Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor<sup/>

Gonçalves, Carlos Augusto de Jesus Oliveira; Pinheiro, João de Jesus Viana; Carneiro, Marcelo Newton; Tabosa, Ana Karla da Silva; Cárdenas, Roberto Carlos Rivadeneira; Carneiro Jr, José Thiers

doi:10.1016/j.bjorl.2023.101372

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 90 (2) • 2024 • https://doi.org/10.1016/j.bjorl.2023.101372 copy

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor^☆ ☆ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME).

Methods

Retrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21-42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx.

Results

There was an increase in nasal width with an average of 1.3467 mm and an increase in the alar base with an average of 1.7333 mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies.

Conclusion

Although our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics.

Level of evidence: Level 4.

Keywords
Maxillary expansion; Soft tissue changes; Transpalatal distractor; Airway

Highlights

Changes were observed in the angular measurements (nasolabial angle).

Changes were observed in the facial soft tissue (nasal width and alar base).

Airway volumetric increase after SARME.

	Nasal width			Wing base			Nasolabial angle
	Pre-OP	Pos-OP	DIF	Pre-OP	Pos-OP	DIF	Pre-OP	Pos-OP	DIF
PAT 01	43.8	45.3	1.5	33.7	35.9	2.2	103.6	113.1	9.5
PAT 02	41.1	44.1	3	29.7	31.2	1.5	103.8	111.8	8
PAT 03	42	42.8	0.8	33.7	34.6	0.9	82.9	95.2	12.3
PAT 04	41.1	41.7	0.6	28	29.1	1.1	100.7	104.8	4.1
PAT 05	36.1	36.4	0.3	29.4	30.7	1.3	106.7	109.1	2.4
PAT 06	41.1	43.4	2.3	25.2	28	2.8	99.5	110.5	11
PAT 07	32.4	33.7	1.3	22.4	22.8	0.4	95.7	97.4	1.7
PAT 08	38.7	39.6	0.9	31.3	31.8	0.5	106.4	112.9	6.5
PAT 09	36.2	37.9	1.7	24.1	26.6	2.5	93.2	87.2	−6
PAT 10	33	34.3	1.3	22.7	24.9	2.2	104.7	109.4	4.7
PAT 11	37.6	37.8	0.2	32.2	33	0.8	132.8	132.8	0
PAT 12	37.4	37	0.4	32.9	31.4	−1.5	116.4	116.9	0.5
PAT 13	39.1	41.6	2.5	36.3	36.8	0.5	114.5	122.4	7.9
Average	38.43	39.62	1.37	29.35	30.52	1.17	104.68	109.50	5.1
SD	0.343	0.378		0.4564	0.4173		7.397	8.889

	NASO			ORO			HYPO			Total
+	Pre-OP	Pos-OP	DIF	Pre-OP	Pos-OP^a a ORO abnormal data.	DIF	Pre-OP	Pos-OP	DIF	Pre-OP	Pos-OP	DIF
PAT 01	65,025	66,258	1233	15,469	15,567	98	4435	4552	117	91,723	105,863	14,140
PAT 02	44,253	55,324	11,071	8727	10,243	1516	1763	3103	1340	57,175	74,128	16,953
PAT 03	71,878	74,810	2932	9727	10,678	951	1867	4006	2139	50,129	61,465	11,336
PAT 04	73,758	83,166	9408	10,556	13,184	2628	2974	3208	234	78,226	84,701	6475
PAT 05	70,265	77,658	7393	14,420	20,174	5754	4055	5082	1027	90,045	106,478	634
PAT 06	54,161	57,985	3824	12,460	29,575	17,115	4782	8760	3978	105,844	134,616	28,772
PAT 07	17,610	65,704	48,094	16,873	71,909	55,036	3657	3823	166	87,461	93,310	5849
PAT 08	60,947	61,668	741	6911	7162	251	1098	2461	1363	56,039	67,780	11,741
PAT 09	101,290	106,316	5026	12,902	16,553	3651	8042	8418	376	122,609	125,337	2728
PAT 10	67,509	69,556	2047	3975	4244	269	1114	1252	138	53,678	58,487	4809
PAT 11	52,795	59,747	6952	8518	13,680	5162	4100	4522	422	55,667	55,673	6
PAT 12	40,935	45,038	4103	7079	10,384	3305	684	772	38	47,439	55,190	7751
PAT 13	43,932	47,089	3157	13,357	24,074	10,717	4536	5274	738	69,513	85,877	16,364
PAT 14	60,308	76,926	16,618	16,802	28,337	11,535	3878	3890	17	82,640	83,058	418
PAT 15	16,702	29,276	12,574	9717	13,203	3486	3098	4079	990	72,560	79,084	6524
Average	56,929	64,263	7334	11,166		8089	3348	4204	856	74,716	84,736	10,020
SD	20,315	20,149		3844			1881	2196		22,146	24,659	4978
Median					13,680*

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: carlosgoncalvescd@gmail.com (C.A. Gonçalves)

Lip filter (Lf)	Vertical depression in the middle area of the upper lip
Pronasal (Prn)	The most prominent point on the nose located in the midline
Alar (Al)	The most lateral point on the outer side of each nostril
Alar curvature (AC)	Point located at the soft tissue insertion of each alar base
Subnasal (Sn)	The midpoint between the junction of the inferior border of the nasal septum and the upper lip, in the midline

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Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor☆ ☆ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.

Abstract

Objective

Methods

Results

Conclusion

Highlights

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor^☆ ☆ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.