Interaktion von Hals-Nasen-Ohren-Heilkunde und Kieferorthopädie: Die Beziehung zwischen dem nasopharyngealen Luftraum und den kraniofazialen Strukturen

Zusammenfassung

Eine anatomisch enge Luftpassage stellt pathophysiologisch einen prädisponierenden Faktor für die Obstruktion der oberen Luftwege dar. In diesem Zusammenhang wird die Beziehung zwischen dem nasopharyngealen Luftraum und den kraniofazialen Strukturen diskutiert. So konnte eine wechselseitige Interaktion zwischen dem Pharynx und der Unterkieferlage nachgewiesen werden, wobei die transversale Dimension des Nasopharynx bei Patienten mit einer Progenie signifikant größer war als bei Patienten mit einer Retrogenie. Auch wurde der Einfluss einer chronischen Obstruktion des nasalen Luftweges auf die kraniofaziale Entwicklung diskutiert. Dabei erscheint die Form-Funktion-Interaktion, die die kausale Beziehung zwischen nasaler Obstruktion und Gesichtsschädelwachstum erklären sollte, nicht eindimensional linear sondern von multifaktorieller Natur zu sein. Unstrittig ist hingegen, dass eine Erweiterung des Oberkiefers sowohl das nasale Volumen und den nasalen Flow als auch das subjektive Empfinden der Patienten verbessert. Eine prognostische Aussage hinsichtlich des Ausmaßes ist aufgrund der individuell unterschiedlichen Reaktionsweise jedoch nicht möglich. Auch in der Therapie eines milden obstruktiven Schlafapnoesyndroms können kieferorthopädische Apparaturen zur Vorverlagerung des Unterkiefers erfolgreich eingesetzt werden. Diese Behandlungsmethode ist insbesondere bei Patienten, die einer CPAP-Behandlung unwillig gegenüber stehen oder nicht tolerieren, in Erwägung zu ziehen.

Abstract

Interaction between Otorhinolaryngology and Orthodontics: Correlation between the Nasopharyngeal Airway and the Craniofacial Complex

In terms of pathophysiology, an anatomically narrow airway is a predisposing factor for obstruction of the upper respiratory tract. The correlation between the nasopharyngeal airway and the craniofacial structures is discussed in this context. Thus a mutual interaction between the pharynx and the mandibular position was demonstrated, whereby the transverse dimension of the nasopharynx was significantly larger in patients with prognathism than in patients with retrognathism. The influence of chronic obstruction of the nasal airway on craniofacial development was also discussed. The form-and-function interaction, which ought to explain the causal relationship between nasal obstruction and craniofacial growth, appears to be of a multifactorial rather than a one-dimensional, linear nature. It is not disputed, however, that expanding the maxilla improves not only nasal volume and nasal flow, but also the subjective sensation of patients, although it is not possible to make a prognostic statement about the extent of this improvement because of the differing reactions of individuals. Orthodontic appliances for advancing the mandible can also be successfully used in the treatment of mild obstructive sleep apnea syndrome. This treatment method should be considered particularly for patients who are unwilling to undergo or cannot tolerate CPAP treatment.

Schlüsselwörter

kraniofaziale Entwicklung - nasopharyngealer Luftweg - Adenoide - forcierte Gaumennahterweiterung (RME) - obstruktives Schlafapnoesyndrom (OSAS) - mandibular advancement device (MAD)

Key words

craniofacial development - nasopharyngeal airway - adenoids - rapid maxillary expansion (RME) - obstructive sleep apnea syndrome (OSAS) - mandibular advancement device (MAD)

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