibited more retrusive maxilla and mandible (SNA, < 0.01; SNB, < 0.001), a more hyperdivergent pattern (facial height ratio, < 0.05), and a more posteriorly positioned hyoid bone (H-PTV, < 0.05), while Group-1 showed larger UA spaces (superior pharyngeal airway space [SPAS] and inferior pharyngeal airway space, all < 0.05) than Group 2, which might indicate the existence of a compensatory response to maintain the UA patency. At T1, Group-1 maintained significantly retrusive maxilla and mandible (SNA and SNB, all < 0.01), exhibited a less anteriorly positioned tongue (TT-PTV, < 0.05), and displayed a more obtuse soft palate angle (SPA, < 0.05) than Group-2. Between T0 and T1, Group-1 demonstrated significant increases in the hyoid symphysis distance (ΔH-RGN, < 0.001), tongue length (ΔTGL, < 0.01), and pharyngeal UA spaces (ΔSPAS and ΔPNS-ad2, all < 0.001).
Even in growing PRS patients with severe mandibular retrusion, the UA dimensions increased due to forward growth of the mandible, repositioning of tongue and hyoid bone, and existence of compensatory mechanism.
本研究旨在评估患有Pierre - Robin序列征（PRS）的生长发育期患者上气道（UA）尺寸的变化。
研究对象为23例未接受生长改良治疗或手术干预的PRS患者。在平均年龄8.81岁（T0）和14.05岁（T1）时纵向获取他们的头颅侧位片。根据患者在T0时的SNB值进行分类（标准：-2标准差）：第1组（下颌骨极度后缩，n = 13）和第2组（下颌骨中度后缩，n = 10）。对T0和T1时的骨骼及UA变量，以及T0 - T1的变化量进行统计学分析。
在T0时，第1组表现出更后缩的上颌骨和下颌骨（SNA，<0.01；SNB，<0.001），更高度分散的模式（面高比，<0.05），以及舌骨位置更靠后（H - PTV，<0.05），而第1组比第2组表现出更大的UA间隙（上咽气道间隙[SPAS]和下咽气道间隙，均<0.05），这可能表明存在一种维持UA通畅的代偿反应。在T1时，第1组仍显著表现为上颌骨和下颌骨后缩（SNA和SNB，均<0.01），与第2组相比，舌的位置更靠前（TT - PTV，<0.05），软腭角更钝（SPA，<0.05）。在T0和T1之间，第1组舌骨联合距离（ΔH - RGN，<0.001）、舌长度（ΔTGL，<0.01）和咽UA间隙（ΔSPAS和ΔPNS - ad2，均<0.001）有显著增加。
即使在患有严重下颌后缩的生长发育期PRS患者中，由于下颌骨向前生长、舌骨和舌的重新定位以及代偿机制的存在，UA尺寸仍会增加。
