The Changes Of CBF Influenced By Maxillary Defect And Rehabilitation Before And After Mastication Movement

Maxillary defect is a common maxillofacial abnormality.The percent of maxillary defect accounts for about 85%of the maxillofacial defect.It has serious influence on patient's chewing,deglutation,pronunciation,respiration,whether physiological or mental health,even exhausted all masticatory function.It is a challenge to rehabilitate these defects by surgery because of the complex anatomy and neighborship.Using prosthesis is still the main way up to now.The masticatory function would be improved to some extent after restored with prosthesis.Masticatory function is one of the important functions of the oral cavity.The implementation of it depends on the integrity of dentition.It not only associated with nutritional intake of the body,growth and development of the oral and maxillofacial area,but also deeply associated with the status of CBE Liu Hongchen et al.argued that changes of the CBF before and after the masticatory movement might play an important role in evaluating the relationship between the oral cavity function and the brain function.This study aimed to study the changes of CBF before and after operation and restoration with prosthesis in patients with maxillary defect by using the TCD made in Germany and compare with control group.It provides a foundation to further reveal the relationship between mastication movement and brain function under maxillary defect condition.This study consists of the following four parts:Part 1.The effect of mastication on the Changes of CBF before and after operation in patients with maxillary defect.Objective:To observe the Changes of CBF before and after maxillectomy during different masticatory intervals and to analyse the influence of decreased masticatory function on CBF.Methods:16 patients before partial or total unilateral maxillectomy performed were selected.Patients after surgery were accorded with Aramany typeⅠ,Ⅱ,Ⅳdefect and the remaining tooth would be accorded with 5-10.The middle cerebral artery(MCA)peak flow-rate in systole period(VS),late diastole period(Vd)and mean peak flow rate(Vm)were recorded with TCD at different intervals,which included without mastication,5 min after mastication,10 min after mastication.After two months of maxillectomy,The blood flow-rate was repeatedly measured.Results were statistically analysis of Repeated Measures Analysis of Variance with software of SPSS13.0 Version.Results:1.For patients with maxillary defect before and after operation:The CBF at Vs caused by mastication approached the remarkable level (P=0.052).The differences of Vm showed the significance of obviousness (p=.014,p＜0.05).During each period of the test,the averages of Vs and Vm of the patients before operation all obviously exceeded the relavent averages of the patients after operation.The effects to Vd caused by mastication appeared no obviousness(P=0.161,p＞0.05).2.For the cases of five and ten minutes after the mastication,compared with that before mastication,both patients before operation and after operation witnessed:The differences of Vs,Vd and Vm caused by mastication all had the significance of obviousness(P=.000,p＜0.01),which showed that the Vs,Vd and Vm of both groups after the mastication were all higher than before mastication.3.The element of repetition:there was obviousness for the differences among the three levels of the element of time(P=.000,p＜0.01).As test time extended longer,the averages of Vs Vd and Vm all reached higher levels.Conclusions:1.Mastication movements can enhance the supply of cerebrum of patients with maxillary defect not only before operation but also after operation.2.MCA Supplies less blood in patients with maxillary defect after operation,compare with patients before operation.Part 2.Comparison study of CBF influenced by mastication movement between maxillary defect patients and people with full dentition.Objective:To Compare the difference of CBF between maxillary defect patients and control group during different masticatory intervals,and discuss the adverse effect of maxillary defect on brain function.Methods:16 patients with maxillary defect were selected as patient group,another 16 peoples without dentition defect were used as control.they were asked to lie down.The Vs,Vd and Vm of MCA was measured at different intervals,which included without mastication,5 min after mastication,10 min after mastication.Results were statistically analysis with Repeated Measures Analysis of Variance with software of SPSS13.0 Version.Results:1.Bwteen the control group and the patient group:The effect to Vs caused by mastication had the significance of obviousness (P=0.017,p＜0.05).The differences of Vd caused by mastication showed the significance of obviousness(p=.044,p＜0.05).The differences of Vm caused by mastication also had the significance of obviousness(P=0.003,p＜0.05).During each period of the test,the averages of Vs,Vd and Vm of the control group all exceeded the relavent averages of the patients.2.For the cases of five and ten minutes after the mastication,compared with that before mastication,both the control group and the patient group witnessed:The differences of Vs,Vd and Vm caused by mastication all had the significance of obviousness(P=.000,P＜0.01),which showed that the Vs,Vd and Vm of both groups after the mastication were all higher than before mastication.3.The element of repetition:there was obviousness for the differences among the three levels of the element of time(P=.000,P＜0.01).As test time extended longer,the averages of Vs,Vd and Vm all reached higher levels. Conclusions:1.MCA Supplies less blood in maxillary defect patients compare with control group.2.Mastication movements can enhance the supply of cerebrum of peoples with full denture.Part 3.The Changes of CBF influenced by mastication before and after restoration with prosthesis in patients with maxillary defect.Objective:To measure the changes of CBF before and after restoration with prosthesis during different masticatory intervals and to evaluate the significance of prosthodontic rehabilitation to CBF.Methods:After two months of maxillectomy,the flow-rate of brain blood flow of patients of experimentⅠwas recorded at different intervals,which included without mastication,5 min after mastication,10 min after mastication with TCD.After one month of inserting maxillary obturator prosthesis,the blood flow-rate was measured again and compared with that of before restoration. Results were statistically analysis with Repeated Measures Analysis of Variance with software of SPSS13.0 Version.Results:1.Between patients with maxillary defect before restoration and after restoration with prosthesis:The effect to Vs caused by mastication approached the level of obviousness(P=0.051).The differences of Vm caused by mastication had the significance of obviousness(P=0.012,p＜0.05).During each period of the test,the averages of Vs and Vm of the control group all exceeded the relavent averages of the patients.The effects to Vd caused by mastication appeared no obviousness(P=0.065,p＞0.05).2.For the cases of five and ten minutes after the mastication,compared with that before mastication,both the patients before restoration and after restoration with prosthesis witnessed:The differences of Vs,Vd and Vm caused by mastication all had the significance of obviousness,which showed that the Vs,Vd and Vm of both patients after the mastication were all higher than before mastication.3.The element of repetition: there was obviousness for the differences among the three levels of the element of time.As test time extended longer,the averages of Vs Vd and Vm all reached higher levels.Conclusions:1.Mastication movements can enhance the supply of cerebrum of patients with maxillary defect not only before restoration but also after restoration with prosthesis.2.MCA Supplies less blood in patients with maxillary defect,compare with them inserted prosthesis.Maxillary obturator prosthesis restoration can promote CBF of maxillary defect patients.Part 4.Comparison study of CBF influenced by mastication movement between maxillary defect patients inserted prosthesis and peoples with full dentition.Objective:To Compare the difference of CBF between maxillary defect patients inserted prosthesis and control group during different masticatory intervals,and to further evaluate the significance of prosthodontic rehabilitation to CBF.Methods:16 maxillary defect patients inserted prosthesis were selected,another 16 peoples without dentition defect were used as control.they were asked to lie down.The flow-rate of brain blood was recorded at different intervals,which included without mastication,5 min after mastication,10 min after mastication.Results were statistically analysis with Repeated Measures Analysis of Variance with software of SPSS13.0 Version.Results:The effects to Vs caused by mastication between two groups appeared no obviousness(P=0.613,p＞0.05).There was no significant difference in Vd of two groups(P=0.715,p＞0.05).The effects to Vm also appeared no obviousness(P=0.488,p＞0.05)Conclusions:MCA Supplies the similar blood in maxillary defect patients after restoration with obturator prosthesis,compare with peoples with full denture to some extent.