替牙期扁桃体伴腺样体肥大患儿过敏因素与颌面畸形的相关性

doi:10.6040/j.issn.1673-3770.0.2021.531

摘要/Abstract

摘要： 目的研究替牙期扁桃体伴腺样体肥大患儿过敏因素与颌面部畸形的相关性。方法对2018-2021年在山东大学齐鲁医院耳鼻咽喉科住院行扁桃体及腺样体切除术的替牙期(6-12岁)儿童207例行过敏原检测,收集患儿一般资料、临床资料及头影测量指标,组间比较采用t检验或非参数检验,相关分析使用Pearson或Spearman相关性分析,过敏原分类间的组间线性趋势采用多项式线性趋势检验。结果男性患儿中,伴有过敏因素与无过敏因素比较,反映上颌骨相对位置的蝶鞍中心(点S),鼻根点(N)及上齿槽座点所构成的角(SNA)及反映下颌骨相对位置的蝶鞍中心(点S),鼻根点(点N)及下齿槽座点(点B)所构成的角(SNB)有统计学差异(P=0.032;P=0.019),而女性患儿中,伴有过敏因素与无过敏因素比较,头影测量指标无明显差异。并且,过敏因素评分与SNA、SNB呈负相关,与其他所测指标无明显相关。并且SNA、SNB均随着过敏原评分的升高而存在线性降低的趋势(线性趋势=0.003;线性趋势=0.015)。结论扁桃体伴腺样体肥大患儿中,伴过敏因素的男性更易发生上颌矢状方向发育不足及下颌后缩,提示过敏是扁桃体伴腺样体肥大男性患儿颌面畸形的危险因素之一。

关键词: 阻塞性睡眠呼吸暂停:过敏因素:颌面部畸形:扁桃体肥大, 腺样体肥大

Abstract: Objective To study the correlation between allergy factors and maxillofacial malformation in children with tonsil and adenoid hypertrophy during tooth replacement. Methods A total of 207 children(6-12 years old)undergoing tonsillectomy and adenoidectomy from 2018 to 2021 were enrolled. Allergen detection was performed on all children, and general data, clinical data and cephalometric indicators were collected. T-test or non-parametric test was used for comparison between groups. Spearman correlation analysis was used for correlation analysis, and polynomial linear trend test was used for inter-group linear trend test of allergen classification. Results There were statistically significant differences in SNA and SNB reflecting maxillary relative position in male children with and without allergic factors(P=0.032; P=0.019)(Table 3). In female children, there was no significant difference in head measurement indexes between those with and without allergic factors. In addition, the score of allergy factors was negatively correlated with SNA and SNB, but had no significant correlation with other indexes.(Table 4)Both SNA and SNB showed a linear decreasing trend with the increase of allergen score(linear trend =0.003; Linear trend =0.015)(FIG. 2, FIG. 3). Conclusion In children with tonsillar adenoid hypertrophy, males with allergic factors are more likely to develop sagittal underdevelopment of the upper jaw and retraction of the mandibular, suggesting that allergy is one of the risk factors for maxillofacial deformity in male children with tonsillar adenoid hypertrophy.

Key words: Obstructive sleep apnea: Anaphylaxis factor, Maxillofacial deformity, Hypertrophy of the tonsils, Adenoid hypertrophy

中图分类号:

R766.3

金霄雪,韩莹莹,郭瑞祥,倪守洁,邹娟娟,王岩,李延忠. 替牙期扁桃体伴腺样体肥大患儿过敏因素与颌面畸形的相关性[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 45-50.

JIN Xiaoxue, HAN Yingying, GUO Ruixiang, NI Shoujie, ZOU Juanjuan, WANG Yan, LI Yanzhong. Correlation between allergy factors and maxillofacial malformation in children with tonsil and adenoid hypertrophy in denture replacement period[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 45-50.

参考文献

[1] Trotman CA, McNamara JA Jr, Dibbets JM, et al. Association of lip posture and the dimensions of the tonsils and sagittal airway with facial morphology[J]. Angle Orthod, 1997, 67(6): 425-432. doi:10.1043/0003-3219(1997)067<0425: AOLPAT>2.3.CO;2.
[2] Nunes WR Jr, Francesco RCD. Variation of patterns of malocclusion by site of pharyngeal obstruction in children[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(11): 1116-1120. doi:10.1001/archoto.2010.187.
[3] Rossi RC, Rossi NJ, Rossi NJC, et al. Dentofacial characteristics of oral breathers in different ages: a retrospective case-control study[J]. Prog Orthod, 2015, 16: 23. doi:10.1186/s40510-015-0092-y.
[4] Chambi-Rocha A, Cabrera-Domínguez ME, Domínguez-Reyes A. Breathing mode influence on craniofacial development and head posture[J]. J Pediatr(Rio J), 2018, 94(2): 123-130. doi:10.1016/j.jped.2017.05.007.
[5] Zou JJ, Yang Y, Fu Q, et al. Eosinophils are more strongly relevant to allergic sensitization than basophils in pediatric adenotonsillar hypertrophy[J]. Front Pediatr, 2021, 9: 598063. doi:10.3389/fped.2021.598063.
[6] 陈文欣, 付勇. 腺样体肥大在儿童分泌性中耳炎发病机制中的作用研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(17): 1359-1362. doi:10.13201/j.issn.1001-1781.2018.17.017. CHEN Wenxin, FU Yong. Advances in the role of adenoid hypertrophy in the pathogenesis of otitis media with effusion in children[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(17): 1359-1362. doi:10.13201/j.issn.1001-1781.2018.17.017.
[7] Kyu-Sup Cho, Seong Heon Kim, Sung-Lyong Hong,et al. Local Atopy in Childhood Adenotonsillar Hypertrophy[J].Am J Rhinol Allergy, 2018, 32(3):160-166. doi: 10.1177/1945892418765003.
[8] Ganesans,Larem A,AL-Saey H, et al.Prevalence of Inhalant Allergic Rhinitis in Children with Adenoid Hypertrophy: A Prospective Radioallergosorbent Test( Rast )Study [J]. J Otolaryngol ENT Res, 2016, 4(5): 00111.
[9] Dogru M, Evcimik MF, Calim OF. Does adenoid hypertrophy affect disease severity in children with allergic rhinitis? [J]. Eur Arch Otorhinolaryngol, 2017, 274(1): 209-213. doi:10.1007/s00405-016-4196-x.
[10] Naclerio R. Clinical manifestations of the release of histamine and other inflammatory mediators.[J]. J Allergy Clin Immunol, 1999, 103: 382-385. doi: 10.1016/s0091-6749(99)70216-2.
[11] Knapp HR, Murray JJ, Leukotrienes as mediators of nasal inflammation[J]. Adv Prostaglandin Thromboxane Leukot Res, 1994, 22: 279-288.
[12] Arimura A, Yasui K, Kishino J, et al. Prevention of allergic inflammation by a novel prostaglandin receptor antagonist, S-5751[J]. J Pharmacol Exp Ther, 2001, 298(2): 411-419.
[13] Proud D, Reynolds CJ, Lacapra S, et al. Nasal provocation with bradykinin induces symptoms of rhinitis and a sore throat.[J]. Am Rev Respir Dis, 1988, 137(3):613-616. doi: 10.1164/ajrccm/137.3.613.
[14] Morais-Almeida M, Wandalsen GF, Solé D. Growth and mouth breathers[J]. Jornal De Pediatr, 2019, 95: 66-71. doi:10.1016/j.jped.2018.11.005.
[15] Zhao ZY, Zheng LL, Huang XY, et al. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis[J]. BMC Oral Health, 2021, 21(1): 108. doi:10.1186/s12903-021-01458-7.
[16] Ahmed MR, Abou-Halawa AS, Ibrahim IH, et al. Effect of topical mometasone furoate on adenoidal lymphoid tissue: a light microscopic study[J]. J Laryngol Otol, 2019, 133(2): 106-109. doi:10.1017/S0022215118002268.
[17] Tuhan\u0131o\u011flu B, Erkan SO. Evaluation of the effects of montelukast, mometasone furoate, and combined therapyon adenoid size: a randomized, prospective, clinical trial with objective data[J]. Turk J Med Sci, 2017, 47(6): 1736-1743. doi:10.3906/sag-1701-179.
[18] Machado Júnior AJ, Crespo AN. Pediatric obstructive sleep apnea: beyond adenotonsillectomy[J]. Sleep Med, 2020, 66: 282-283. doi:10.1016/j.sleep.2019.09.011.
[19] Machado-Júnior AJ, Zancanella E, Crespo AN. Rapid maxillary expansion and obstructive sleep apnea: a review and meta-analysis[J]. Med Oral Patol Oral Cir Bucal, 2016, 21(4): e465-e469. doi:10.4317/medoral.21073.
[20] Macario C, Chang ET, Song SA, et al. Rapid maxillary expansion for pediatric obstructive sleep apnea: a systematic review and meta-analysis[J]. Laryngoscope, 2017, 127(7): 1712-1719. doi:10.1002/lary.26352.
[21] Vale F, Albergaria M, Carrilho E, et al. Efficacy of rapid maxillary expansion in the treatment of obstructive sleep apnea syndrome: a systematic review with meta-analysis[J]. J Evid Based Dent Pract, 2017, 17(3): 159-168. doi:10.1016/j.jebdp.2017.02.001.
[22] 李丹阳, 梁辉. 口面肌功能治疗对阻塞性睡眠呼吸暂停研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 108-114. doi:10.6040/j.issn.1673-3770.0.2020.286. LI Danyang, LIANG Hui. Advancements in orofacial myofunctional therapy for obstructive sleep apnea[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 108-114. doi:10.6040/j.issn.1673-3770.0.2020.286.
[23] Camacho M, Certal V, Abdullatif J, et al. Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis[J]. Sleep, 2015, 38(5): 669-675. doi:10.5665/sleep.4652.
[24] Lin HY, Xiong HH, Ji CJ, et al. Upper airway lengthening caused by weight increase in obstructive sleep apnea patients[J]. Respir Res, 2020, 21(1): 272. doi:10.1186/s12931-020-01532-8.
[25] Wang SH, Keenan BT, Wiemken A, et al. Effect of weight loss on upper airway anatomy and the apnea-hypopnea index. the importance of tongue fat[J]. Am J Respir Crit Care Med, 2020, 201(6): 718-727. doi:10.1164/rccm.201903-0692OC.
[26] Bouloukaki I, Mermigkis C, Markakis M, et al. Cardiovascular effect and symptom profile of obstructive sleep apnea: does sex matter? [J]. J Clin Sleep Med, 2019, 15(12): 1737-1745. doi:10.5664/jcsm.8074.

相关文章 15

[1]	黄焕,华红利,邓玉琴,江承洋,王雨薇,杨星海. 儿童过敏性鼻炎、扁桃体腺样体肥大和鼻窦炎之间相关性及其对临床指导价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 34-41.
[2]	王尧,陈静怡,杨颖超,苏开明. 先天性纤维蛋白原缺乏症儿童的扁桃体腺样体切除病例分析1例及文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 77-80.
[3]	赵云,滕支盼,李琦,沈小飞. 儿童腺样体扁桃体切除后圆枕增生26例[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 43-48.
[4]	朱雅欣,刘峰,关建,殷善开. 儿童扁桃体腺样体肥大组织淋巴细胞改变的研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 62-67.
[5]	崔佳文,王怡超,刘鲲鹏,王树霞,胡丽君,顾非. 推拿改善腺样体肥大患儿呼吸暂停低通气指数的临床观察[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 133-138.
[6]	倪守洁,邹娟娟,郭瑞祥,韩莹莹,金霄雪,李延忠,王岩. 儿童头颅侧位片测量参数对腺样体肥大诊断价值的研究[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 39-44.
[7]	王兴鑫,杨欣雨,郑晓军,丁麟,盛亚文,毕晓云,杨继国. 穴位贴敷疗法治疗小儿腺样体肥大1例[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 122-124.
[8]	袁晨阳, 刘燕, 房振胜. 儿童阻塞性睡眠呼吸暂停低通气综合征对肺功能的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 143-148.
[9]	吴华,孙永明,郑建华,蔡雪花. 腺样体消融联合鼓膜打孔术治疗儿童腺样体肥大合并分泌性中耳炎55例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 71-75.
[10]	谷婷婷,刘岩,张悦,于丹,文连姬. 内舒拿联合孟鲁司特钠治疗腺样体肥大的Meta分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 47-55.
[11]	张立强. 儿童鼻窦炎与腺样体肥大的关系[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 25-28.
[12]	刘燕,魏萍,寇巍,胡思洁,武小芳,刘萌雅,陈成,姚红兵. 儿童腺样体肥大与耳鼻咽喉科常见疾病关系的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 149-154.
[13]	王驰,刘星,孔磊,洪兴和,宁博. 鼻内镜下等离子射频消融术对合并鼻窦炎的小儿腺样体肥大患者疗效及鼻腔黏膜纤毛清除功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 78-81.
[14]	周鼎坤,蔡郁,田艳华,滕博,冯青杰. Crouzon儿童腺样体切除术后并发Grisel综合征一例[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 119-120.
[15]	王岩,师晓丽. 变态反应与儿童OSAHS的关系[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 14-18.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed