手术辅助上颌骨快速扩弓对鼻气道流场特征的影响

doi:10.19438/j.cjoms.2018.03.009

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (3): 237-241.doi: 10.19438/j.cjoms.2018.03.009

手术辅助上颌骨快速扩弓对鼻气道流场特征的影响

聂萍，陶丽，孙蕙珺，于倩，朱敏

上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科，国家口腔疾病临床研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海200011

收稿日期:2018-01-08 修回日期:2018-03-02 出版日期:2018-05-20 发布日期:2018-06-12
通讯作者: 朱敏，E-mail:zminnie@126.com
作者简介:聂萍（1984-），女，硕士，主治医师，E-mail: nieping1011@sina.com
基金资助:
上海交通大学医工（理）交叉基金资助（YG2017QN12）；上海高校青年教师培养资助计划（shjdy029）

Evaluation of the effect of surgically assisted rapid maxillary expansion on the characteristics of nasal airflow

NIE Ping, TAO Li, SUN Hui-jun, YU Qian, ZHU Min.

Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center of Stomatology; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011, China

Received:2018-01-08 Revised:2018-03-02 Online:2018-05-20 Published:2018-06-12

摘要/Abstract

摘要： 目的： 采用计算机数值模拟方法，研究手术辅助上颌骨快速扩弓对鼻腔气流动力学特征的影响。方法： 选择8例上颌骨横向发育不足，伴一侧或双侧后牙反的成人患者进行手术辅助上颌快速扩弓。所有研究对象均在治疗前（T1）、扩弓保持3个月后（T2）拍摄螺旋CT，采用Mimics10.0软件建立上气道三维模型，并利用ANSYS14.0软件系统对三维气道进行网格划分、流场数值模拟以及计算模拟结果的后处理，以获得鼻腔内气流速率、压力，鼻腔各截面面积、鼻腔容积和鼻阻力数据。采用SPSS 16.0 软件包中的配对t检验比较T1、 T2时期鼻气道气流场参数的改变。结果： 扩弓后鼻腔整体流速趋于稳定，流速较治疗前减小；术前鼻腔内多处见湍流形成，而术后则较少见湍流及涡流形成；鼻腔负压绝对值显著减小（P<0.05），鼻腔横截面积及鼻腔容积增加，且鼻阻力显著降低（P<0.05）。结论： 手术辅助快速扩弓可对鼻气道形态及气流动力学特征产生一定影响，有利于鼻气道通气功能改善。

关键词: 手术辅助上颌快速扩弓 , 鼻气道 , 计算流体力学

Abstract: PURPOSE: To study the effect of surgically assisted rapid maxillary expansion on nasal airflow dynamics by computer numerical simulation. METHODS: The sample comprised 8 adult patients with maxillary transverse deficiency. They had unilateral or bilateral posterior teeth crossbite. Spiral CT scans were taken before treatment(T1) and 3 months after expansion(T2). The three-dimensional model of the upper airway was established by using Mimics10.0 software, and the analysis of computational fluid dynamics was simulated by ANSYS14.0 software in order to obtain the airflow velocity, the nasal cavity pressure, the cross-sectional area of nasal cavity, nasal airway volume and resistance. The nasal airflow parameters were analyzed with SPSS16.0 software package for paired t test, respectively. RESULTS: The whole nasal velocity was tended to be stable after expansion, and it decreased significantly compared with that before expansion(P<0.05). There was more turbulent flows formation in the nasal airway preoperatively than postoperatively. The absolute value of nasal negative pressure decreased after expansion(P<0.05). The cross-sectional area of nasal cavity and nasal volume increased, while the nasal airway resistance decreased significantly after expansion (P<0.05). CONCLUSIONS: Surgically assisted rapid maxillary expansion has certain effect on nasal airway morphology and airflow dynamics, which is beneficial to the improvement of nasal airway ventilation function.

Key words: Surgically assisted rapid maxillary expansion, Nasal airway, Computational fluid dynamics

中图分类号:

R782.2

聂萍，陶丽，孙蕙珺，于倩，朱敏. 手术辅助上颌骨快速扩弓对鼻气道流场特征的影响[J]. 中国口腔颌面外科杂志, 2018, 16(3): 237-241.

NIE Ping, TAO Li, SUN Hui-jun, YU Qian, ZHU Min.. Evaluation of the effect of surgically assisted rapid maxillary expansion on the characteristics of nasal airflow[J]. China J Oral Maxillofac Surg, 2018, 16(3): 237-241.

参考文献

[1] Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion in children with obstructive sleep apnea syndrome [J]. Sleep, 2004, 27(4): 761-766.
[2] Deeb W, Hansen L, Hotan T, et al. Changes in nasal volume after surgically assisted bone-borne rapid maxillary expansion [J]. Am J Orthod Dentofacial Orthop, 2010, 137(6): 782-789.
[3] 钱玉梅, 陈丽萍, 吴亚东, 等. 人体上呼吸道三维数值模型的建立与气体流场数值模拟分析[J].上海口腔医学, 2010, 19(3): 310-314.
[4] Qian Y, Qian H, Wu Y, et al. Numeric simulation of the upper airway structure and airflow dynamic characteristics after unilateral complete maxillary resection [J]. Int J Prosthodont, 2013, 26(3): 268-271.
[5] 李懿波, 李永明, 陈金武, 等. OSAHS患者经口腔矫治器治疗前后上呼吸道形态及气流动力学变化 [J]. 实用口腔医学杂志, 2014, 30(2): 183-187.
[6] Kimbell JS, Subramaniam RP. Use of computational fluid dynamics models for dosimetry of inhaled gases in the nasal passages [J]. Inhal Toxicol, 2001, 13(5): 325-334.
[7] Martonen TB, Quan L, Zhang Z, et al. Flow simulation in the human upper respiratory tract [J]. Cell Biochem Biophys, 2002, 37(1): 27-36.
[8] Xu C, Sin S, McDonough JM, et al. Computational fluid dynamics modeling of the upper airway of children with obstructive sleep apnea syndrome in steady flow [J]. J Biomech, 2006, 39(11): 2043-2054.
[9] Jeong SJ, Kim WS, Sung SJ. Numerical investigation on the flow characteristics and aerodynamic force of the upper airway of patient with obstructive sleep apnea using computational fluid dynamics [J]. Med Eng Phys, 2007, 29(6): 637-651.
[10] Mihaescu M, Murugappan S, Gutmark E, et al. Computational modeling of upper airway before and after adenotonsillectomy for obstructive sleep apnea [J]. Laryngoscope, 2008, 118(2): 360-362.
[11] Yu CC, Hsiao HD, Lee LC, et al. Computational fluid dynamic study on obstructive sleep apnea syndrome treated with maxillomandibular advancement[J]. J Craniofac Surg, 2009, 20(2): 426-443.
[12] 臧洪瑞, 刘迎曦, 张罗, 等. 鼻腔扩容术对上气道流场改变的数值模拟 [J]. 中国耳鼻咽喉头颈外科, 2014, 21(2): 85-88.
[13] Peltom?ki T. The effect of mode of breathing on craniofacial growth-revisited [J]. Eur J Orthod, 2007, 29(5): 426-429.
[14] 刁晓洁, 李彪, 孙昊, 等. 采用超声骨刀在局部麻醉下行外科辅助上颌骨快速扩弓术的临床应用 [J].华西口腔医学杂志, 2014, 32(4): 350-354.
[15] Sayinsu K, Isik F, Arun T. Sagittal airway dimensions following maxillary protraction: a pilot study [J]. Eur J Orthod, 2006, 28(2): 184-189.
[16] Smith T, Ghoneima A, Stewart K, et al. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion [J]. Am J Orthod Dentofacial Orthop, 2012, 141(5): 618-626.
[17] Nada RM, van Loon B, Schols JG, et al. Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion [J]. Eur J Oral Sci, 2013, 121(5): 450-456.
[18] Iwasaki T, Saitoh I, Takemoto Y, et al. Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics [J]. Am J Orthod Dentofacial Orthop, 2012, 141(3): 269-278.
[19] Iwasaki T, Takemoto Y, Inada E, et al. The effect of rapid maxillary expansion on pharyngeal airway pressure during inspiration evaluated using computational fluid dynamics [J]. Int J Pediatr Otorhinolaryngol, 2014, 78(8): 1258-1264.
[20] 聂萍, 陶丽, 唐艳梅, 等. 手术辅助上颌快速扩弓对鼻气道形态和鼻阻力的影响 [J].中国口腔颌面外科杂志, 2015, 13(2): 147-150.

手术辅助上颌骨快速扩弓对鼻气道流场特征的影响

Evaluation of the effect of surgically assisted rapid maxillary expansion on the characteristics of nasal airflow

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