Hızlı Maksiller Genişletmenin Dentofasiyal ve Medikal Etkileri
Özet
Maksiller darlık, transversal yönde yetersizlik nedeniyle tek veya çift taraflı çapraz kapanışla karakterize kraniofasial bir anomali olup tedavisinde etiyolojik faktörün tespiti ve erken müdahale kritik öneme sahiptir. Adölesan dönemde sıkça başvurulan Hızlı Üst Çene Genişletmesi (HÜÇG), median palatal sutura ortopedik kuvvetler uygulayarak suturun açılmasını ve maksillanın iskeletsel olarak genişlemesini sağlar. Bu tedavi yaklaşımının, maksiller segmentlerin ayrılması, üst kesici dişler arasında geçici diastema oluşumu ve posterior dişlerin bukkale devrilmesi gibi belirgin dentofasiyal etkileri mevcuttur. İskeletsel olarak ise maksillanın öne ve aşağı hareketiyle birlikte mandibulanın posterior rotasyonu ve alt yüz yüksekliğinde artış gözlenir. Dental etkilerin ötesinde, HÜÇG'nin burun tabanını ve hacmini genişleterek nazal hava yolu direncini azaltması, medikal alanda devrim niteliğinde sonuçlar doğurmaktadır. Bu anatomik değişim; ağız solunumundan burun solunumuna geçişi kolaylaştırarak astım ve alerjik rinit semptomlarını hafifletmekte, Obstrüktif Uyku Apne Sendromu (OSAS) olan çocuklarda orofaringeal boşluğu iyileştirmektedir. Ayrıca, hava akışının düzelmesiyle uyku kalitesini artırıp Nocturnal Enürezis (gece yatak ıslatma) sıklığını azaltmakta, yumuşak damak kaslarını gererek östaki borusunun açılmasını sağlamakta ve İletim Tipi İşitme Kaybı (İTİK) ile şaşılık gibi okülomotor bozuklukların tedavisinde cerrahi olmayan, koruyucu ve etkili bir alternatif sunmaktadır.
Rapid maxillary deficiency is a craniofacial anomaly characterized by transverse insufficiency causing unilateral or bilateral crossbite, making etiological identification and early intervention critical for successful treatment. Rapid Maxillary Expansion (RME), frequently utilized during adolescence, applies heavy orthopedic forces to the median palatal suture to achieve sutural opening and skeletal expansion. This treatment approach exhibits prominent dentofacial effects, including the separation of maxillary segments, temporary diastema formation between upper incisors, and buccal tipping of posterior teeth. Skeletally, it induces forward and downward movement of the maxilla, leading to posterior rotation of the mandible and an increase in lower facial height. Beyond dental effects, RME's widening of the nasal floor and volume reduces nasal airway resistance, yielding revolutionary medical outcomes. This anatomical alteration facilitates the transition from mouth to nasal breathing, alleviating asthma and allergic rhinitis symptoms, and improving the oropharyngeal space in children with Obstructive Sleep Apnea Syndrome (OSAS). Furthermore, by improving airflow and sleep quality, it reduces the frequency of Nocturnal Enuresis, stretches soft palate muscles to open the Eustachian tube, and offers a conservative, effective non-surgical alternative for managing conductive hearing loss and oculomotor disorders like strabismus.
Referanslar
Guerini V. A history of dentistry from the most ancient times until the end of the eighteenth century: Lea & Febiger; 1909.
Bishara SE, Staley RN. Maxillary expansion: clinical implications. American Journal of Orthodontics and Dentofacial Orthopedics. 1987;91(1): 3-14. doi:10.1016/0889-5406(87)90202-2
Helm S. Malocclusion in Danish children with adolescent dentition: an epidemiologic study. American Journal of Orthodontics. 1968;54(5): 352-366. doi:10.1016/0002-9416(68)90304-7
Basciftci F, Demir A, Sarı Z, et al. Prevalence of orthodontic malocclusions on school children in Konya: an epidemiologic study. Turkısh Journal of Orthodontics. 2002;15(2): 92-98. doi:10.13076/1300-3550-15-2-92
Lindner A, Modéer T. Relation between sucking habits and dental characteristics in preschoolchildren with unilateral cross-bite. European Journal of Oral Sciences. 1989;97(3): 278-283. doi:10.1111/j.1600-0722.1989.tb01613.x.
Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. American Journal of Orthodontics. 1970;58(1): 41-66. doi:10.1016/0002-9416(70)90127-2.
Lagravere MO, Major PW, Flores-Mir C. Long-term dental arch changes after rapid maxillary expansion treatment: a systematic review. The Angle Orthodontist. 2005;75(2): 155-161. doi:10.1043/0003-3219(2005)075<0151:LDACAR>2.0.CO;2
Suri L, Taneja P. Surgically assisted rapid palatal expansion: a literature review. American Journal of Orthodontics and Dentofacial Orthopedics. 2008;133(2): 290-302. doi:10.1016/j.ajodo.2007.01.021
Proffit W, Fields Jr H, Sarver D. Contemporary orthodontics. 15. Atlanta: Elsevier Health Sciences. 2014.
Akkaya S, Lorenzon S, Üçem T. Comparison of dental arch and arch perimeter changes between bonded rapid and slow maxillary expansion procedures. The European Journal of Orthodontics. 1998;20(3): 255-261. doi:10.1093/ejo/20.3.255.
Garrett BJ, Caruso JM, Rungcharassaeng K, et al. Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. American Journal of Orthodontics and Dentofacial Orthopedics. 2008;134(1): 8-9. doi:10.1016/j.ajodo.2008.06.004
Ricketts RM. The influence of orthodontic treatment on facial growth and development. The Angle Orthodontist. 1960;30(3): 103-133.
Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. The Angle Orthodontist. 1961;31(2): 73-90.
Davidovitch M, Efstathiou S, Sarne O, et al. Skeletal and dental response to rapid maxillary expansion with 2-versus 4-band appliances. American Journal of Orthodontics and Dentofacial Orthopedics. 2005;127(4): 483-492. doi:10.1016/j.ajodo.2004.01.021
Işeri H, Tekkaya AE, Öztan Ö, et al. Biomechanical effects of rapid maxillary expansion on the craniofacial skeleton, studied by the finite element method. The European Journal of Orthodontics. 1998;20(4): 347-356. doi:10.1093/ejo/20.4.347
Jafari A, Shetty KS, Kumar M. Study of stress distribution and displacement of various craniofacial structures following application of transverse orthopedic forces—a three-dimensional FEM study. The Angle Orthodontist. 2003;73(1): 12-20. doi:10.1043/0003-3219(2003)073<0012:SOSDAD>2.0.CO;2
Lebret LM. Changes in the palatal vault resulting from expansion. The Angle Orthodontist. 1965;35(2): 97-105. doi:10.1043/0003-3219(1965)035<0097:CITPVR>2.0.CO;2
Chung C-H, Font B. Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion. American Journal of Orthodontics and Dentofacial Orthopedics. 2004;126(5): 569-575. doi:10.1016/j.ajodo.2003.10.035
Ogura JH, Dammkoehler R, Nelson JR, et al. Nasal obstruction and the mechanics of breathing: physiologic relationships and the effects of nasal surgery. Archives of Otolaryngology. 1966;83(2): 135-150. doi:10.1001/archotol.1966.00760020137010
Timms D. The reduction of nasal airway resistance by rapid maxillary expansion and its effect on respiratory disease. The Journal of Laryngology & Otology. 1984;98(4): 357-362. doi:10.1017/s0022215100146730
Lima MS, Nader CMFF, Franco LP, et al. Pulmonary hypertension evaluation by Doppler echocardiogram in children and adolescents with mouth breathing syndrome. Brazilian Journal of Otorhinolaryngology. 2017;83(3): 292-298. doi:10.1016/j.bjorl.2016.03.020
Gray LP. Results of 310 cases of rapid maxillary expansion selected for medical reasons. The Journal of Laryngology & Otology. 1975;89(6): 601-614. doi:10.1017/s0022215100080804
Toraldo D, Passali D, Sanna A, et al. Cost-effectiveness strategies in OSAS management: a short review. Acta Otorhinolaryngologica Italica. 2017;37(6): 447-453. doi:10.14639/0392-100X-1520
Jamieson A, Guilleminault C, Partinen M, et al. Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep. 1986;9(4): 469-477. doi:10.1093/sleep/9.4.469
Güray E, Karaman AI. Effects of Adenoidectomy on Dentofacial Structures: A 6-Year Longitudinal Study. World Journal of Orthodontics. 2002;3(1): 73-81.
Tasker C, Crosby J, Stradling J. Evidence for persistence of upper airway narrowing during sleep, 12 years after adenotonsillectomy. Archives of Disease in Childhood. 2002;86(1): 34-37. doi:10.1136/adc.86.1.34
Guilleminault C, Li KK, Khramtsov A, et al. Sleep disordered breathing: surgical outcomes in prepubertal children. The Laryngoscope. 2004;114(1): 132-137. doi:10.1097/00005537-200401000-00024
Harvold EP, Tomer BS, Vargervik K, et al. Primate experiments on oral respiration. American Journal of Orthodontics. 1981;79(4): 359-372. doi:10.1016/0002-9416(81)90379-1
Pirelli P, Marullo M, Casagrande M, et al. Espansione Rapida del Mascellare: effetti sulla funzionalita'respiratoria ed uditiva. 1995.
Cistulli PA, Palmisano RG, Poole MD. Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep. 1998;21(8): 831-835. doi:10.1093/sleep/21.8.831
Chervin RD, Hedger K, Dillon JE, et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Medicine. 2000;1(1): 21-32. doi:10.1016/s1389-9457(99)00009-x
Koyuncu E, Türkkani MH, Sarikaya FG, et al. Sleep disordered breathing in children with cerebral palsy. Sleep medicine. 2017;30: 146-150. doi:10.1016/j.sleep.2016.01.020
Nevéus T. Nocturnal enuresis—theoretic background and practical guidelines. Pediatric Nephrology. 2011;26(8): 1207-1214. doi:10.1007/s00467-011-1762-8
Villa MP, Malagola C, Pagani J, et al. Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Medicine. 2007;8(2): 128-134. doi:10.1016/j.sleep.2006.06.009
Weider DJ, Sateia MJ, West RP. Nocturnal enuresis in children with upper airway obstruction. Otolaryngology—Head and Neck Surgery. 1991;105(3): 427-432. doi:10.1177/019459989110500314
Leach J, Olson J, Hermann J, et al. Polysomnographic and clinical findings in children with obstructive sleep apnea. Archives of Otolaryngology–Head & Neck Surgery. 1992;118(7): 741-744. doi:10.1001/archotol.1992.01880070071013
Hyla-Klekot L, Truszel M, Paradysz A, et al. Influence of orthodontic rapid maxillary expansion on nocturnal enuresis in children. BioMed Research İnternational. 2015;2015. http://dx.doi.org/10.1155/2015/201039
Freeman R. Psychopharmacology and the retarded child. Psychiatric approach to mental retardation New York: Basic Books. 1970:294-368.
Timms DJ. Rapid maxillary expansion in the treatment of nocturnal enuresis. The Angle Orthodontist. 1990;60(3): 229-233. doi:10.1043/0003-3219(1990)060<0229:RMEITT>2.0.CO;2
Kurol J, Modin H, Bjerkhoel A. Orthodontic maxillary expansion and its effect on nocturnal enuresis. The Angle Orthodontist. 1998;68(3): 225-232. doi:10.1043/0003-3219(1998)068<0225:OMEAIE>2.3.CO;2
Usumez S, İşeri H, Orhan M, et al. Effect of rapid maxillary expansion on nocturnal enuresis. The Angle Orthodontist. 2003;73(5): 532-538. doi:10.1043/0003-3219(2003)073<0532:EORMEO>2.0.CO;2
Taşpinar F, Üçüncü H, Bishara SE. Rapid maxillary expansion and conductive hearing loss. The Angle Orthodontist. 2003;73(6): 669-673. doi:10.1043/0003-3219(2003)073<0669:RMEACH>2.0.CO;2
Cazzolla AP, Campisi G, Lacaita GM, et al. Changes in pharyngeal aerobic microflora in oral breathers after palatal rapid expansion. BMC Oral Health. 2006;6(1): 1-6. doi:10.1186/1472-6831-6-2
Villano A, Grampi B, Fiorentini R, et al. Correlations between rapid maxillary expansion (RME) and the auditory apparatus. The Angle Orthodontist. 2006;76(5): 752-758. doi:10.1043/0003-3219(2006)076[0752:CBRMER]2.0.CO;2
Kılıç N, Yörük Ö, Kılıç SC, et al. Rapid maxillary expansion versus middle ear tube placement: Comparison of hearing improvements in children with resistance otitis media with effusion. The Angle Orthodontist. 2016;86(5): 761-767. doi:10.2319/101515-693.1
De Stefano A, Baffa C, Cerrone D, et al. Management of recurrent otitis media with rapid maxillary expansion: our experience. Acta Oto-Rhino-Laryngologica Belgica. 2009;5(1): 13-17.
Monaco A, Tepedino M, Sabetti L, et al. An adolescent treated with rapid maxillary expansion presenting with strabismus: A case report. Journal of Medical Case Reports. 2013;7(1): 1-5. doi:10.1186/1752-1947-7-222
Monaco A, Streni O, Marci MC, et al. Convergence defects in patients with temporomandibular disorders. The Journal of Craniomandibular&Sleep Practice 2003;21(3): 190-195. doi:10.1080/08869634.2003.11746250
Monaco A, Streni O, Marci M, et al. Relationship between mandibular deviation and ocular convergence. Journal of Clinical Pediatric Dentistry. 2005;28(2): 135-138. doi:10.17796/jcpd.28.2.mj7311l03m257134
Monaco A, Spadaro A, Sgolastra F, et al. Prevalence of astigmatism in a paediatric population with malocclusions. European Journal of Paediatric Dentistry. 2011;12(2): 91-94.
Monaco A, Spadaro A, Sgolastra F, et al. Prevalence of hyperopia and strabismus in a paediatric population with malocclusions. European journal of paediatric dentistry. 2011;12(4): 272-274.
Monaco A, Cattaneo R, Spadaro A, et al. Visual input effect on EMG activity of masticatory and postural muscles in healthy and in myopic children. European Journal of Paediatric Dentistry. 2006;7(1): 18-22.
Monaco A, Cattaneo R, Spadaro A, et al. Ocular correction effects on EMG activity of stomatognathic muscles in children with functional mandibular lateral-deviation: a case control study. European Journal of Paediatric Dentistry. 2006;7(2): 81-88.
