Objective:This study aimed to investigate the change of the position of the tongue before and after combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion. Methods:A total of 30 children with skeletal class Ⅱ malocclusion and unobstructed upper airway were selected. The 30 children were divided into mouth-breathing group（n=15） and nasal-breathing group（n=15） and CBCT was taken. The images were measured by Invivo5 software. The measurement results of the tongue position of the two groups were analyzed by independent samples t-test. 15 mouth-breathing children with skeletal class Ⅱ malocclusion were selected for maxillary expansion and orofacial myofunctional therapy. CBCT was taken before and after treatment, the measurements were analyzed by paired sample t test with SPSS 27.0 software package. Results:The measurement of the tongue position of the mouth-breathing and nasal-breathing groups were compared, the differences were statistically significant（P<0.05）. The measurement of the tongue position showed significant difference after the combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion（P<0.05）. Conclusion:Skeletal class Ⅱ malocclusion children with mouth-breathing have low tongue posture. The combined treatment of maxillary expansion and orofacial myofunctional therapy can change the position of the tongue.
Child ; Humans ; Myofunctional Therapy/methods* ; Mouth Breathing/therapy* ; Palatal Expansion Technique ; Tongue ; Malocclusion/therapy*

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep respiratory disorder characterized by upper respiratory collapse during sleep, with a high prevalence and potentially fatal complications. Currently, maxillary transverse deficiency are considered to be an important pathogenic factor of OSAHS. For patients with poor compliance with positive airway pressure therapy, rapid maxillary expansion can increase the volume and ventilation of the upper respiratory tract, which is an alternative treatment. This paper reviewed the current research on surgically assisted rapid palatal expansion, miniscrew assisted rapid palatal expansion, and distraction osteogenesis maxillary expansion in the treatment of adult OSAHS. By comparing the indications, contraindications, complications, efficacy and long-term stability of the three treatment methods, it provided reference for treatment of patients with OSAHS.
Adult ; Humans ; Nose ; Palatal Expansion Technique ; Palate ; Sleep Apnea, Obstructive/surgery* ; Syndrome

Rapid palatal expansion is commonly uesd to correct maxillary transverse deficiency. The timing and effects of palatal expansion, and the choice of palatal expansion devices are related to the condition of midpalatal suture. Nowadays, there are several methods to assess the condition of midpalatal suture, including physiological age, skeletal age, occlusal film, CT, ultrasonography and so on. This narrative review seeks to review these methods for assessment of midpalatal suture.
Palatal Expansion Technique ; Cranial Sutures/diagnostic imaging* ; Maxilla/diagnostic imaging* ; Palate/diagnostic imaging*

OBJECTIVE: To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask. METHODS: In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis. RESULTS: Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R²=42.5%. CONCLUSION RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.
Cone-Beam Computed Tomography/methods* ; Constriction ; Humans ; Malocclusion, Angle Class III/therapy* ; Maxilla/diagnostic imaging* ; Palatal Expansion Technique ; Sutures

OBJECTIVES: This study aimed to assess the influence of different types of rapid maxillary expansion on root resorption (RR). METHODS: Literature searches were carried out electronically in five English and two Chinese databases. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies, and case-control studies were included. The data were extracted by three authors. The risk of bias in the RCTs and nonrandomized studies were assessed in accordance with corresponding scales. RESULTS: Among the 400 articles identified, seven were included for the final analysis. Three studies were graded as high value of evidence, while two and another two studies were graded as moderate value and low value, respectively. According to the available evidence, the tooth-borne maxillary expansion caused more obvious RR of anchorage teeth than the bone-borne one. In addition, the Haas-type palatal acrylic pads could not effectively reduce the degree of RR. The difference in the design of the retainer between the tooth-borne maxillary expansion (the use of a band or wire framework to connect the anchorage tooth) did not cause the difference in the incidence and degree of RR. CONCLUSIONS Clinical evidence suggested that bone-borne maxillary expansion may decrease the amount of RR, while the amounts of resorption did not significantly differ between Haas and Hyrax and between different retainer types of Hyrax.
Case-Control Studies ; Humans ; Maxilla ; Palatal Expansion Technique ; Palate ; Root Resorption ; Tooth

OBJECTIVE: To assess the efficacy of bone anchorage and maxillary facemask protraction devices in treating skeletal class Ⅲ malocclusion in adolescents. METHODS: Articles relating to the use of bone anchorage and maxillary facemask protraction devices for treating skeletal class Ⅲ malocclusion in adolescents were searched from the databases of Cochrane Library, PubMed, EmBase, CNKI, and Wanfang database. Several inclusion and exclusion criteria were developed for the article screening. The clinical data were extracted, and the quality of the selected articles was evaluated. A Meta-analysis of SNA, SNB, ANB, ANS-Me, Wits, and U1-PP change was performed by using RevMan 5.3. RESULTS: Seven studies (264 patients) were included in the Meta-analysis. Among these studies, three were randomized controlled trials, and four were non-randomized controlled trials. Compared with the maxillary facemask protraction device group, the bone ancho-rage device group had higher SNA changes and lower ANS-Me, Wits, and U1-PP changes (P<0.05). No significant differences were observed in the SNB and ANB changes between these two groups. CONCLUSIONS Compared with the maxillary facemask protraction device, the bone anchorage device can increase the extent of protraction of the maxilla and has better controls for the labial inclination of the maxillary anterior teeth in treating skeletal class Ⅲ malocclusion among adolescents. However, additional high-quality randomized controlled trials must be performed to verify the results.
Adolescent ; Cephalometry ; Extraoral Traction Appliances ; Humans ; Malocclusion, Angle Class III ; Maxilla ; Palatal Expansion Technique

OBJECTIVE: To study the comprehensive impact of scar and maxillary expansion combined with protraction on the development of maxilla with cleft lip and palate after repair operation. METHODS: In the original finite element model of the maxilla with cleft palate, a finite element model of the maxilla with cleft lip and palate was established by using Boolean operation in ANSYS. Scar force after cleft lip and palate repair and maxillary expansion force combined with protraction were added simultaneously to process the stress analysis. RESULTS: Maxillary deformation occurred in the three-dimensional direction. The comparison of displacements was as follows: X-axis>Z-axis>Y-axis. CONCLUSIONS Maxillary growth is significantly inhibited in the three-dimensional direction under the comprehensive impact of scar and maxillary expansion combined with protraction after repair operation, especially transverse and sagittal growth.
Cicatrix/pathology* ; Cleft Lip/surgery* ; Cleft Palate/surgery* ; Finite Element Analysis ; Humans ; Maxilla/surgery* ; Palatal Expansion Technique

In this report, we describe a case involving a 34-year-old woman who showed good treatment outcomes with long-term stability after multidisciplinary treatment for unilateral cleft lip and palate (CLP), maxillary hypoplasia, severe maxillary arch constriction, severe occlusal collapse, and gingival recession. A comprehensive treatment approach was developed with maximum consideration of strong scar constriction and gingival recession; it included minimum maxillary arch expansion, maxillary advancement by distraction osteogenesis using an internal distraction device, and mandibular setback using sagittal split ramus osteotomy. Her post-treatment records demonstrated a balanced facial profile and occlusion with improved facial symmetry. The patient's profile was dramatically improved, with reduced upper lip retrusion and lower lip protrusion as a result of the maxillary advancement and mandibular setback, respectively. Although gingival recession showed a slight increase, tooth mobility was within the normal physiological range. No tooth hyperesthesia was observed after treatment. There was negligible osseous relapse, and the occlusion remained stable after 5 years of post-treatment retention. Our findings suggest that such multidisciplinary approaches for the treatment of CLP with gingival recession and occlusal collapse help in improving occlusion and facial esthetics without the need for prostheses such as dental implants or bridges; in addition, the results show long-term post-treatment stability.
Adult ; Cicatrix ; Cleft Lip* ; Constriction ; Dental Implants ; Esthetics ; Female ; Gingival Recession* ; Humans ; Hyperesthesia ; Lip ; Osteogenesis, Distraction* ; Osteotomy, Sagittal Split Ramus* ; Palatal Expansion Technique ; Palate* ; Prostheses and Implants ; Recurrence ; Tooth ; Tooth Mobility

OBJECTIVE: The aim of this retrospective study was to evaluate and compare the changes in the pharyngeal airway (PA), maxillary sinus volume, and skeletal parameters after rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy. METHODS: The records of 40 patients with skeletal Class III malocclusion due to maxillary retrognathism were collected, and the patients were assigned into two groups. The first group comprised 8 male and 12 female patients (mean age, 10.0 ± 1.1 years) treated using RME/FM for an average of 10 months. The second group comprised 10 male and 10 female patients (mean age, 9.64 ± 1.3 years) treated using Alt-RAMEC/FM for an average of 12 months. Cone-beam computed tomography images acquired before (T0) and after treatment (T1) were evaluated. RESULTS: Regarding the skeletal effects, significant differences between the groups were the increase in ANS-HRP (perpendicular distance of ANS to the horizontal reference plane, 0.99 mm, p <0.05) in the Alt-RAMEC/FM group and the decrease in PP-SN (palatal plane to Sella-Nasion plane, 0.93°, p < 0.05) in the RME/FM group. Maxillary sinus volumes increased significantly in both the groups, and the increase was statistically significantly higher in the Alt-RAMEC/FM group. Although no significant intergroup differences were observed in PA volumes, both lower (1,011.19 mm3) and total (1,601.21 mm3), PA volume increased significantly in the Alt-RAMEC/FM group. CONCLUSIONS: The different expansion devices and protocols used with FM therapy do not seem to affect the forward movement of the maxilla and PA volumes. In contrast, the increase in maxillary sinus volume was greater in the Alt-RAMEC/FM protocol.
Cone-Beam Computed Tomography ; Constriction* ; Female ; Humans ; Male ; Malocclusion ; Maxilla ; Maxillary Sinus ; Palatal Expansion Technique* ; Retrognathia ; Retrospective Studies

OBJECTIVE: This study aims to compare the effects of fast and slow expansion on nasal cavity structure. METHODS: A total of 40 patients were selected and randomly divided into two groups. Cone-beam computer tomography (CBCT) was obtained before and after surgery and used for comparing the changes in nasal structure before and after treatment. RESULTS: Fast expansion had resulted in greater changes in the basilar and nasal bone arch extension structures than slow expansion. No significant difference at maxillary width and nasal parenchyma. CONCLUSIONS Rapid expansion therapy has more beneficial effects on nasal function.
Cephalometry ; Cone-Beam Computed Tomography ; Humans ; Maxilla ; diagnostic imaging ; Nasal Cavity ; Nose ; Palatal Expansion Technique