Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose

Badreddine, Fauze Ramez; Fujita, Reginaldo R.; Alves, Fabio Eduardo Maiello Monteiro; Cappellette Jr., Mario

doi:10.1016/j.bjorl.2017.01.009

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz. j. otorhinolaryngol. 84 (2) • Mar-Apr 2018 • https://doi.org/10.1016/j.bjorl.2017.01.009 copy

Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose^☆ ☆ Please cite this article as: Badreddine FR, Fujita RR, Alves FE, Cappellette Jr. M. Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose. Braz J Otorhinolaryngol. 2018;84:196-205.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Rapid maxillary expansion can change the form and function of the nose. The skeletal and soft tissue changes can influence the esthetics and the stability of the results obtained by the procedure.

Objective

The aim of this retrospective study was to evaluate the short-term effects of rapid maxillary expansion on the skeletal and soft tissue structures of the nose, in mouth-breathing patients, using a reliable and reproducible, but simple methodology, with the aid of computed tomography.

Methods

A total of 55 mouth-breathing patients with maxillary hypoplasia were assessed and were divided into an experimental group treated with rapid maxillary expansion(39 patients, 23 of which were male and 16 female, with an average age of 9.7 years and a standard deviation of 2.28, ranging from 6.5 to 14.7 years) and a control group (16 patients, 9 of which were male and 7 female, with an average age of 8.8 years, standard deviation of 2.17, ranging from 5.11 to 13.7 years). The patients of the experimental group were submitted to multislice computed tomography examinations at two different points in time: (T1) pre-rapid maxillary expansion and (T2) three months after the procedure. The control group underwent to the same exams at the same intervals of time. Four skeletal and soft tissue variables were assessed, comparing the results of T1 and T2.

Results

There was in the experimental group a significant increases in all the skeletal and soft tissue variables (p < 0.05) but no significant alteration was found in the control group. When comparing the experimental group and the control group, the most important change occurred in the width of the pyriform aperture (p < 0.001).

Conclusion

Rapid maxillary expansion is capable of altering the shape and function of the nose, promoting alterations in skeletal and soft tissue structures. This kind of study may, in the future, permit the proper planning of esthetic procedures at the tip and base of the nose and also the performance of objective measurements in early or late surgical outcomes.

KEYWORDS
Maxillary expansion; Palatal expansion technique; Nasal cavity; Nose

Variable	Group	Pre-RME M ± DP (Min-Max)	Post-RME M ± DP (Min-Max)	Pre-RME post-RME alteration (average)		p^a a p, significance value of Student's t-test for paired samples (difference between pre and post). (pre-RME-post-RME)
				mm	%
Nasal height	EG	44.81 ± 4.01 (38.37-57.34)	46.32 ± 3.94 (40.23-57.14)	+1.51	+3.37%	<0.001
Nasal height	CG	44.93 ± 4.35 (38.01-52.13)	45.05 ± 4.21 (38.41-52.91)	+0.12	+0.27%	0.537
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.920	0.003
Height of pyriform aperture	EG	31.52 ± 3.42 (22.66-37.15)	32.78 ± 3.40 (24.72-39.33)	+1.26	+4.00%	< 0.001
Height of pyriform aperture	CG	31.24 ± 3.51 (25.05-37.26)	31.14 ± 3.24 (25.40-37.98)	-0.10	-0.32%	0.776
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.790	0.003
Width of pyriform aperture	EG	21.64 ± 1.73 (17.83-25.34)	23.62 ± 2.45 (18.19-31.39)	+1.98	+9.15%	< 0.001
Width of pyriform aperture	CG	21.28 ± 1.98 (17.52-24.55)	21.28 ± 1.88 (17.83-24.41)	0.00	0.00%	0.985
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.503	0.001
Total length of the nose	EG	47.25 ± 3.35 (37.76-54.61)	47.78 ± 3.53 (37.18-54.87)	+0.53	+1.12%	0.002
Total length of the nose	CG	47.50 ± 3.09 (41.22-53.16)	47.71 ± 2.83 (42.08-52.75)	+0.21	+0.44%	0.444
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.796	0.938

Variable	Group	Pre-RME M ± DP (Min-Max)	Post-RME M ± DP (Min-Max)	Pre-RME Post-RME alteration (average)		p^a a p, significance value of Student's t-test for paired samples (difference between pre and post). (pre-RME-post-RME)
				mm	%
Width of the soft tissue insertion	EG	32.59 ± 2.84 (28.73-39.95)	34.02 ± 2.85 (29.58-41.99)	+1.43	+4.39%	< 0.001
Width of the soft tissue insertion	CG	32.71 ± 1.72 (30.09-35.44)	32.78 ± 1.89 (29.88-36.19)	+0.07	+0.21%	0.758
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.876	0.002
Alar width	EG	32.68 ± 3.27 (27.13-40.59)	33.81 ± 3.32 (27.43-42.75)	+1.13	+3.46%	< 0.001
Alar width	CG	32.69 ± 1.74 (30.16-35.81)	32.29 ± 2.08 (29.13-36.31)	-0.40	-1.22%	0.085
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.990	0.003
Height of the nasal soft tissue	EG	47.95 ± 4.07 (41.27-58.77)	49.74 ± 4.39 (41.70-59.14)	+1.79	+3.73%	< 0.001
Height of the nasal soft tissue	CG	47.49 ± 4.69 (40.16-55.89)	47.69 ± 4.67 (40.41-55.86)	+0.20	+0.42%	0.101
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.714	0.003
Length of the nasal soft tissue	EG	15.89 ± 1.62 (12.17-18.84)	16.57 ± 1.67 (12.38-20.68)	+0.68	+4.28%	< 0.001
Length of the nasal soft tissue	CG	15.41 ± 1.38 (13.30-17.74)	15.66 ± 1.57 (12.05-18.29)	+0.25	+1.62%	0.161
p^b b p, significance value of Student's t-test for independent samples (difference between the EG and the CG). (between groups)		0.301	0.068

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:dr.fauze@hotmail.com, badreddinefauze@hotmail.com (F.R. Badreddine).

Nasion (N)	Intersection of the frontal bone and two nasal bones.
Anterior Nasal Spine (ANS)	Most anterior point of the maxilla's nasal spine.
Posterior Nasal Spine (PNS)	Most posterior point of the maxilla's nasal spine.

Nasion (N')	Point of the midline of the soft tissue that lies directly over the hard tissue, in the direction of the skeletal Nasion (N).
Pronasal (Prn)	Most prominent point of the nose located on the median.
Alar (Al)	The most lateral point of the contour of each nostril.
Alar Curvature (Ac)	Point located at the soft tissue insertion of each alar base.
Subnasal (Sn)	Mid-point between the meeting of the lower edge of the nasal septum and upper lip, located on the median.