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Informationen aus Orthodontie & Kieferorthopädie 2012; 44(04): 247-251
DOI: 10.1055/s-0032-1331167
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© Georg Thieme Verlag KG Stuttgart · New York

Atemstörungen und kraniofaziales Wachstum – Konsequenzen und Behandlungsoptionen

Impaired Breathing and Craniofacial Growth – Consequences and Treatment Options
T. Peltomäki
1   Oral and Maxillofacial Unit, Tampere University Hospital and Department of Otolaryngology, University of Tampere, ­Tampere, Finland
,
J. Kurimo
1   Oral and Maxillofacial Unit, Tampere University Hospital and Department of Otolaryngology, University of Tampere, ­Tampere, Finland
,
R. Jaanimets
1   Oral and Maxillofacial Unit, Tampere University Hospital and Department of Otolaryngology, University of Tampere, ­Tampere, Finland
2   Medical Imaging Center, Tampere University Hospital, Tampere, Finland
,
J. Järnstedt
2   Medical Imaging Center, Tampere University Hospital, Tampere, Finland
,
A. Miettinen
1   Oral and Maxillofacial Unit, Tampere University Hospital and Department of Otolaryngology, University of Tampere, ­Tampere, Finland
› Author Affiliations
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Publication History

Publication Date:
09 January 2013 (online)

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Zusammenfassung

Über den Einfluss der Atmung auf das kraniofaziale Wachstum und die okklusale Entwicklung wird in der Kieferorthopädie schon seit Jahrzehnten diskutiert. Man geht zwar davon aus, dass eine Beziehung zwischen Form, also den kraniofazialen Strukturen, und Funktion, der Atmung, besteht. Die Art dieser Beziehung ist allerdings noch weitgehend ungeklärt. Beeinflusst die Morphologie kraniofazialer Strukturen (Lage des Unterkiefers, Breite des Oberkiefers) die Atmung, oder hat etwa die Art der Atmung (Nasen- oder Mundatmung, behindert oder nicht behindert, besonders während des Schlafes) Auswirkungen auf die kraniofaziale und okklusale Entwicklung.

Während der vergangenen 3 Jahrzehnte haben sich Forschung und klinisches Interesse an der Atmung den nächtlichen Atemregulationsstörungen zugewandt. Das Spektrum dieser Atemstörungen reicht von chronischem oder habituellem Schnarchen bis hin zum Widerstandssyndrom der oberen Atemwege und zur obstruktiven Schlafapnoe.

Bei Kindern gelten große Rachenmandeln und Tonsillen als Hauptursachen für nächtliche Atemregulationsstörungen, wobei Schnarchen oder Atemgeräusche während des Schlafes die häufigsten Symptome darstellen. Eine Adenotomie ist bei 2/3 der pädiatrischen Patienten mit nächtlichen Atemregulationsstörungen die Therapie der Wahl. Personen mit persistierender Symptomatik sind übergewichtig, haben schwere nächtliche Atemregulationsstörungen und/oder haben, als Folge von Anpassungsvorgängen, ungünstige dentale und kraniofaziale Verhältnisse. In solchen Fällen ist das Fachwissen der Kieferorthopädie gefragt, mit deren Hilfe ein Oberkiefer geweitet und ein Unterkiefer nachentwickelt werden kann.

Risikofaktoren in Verbindung mit obstruktiver Schlafapnoe bei Erwachsenen, wie z. B. solche Faktoren, die die Größe der Atemwege speziell hinter der Zunge beeinflussen, im Zusammenhang mit einer physiologischen Verminderung des Muskeltonus im Schlaf, führen zur obstruktiven Atmung. Bei übergewichtigen und fettleibigen Patienten stellt vergrößertes Fettgewebe in den parapharyngealen Bereichen für sich alleine schon eine wichtige Ursache für die Erkrankung dar. Bei normalgewichtigen Personen spielt demgegenüber eine abweichende Anatomie der oberen Atemwege und der Hart- bzw. Weichgewebe beim Entstehen einer obstruktiven Schlafapnoe eine Rolle. Als effektivste chirurgische Therapie bei der obstruktiven Schlafapnoe Erwachsener hat sich die chirurgische Vorverlagerung von Ober- und Unterkiefer erwiesen, obwohl hier noch Untersuchungen zur Langzeitstabilität der Ergebnisse erforderlich sind.

Abstract

The impact of mode of breathing on craniofacial growth and occlusal development has been a widely debated issue in orthodontics for decades. Form-function relationship between craniofacial structure and breathing function has been acknowledged, but understanding of this association is poorly understood. Does craniofacial morphology (mandibular position, width of maxilla) have an impact on breathing, or does breathing (nose vs. mouth, disturbed or undisturbed particularly during sleep) affect craniofacial and occlusal development.

During the past 3 decades research and clinical interest on breathing function has focused to sleep disordered breathing (SDB). This continuum spectrum of breathing anomalies ranges from chronic or habitual snoring to upper airway resistance syndrome (UARS) and to obstructive sleep apnea (OSA).

In children large adenoids and tonsils are considered as the main causes of SDB with snoring or noise breathing at sleep being the most frequent symptoms. Adenotonsillectomy is effective first-line therapy for 2/3 of pediatric SDB patients. Individuals with persisting symptoms are obese, have severe SDB and/or have already due to adaptation an unfavourable dental and craniofacial structure, which calls for orthodontic expertise to widen maxilla and/or advance mandible.

Risk factors related to OSA in adults include factors which reduce upper airway size, particularly behind the tongue, and concomitantly with physiological reduction of muscular tonus at sleep, lead to obstructed breathing. In overweight and obese subjects increased adipose tissue in the parapharyngeal areas is alone a significant causative factor for the disease, but in normal weight individuals abnormal upper airway anatomy of soft and/or hard tissues plays a role in the development of OSA. Maxillomandibular surgical advancement has been found to be the most effective surgical therapy in adult OSA, however, studies of long term stability are still needed.

Schlüsselwörter

Schlafapnoe - Adenotomie - Expansion der Maxilla - Nachentwicklung des ­Unterkiefers - Vorverlagerung von Ober- und Unterkiefer

Key words

sleep apnea - adenotonsillectomy - maxillary expansion - mandibular advancement - maxillomandibular advancement
 

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