Acta Oto-Laryngologica

ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20

Growth Influence on Tubal Function W. Mann, I. Jonas & G. Münker To cite this article: W. Mann, I. Jonas & G. Münker (1979) Growth Influence on Tubal Function, Acta Oto-Laryngologica, 87:3-6, 451-457, DOI: 10.3109/00016487909126450 To link to this article: http://dx.doi.org/10.3109/00016487909126450

Published online: 08 Jul 2009.

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Date: 08 May 2016, At: 06:45

Acta Otolaryngol87: 451457, 1979

GROWTH INFLUENCE ON TUBAL FUNCTION

W. Mann, I. Jonas and G. Munker From the ENT Clinic and the Orthodontic Department of the Dental School, University of Freiburg i . Br., FRG

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(Received July 18, 1978)

Abstract. The influence of growth on tubal function was studied in 26 children by means of tubal function tests in a pressure chamber and by geometric analysis of lateral cephalograms. Good tubal function coincided with mesoor brachycephalic skeletons, poor tubal function with dolichocephalic morphologic patterns. According to our results, tubal function seems to be strongly influenced by the growth processes of the skull.

As in every system the pathophysiology of the Eustachian tube is the result of form and function of the environmental bony structures, soft tissues and spaces. Disorders of any of these neighbouring components may influence the functional pattern of the tube. It is a well known fact that the incidence of tubal dysfunction is increased in childhood and that with maturity the incidence decreases. According to Holborow (1970), this decrease is correlated to the three-dimensional change in the position of the tube. The repositioning of the tube is by no means an isolated process, but is correlated to the obvious growth of the craniofacial skeleton. According to the most popular current working hypothesis, this complex growth pattern means the increase in size, translation and rotation of the bony structures in the form of remodelling, drift and displacement. The stimulating and controlling factors are still debated. However, chondrocranial growth is affected by intrinsic genetic and epi-genetic factors, while desmocranial growth is mainly influenced by environmental factors. The zone of remodelling and adaptation is localized in sutural and cartilaginous tissues.

Disregarding the discussion about their autonomy, the activity of the synchondroses of the cranial base, the cartilaginous part of the nasomaxillary complex and the condyle of the mandible are of utmost importance. According to longitudinal cephalometric studies, three different craniofacial growth patterns may be distinguished: the normal, the horizontal, and the vertical type-the latter two combine with the dolichocephalic and brachycephalic physiognomy. Normally the face components develop along the Y-axis always in a downward and forward position (Brodie, 1941). In the horizontal type the balanced relation between vertical and sagittal movement is modified in favour of an anterior rotation, neglecting the development of facial height. In the vertical type the balance is reversed. One finds a pronounced inclination of the nasomaxillary and dental complexes to the middle cranial fossa (Enlow, 1975). A relative lack of growth of this skull component results in an inversed effect. These observations are supported by the work of Ricketts (1975). The various growth patterns result in a divergent morphology and affect the mandibular position in relation to the craniofacial structures (Bjork, 1969; Ricketts, 1975; Enlow, 1975). Considering the above-mentioned morphological variations , the reason for this study was to evaluate a possible correlation between tubal function and various craniofacial growth patterns. Actu Otolaryngol87

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W . Munn et al.

Fig. 1 . ( a ) Landmarks from the cephalometric analysis at Freiburg. N=Nasion, the most antero-superior point of the nasofrontal suture at the midline; S=Sella turcica, the midpoint of the pituitary fossa in the medio-sagittal plane as determined by inspection; Se=Middle of the entrance of sella turcica, a derived landmark by bisecting the connecting line between processus clinoideus posterior and tuberculum sellae; Ar=Articulare, the intersection of the radiographicimages of the inferior surface of cranial base and the dorsal contours of ramus mandibulae; Go=Gonion, a derived landmark at the intersection of the ramal and mandibular planes which are drawn tangentially to the lower and dorsal borders of the mandible running through point Ar and Me; Me=Menton, the inferiormost point on the mandible at the symphysis; Gn=Gnathion, the inferiormost point in the contour of the chin; Pog=Pogonion, the anteriormost point on the bony chin at the midline; B=Point B, the deepest point on the curvature of the anterior border of the mandible between pogonion and the alveolar crest of the lower central incisor at the midline; A=Point A, the deepest point on the curvature of the anterior border of the maxillary bone between anterior nasal spine and the alveolar crest of the upper central incisor; ANS = Anterior nasal spine, the anteriormost tip of the bony anterior nasal spine at the midline; PNS=Posterior nasal spine, a derived landmark at the intersection of the pterygomaxillary fissure and the palate roof; Agn=Antegonial notch, the point of greatest concavity of the lower border of the mandible in front of the masseter insertion;

UIE=Upper incisor edge, the tip of the incisal edge of the more anteriorly placed upper central incisor; UIA=Upper incisor apex, the point of intersection between the long axis of the more anteriorly positioned upper central incisor and the contour of that tooth’s root-end curvature; LIE=Lower incisor edge, the tip of the incisal edge of the more anteriorly placed lower incisor; LIA=Lower incisor apex, the point of intersection between the long axis of the more anteriorly positioned lower incisor and the contours of the tooth’s root-end curvature.

( b ) Linear and angular measurements from the cephalometric analysis at Freiburg. NSAr=the included angle determined by the points sella, nasion, and articulare; SArGo=the included angle determined by the points sella, articulare, and gonion; ArGoMe=the included angle determined by the points articulare, gonion, and menton; S u m a = a derived angle, the addition of the values from QNSAr, SArGo, ArGoMe; NGoAr=the included angle determined by the points nasion, gonion, and articulare; NGoMe=the included angle determined by the points nasion, gonion, and menton; SNA=the included angle determined by the points sella, nasion, and A-point; SNB=the included angle determined by the points sella, nasion, and B-point; ANB=the included angle determined by the points Apoint, nasion, and B-point; SNPog=the included angle determined by the points sella, nasion, and pogonion; Maxillary-mandibular plane =the acute angle formed by the intersection of the line anterior nasal spineposterior nasal spine and the line gonion - mention;

Growth influence on tubal function

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Table I. Significant statistic datas of the cephalometric analysis Good tubal function Measurement

Mean

S.D.

394.0" 2.63" 72.6" 2.57" 34.9" 2.90" 63.1% 2.68% 3.90" 103.0" 64.9rnm 2.94mrn 22.3 mm 2.47 mm

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(Linder-Aronson)

36.3 mm

2.42 mm

MATERIAL AND METHOD After a general ENT examination, 16 girls and 10 boys aged 6 4 years underwent a tubalfunction test. According to the method of Munker (1972) tubal function was measured simultaneously in both ears with registration of middle ear impedance changes during a simulated flight in a pressure chamber. Go-Me - S-N=the acute angle formed by the intersection of the line sella- nasion and the line gonion -menton; Y axis angle=the acute angle formed by the intersection between the lines sella-nasion and sella-gnathion; Facial height ratio= the percentage ratio between the posterior facial height (sella-gonion) and the anterior facial height (nasion-menton); Upper 1 to S-N=the included angle determined by upper incisor edge, the intersection between the line upper incisor edge-upper incisor apex, and the line sellanasion; Lower 1 to mandibular plane=the included angle determined by lower incisor edge, the intersection between the line lower incisor edge-lower incisor apex, and the line gonion - menton; NSe=anterior cranial base length, the distance between the points nasion and sella entrance; mandibular base length=the distance between point gonion and the projection of pogonion on the line gonion -menton; maxillary base length= the distance between point posterior nasal spine and the projection of A-point on the line anterior-posterior nasal spine; ramus length=the distance between the points articulare and gonion; lateral cranial base length=the distance between the points sella and articulare; Go-Agn=length of the distance between the point gonion and the projection of antegonial notch on the line gonion-menton. 30-792957

Poor tubal function Mean

S.D.

P(T)

399.5" 76.3" 38.8" 60.4 % 96.7" 62.6 mm 20.2 mrn

4.12" 3.20" 3.82" 2.82% 4.35" 2.66 mm 2.13 rnrn

so.01 so.01 s0.05

39.2mm

3.06 mm N=26

G0.05 GO.01 90.05 s0.05 s0.05

Lateral cephalograms were taken in the usual occlusion position (film-focus distance: 4 m). To increase the accuracy of the pictures the standardization was accomplished by means of a head holder (cephalostat). The linear and geometric measurements to portray the craniofacial skeletons were performed according to the method at Freiburg (Rakosi, 1973) (Fig. 1). The roentgenographic examination included the evaluation of the bony and soft tissues of the nasopharynx (LinderAronson, 1970). RESULTS According to the tubal function test the patients were classified into four groups: groups one and two were judged as having good tubal function, groups three and four as having poor tubal function. In this sequence the relation between the two classes (good function vs. poor function) was 3 1 % :69 %. No divergent distribution according to sex differences was seen. The various general ENT findings showed no coincidence with the group classification. Only the size of the adenoids proved a significant correlation to tubal function. Large adenoids (33%) often coincided with poor tubal function. The results of the cephalometric analysis were as follows: No group differences could be evaluated for the angular measurements Acta Otolaryngol87

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M.P. * 14, 6.68

66 %

79' 76' ANB '3 SNPOG 77' SNA

SNB

Fig. 2. Patient with good tuba1 function and brachycephalic craniofacial growth pattern.

SNA, SNB, ANB, SNPog, NSAr, SArGo, and ArGoMe or for the linear determinations to estimate the length of the dental bases. Significant group differences were proved by means of the values for: sum4(Bjork) (addition of theQNSAr, SArGo, ArGoMe), 4NGoMe, s o: m e % ,

Qm-m,

m,

Growth influence on tubal function.

Acta Oto-Laryngologica ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20 Growth Influence on Tubal...
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