儿童上呼吸道阻塞对颅颌面部骨骼发育及口颌系统功能影响的研究进展

刘佳鑫 陈锐 任利玲

[关键词]上呼吸道阻塞;口颌系统;颅颌面部发育;儿童

[中图分类号]R782.2    [文献标志码]A    [文章编号]1008-6455（2021）11-0173-03

Research Progress on the Effect of Upper Respiratory Tract Obstruction on the Shape and Function of Oral and Maxillary System in Children

LIU Jia-xin， CHEN Rui， REN Li-ling

（Stomatology School of Lanzhou University， Lanzhou 730000，Gansu，China）

Abstract： Craniofacial complex growth is mainly determined by genetic and environmental factors， especially the abnormal function of oral cavity and its surrounding organs is mainly acquired from environmental factors. In recent years， with the increasing number of children with upper respiratory tract obstruction， the change of craniofacial and oral function caused by the obstruction has become an issue of increasing concern to orthodontists and parents of children. In order to provide some reference for the clinical work of orthodontic department and otolaryngology department， this paper reviewed the effect of upper respiratory tract obstruction on cranial and maxillofacial appearance and the function of oral and maxillary system in children.

Key words： upper respiratory tract obstruction; oral and maxillofacial system; craniofacial development; child

临床上，通常将鼻、咽、喉所构成的腔统称为上呼吸道，其在解剖位置上与口颌系统相毗邻，在功能上相互影响。上呼吸道阻塞是指由多种原因导致的上气道气流受阻，按其机制可分为上气道形态的异常、上气道开放肌功能异常、呼吸驱动和调控障碍以及觉醒阈异常[1]。腺样体肥大和扁桃体肥大是上气道阻塞的第二大常见病因，会引起睡眠障碍、打鼾、呼吸短促和口呼吸等症状[2-4]，这些症状均会影响儿童的生长发育，并进而对儿童的口颌系统功能产生损害。现综述儿童上呼吸道阻塞对生长发育以及形态功能的影响，并且分析当下的临床现状及问题。

1  儿童上呼吸道阻塞對颅颌面部生长发育的影响

大多数学者认为腺样体和扁桃体肥大等上呼吸道阻塞会影响儿童颅颌面部的发育，赵瑞等[5]通过病例调查研究发现，上呼吸道阻塞患儿错牙合畸形的发生率均高于普通人群。周顺泉[6]及Nunes等[7]将腺样体和扁桃体肥大的患儿进行区分，他们发现腺样体肥大患儿主要表现为骨性Ⅱ类错牙合畸形，而扁桃体肥大患儿则表现为骨性Ⅲ类错牙合畸形。Diouf等[8-9]研究发现上呼吸道阻塞程度越严重、病程越长的患者，其错牙合畸形表现越严重，四度肥大的扁桃体甚至会引发严重反牙合和偏牙合。腺样体和扁桃体肥大之所以会引起不同的错……