تاثير انسداد كامل بيني بر آناتومي ساختارهاي كرانيوفاسيال: يك مطالعه حيواني

The effect of total nasal obstruction on the anatomy of craniofacial structures: An animal study

زﻣﯿﻨﻪ و ﻫﺪف: اﻧﺴﺪاد ﺑﯿﻨﯽ ﺑﺎ درﺟﺎت ﻣﺨﺘﻠﻒ از ﻣﺸﮑﻼت ﺷﺎﯾﻊ در دوران ﮐﻮدﮐﯽ اﺳﺖ ﮐﻪ در ﺻﻮرت ﻋﺪم ﻣﺪاﺧﻠﻪ زود ﻫﻨﮕﺎم ﻣﯽﺗﻮاﻧﺪ اﺛﺮات ﺧﻮد ﺑﺮ ﻧﺎﺣﯿــﻪ دﻫــﺎن را ﺗﺎ ﺑﺰرﮔﺴﺎﻟﯽ ﺣﻔﻆ ﮐﻨﺪ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ ﺗﺄﺛﯿﺮ اﻧﺴﺪاد ﮐﺎﻣﻞ ﺑﯿﻨﯽ ﺑﺮ ﻧﺎﺣﯿﻪ ﻓﮏ، ﺟﻤﺠﻤﻪ و ﺻﻮرت ﺧﺮﮔﻮشﻫﺎ اﻧﺠﺎم ﺷﺪ. روش ﺑﺮرﺳﯽ: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺣﯿﻮاﻧﯽ 44 ﺧﺮﮔﻮش ﺑﺎ ﻗﺮاﺑﺖ ژﻧﺘﯿﮑﯽ ﺑﺎﻻ اﻧﺘﺨﺎب ﺷﺪﻧﺪ. ﺗﺤﺖ ﺑﯽﻫﻮﺷﯽ در ﻧﻮاﺣﯽ ﻣﺨﺘﻠﻒ ﺟﻤﺠــﻪ اﯾﻤﭙﻠﻨﺖﻫــﺎي ﻓﻠــﺰي ﻗــﺮار داده ﺷﺪ و از آنﻫﺎ رادﯾﻮﮔﺮاﻓﯽﻫﺎي ﻧﯿﻢرخ، ﺧﻠﻔﯽ- ﻗﺪاﻣﯽ و اﮐﻠﻮزال ﺗﻬﯿﻪ ﺷﺪ. ﺣﻔﺮات ﺑﯿﻨﯽ ﻧﯿﻤﯽ از ﻧﻤﻮﻧﻪﻫﺎ )ﮔﺮوه آزﻣﺎﯾﺶ( ﺑﻪ ﺻﻮرت ﮐﺎﻣﻞ ﺗﻮﺳﻂ ﺟﺮاﺣﯽ ﺑﺴــﺘﻪ ﺷــﺪ. در ﺑﻘﯿﻪ ﻧﻤﻮﻧﻪﻫﺎ )ﮔﺮوه ﮐﻨﺘﺮل( اﯾﻦ ﻣﺪاﺧﻠﻪ اﻧﺠﺎم ﻧﺸﺪ. در اداﻣﻪ ﺗﻤﺎﻣﯽ ﺧﺮﮔﻮشﻫﺎ ﺗﺎ ﭘﺎﯾﺎن دوران رﺷﺪ در ﺷﺮاﯾﻂ ﯾﮑﺴﺎن ﻧﮕﻬﺪاري ﺷﺪﻧﺪ. در ﻧﻬﺎﯾﺖ رادﯾﻮﮔﺮاﻓﯽﻫــﺎ ﻣﺠــﺪداً ﺗﮑﺮار و ﭘﺎراﻣﺘﺮﻫﺎي ﻣﺨﺘﻠﻒ ﻣﺮﺑﻮط ﺑﻪ ﻓﮏ و ﺻﻮرت و ﺟﻤﺠﻤﻪ در آنﻫﺎ اﻧﺪازهﮔﯿﺮي و ﺑﺎ ﮔﺮاﻓﯽﻫﺎي اوﻟﯿﻪ ﻣﻘﺎﯾﺴﻪ ﺷﺪ. آزﻣﻮن آﻣــﺎري ﻣــﻮرد اﺳــﺘﻔﺎده، آزﻣــﻮن ﻣﻘﺎﯾﺴــﻪ ﻣﯿﺎﻧﮕﯿﻦﻫﺎ )T-test( ﺑﻮده و آﺳﺘﺎﻧﻪ ﻣﻌﻨﯽداري در اﯾﻦ ﻣﻄﺎﻟﻌﻪ 0/05 ﺗﻌﯿﯿﻦ ﺷﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﺑﺮ اﺳﺎس ﻧﺘﺎﯾﺞ ﺑﻪ دﺳﺖ آﻣﺪه ارﺗﻔﺎع ﻋﻤﻮدي ﺻﻮرت )0/01=P(، ﻋﻤﻖ ﻣﺎﮔﺰﯾﻼ )0/05=P(، ﭼﺮﺧﺶ ﭘﻠﻦ ﻣﻨﺪﯾﺒﻞ و ﻣﺎﮔﺰﯾﻼ )0/005=P(، زاوﯾــﻪ آرﺗﯿﮑــﻮﻻر )0/005=P( در ﮔﺮوه آزﻣﺎﯾﺶ ﺑﻪ ﺻﻮرت ﻣﻌﻨﯽداري ﺑﯿﺸﺘﺮ و ﻋﺮض ﺑﯿﻦ دﻧﺪاﻧﯽ )0/005=P(، ﻣﺤﯿﻂ ﻣﺎﮔﺰﯾﻼ )0/005=P(، ﻗﻄــﺮ ﻧﺎزوﻓــﺎرﻧﮑﺲ )0/01=P(، ﭘﺮوﺗــﺮوژن ﻣﺎﮔﺰﯾﻼ و ﻣﻨﺪﯾﺒﻞ )0/005=P( ﺑﻪ ﺻﻮرت ﻣﻌﻨﯽداري ﮐﻤﺘﺮ از ﮔﺮوه ﮐﻨﺘﺮل ﺑﻮد. ﺗﻔﺎوت ﻣﻌﻨﯽداري ﺑﯿﻦ دو ﮔﺮوه در ﭘﺎراﻣﺘﺮﻫﺎي ﻃﻮل ﺑــﯿﺲ ﺟﻤﺠﻤــﻪ )0/30=P(، زاوﯾــﻪ ﮔﻮﻧﯿﺎل )0/40=P( و ﻃﻮل ﻣﺎﮔﺰﯾﻼ )0/10=P( دﯾﺪه ﻧﺸﺪ. ﻧﺘﯿﺠﻪﮔﯿﺮي: ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﮐﻪ اﻧﺴﺪاد ﮐﺎﻣﻞ ﺑﯿﻨﯽ ﺗﺄﺛﯿﺮات ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪاي ﺑﺮ روي ﺳﺎﺧﺘﺎرﻫﺎي ﻓﮏ، ﺻﻮرت و ﺟﻤﺠﻤﻪ دارد.

Nasal obstruction is a common condition among children, in which delaying treatment can stabilize its negative effects on dentoalveolar structures during adulthood. In this study we aimed to investigate the effect of total nasal obstruction on the craniofacial structures of rabbits. Materials and Methods In this animal study, total numbers of 44 rabbits with high genetic proximity were selected. Several metal implants were inserted in the anatomic landmarks of their skulls and then underwent three different types of x-ray exposure (lateral, posterior-anterior and occlusal views). Half of them underwent surgically assisted total nasal obstruction, and the other half were considered as control group. All rabbits were kept in the same environment up to maturation period. Then, they underwent the same x-ray exposures. The primary and final radiographs were traced and various linear and angular were compared between them. Results The anterior facial height (P=0.01), maxillary depth (P=0.005), articular angle (P=0.005), maxillary and mandibular plan angle were significantly more in the rabbits with total nasal obstruction. However, the interdental width (P=0.005), maxillary perimeter (P=0.005), nasopharyngeal width (P=0.01) and maxillary and mandibular width were significantly less in them. The skull base length (P=0.30), gonial angle (P=0.40), and maxillary length (P=0.10) were not significantly different between the two groups. Conclusion Total nasal obstruction had various impacts on the craniofacial structures.