Photographic assessment of nasal morphology following rapid maxillary expansion in children

Abstract

ObjectiveThe aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. Material and MethodsFacial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. ResultsFrom the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. ConclusionRME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Immediate effects of rapid maxillary expansion on the naso-maxillary facial soft tissue using 3D stereophotogrammetry

“…Similar results were found with previous studies using direct clinical measurements and 2D photographs. 20,27 The present study highlights the subtle changes of widening of the soft tissue nasal base and flattening of the nose as seen by an increase in nasal tip horizontal displacement angle (AcR-Prn-AcL) following RME.…”

The Effects of Maxillary Expansion on the Soft Tissue Facial Profile

“…However, a statistical assessment of whether or not there existed a consistent relationship between soft tissue changes with the underlying hard tissue alterations was not performed in those studies ( 32 , 33 ). Although detailed evaluation of soft tissue changes and their correlation with the underlying dento-alveolar changes have been described in previous SARME studies ( 18 , 22 ), the soft tissue regions evaluated in three-dimensional study of Nada et al ( 22 ) were limited to the upper lip and cheek region adjacent to the angle of the mouth, while Filho et al’s ( 18 ) cephalometric study provided limited information associated with naso-labial area only. Considering that the residual loads at the termination of the appliance activation dissipated within 6 weeks, the retention phase of the current study via the expansion appliance can be deemed sufficient ( 36 ).…”

“…Therefore, authors pointed out that the findings associated with lip position may have been influenced by the dental movement resulting from active orthodontics ( 22 , 38 ). In the cephalometric study investigating the effects of different suturing techniques on the upper lip of patients undergoing SARME, Filho et al ( 18 ) reported that a tendency for retro-positioning of the upper lip following SARME with conventional suturings when compared with SARME using simple V-Y suture. The dissimilar findings described in preceeding studies might also be attributable to multifactorial consequences of different elements, such as the surgical technique (localization and extent of maxillary osteotomies), complex anatomy and dynamics of the upper lip, amount of the soft tissues, facial type and measuring methods applied in the studies ( 21 , 39 , 40 ).…”

“…Although the dental and skeletal effects of expansion using dental or skeletal anchorage are well documented, little information is available concerning the overlying soft tissue changes following these treatment modalities. The authors who have analyzed soft tissue changes associated with RME and SARME were more interested with naso-maxillary region ( 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ). They reported modifications in cheek, upper lip and nasal morphology which were explained majorly by the transversal enlargement of the maxilla, except for few studies ( 19 , 23 ) reporting that RME did not have significant clinical effects on the nose.…”

“…While the influence of RME on overall facial profile has been discussed in a few studies with conflicting results ( 31 , 32 , 33 ), no attempt has been made to test the correlations between the soft tissue changes and the underlying dentoalveolar alterations. Although previous SARME studies correlated soft tissue changes with changes in the hard tissue, those studies included nasolabial area only ( 18 , 22 ). Thus it becomes apparent that new studies involving more detailed assessment of the alterations in the overall soft tissue profile induced by RME and SARME as well as their correlations with the hard tissue changes are needed.…”