title: Effect of Clark's twin-block appliance (CTB) and non-extraction fixed mechano-therapy on the pharyngeal dimensions of growing children.
abstract: BACKGROUND
  Narrow airway dimensions due to mandibular deficiency can predispose an individual to severe respiratory distress. Hence, treatment with mandibular advancement devices at an early age might help improving the pharyngeal passage and reduce the risk of respiratory difficulties. Therefore, the aim of the current study was to evaluate the mean changes in the pharyngeal dimensions of children with mandibular deficiency treated with Clark's twin-block appliance (CTB) followed by fixed orthodontic treatment.
  
  
  METHODS
  Orthodontic records of 42 children with mandibular deficiency were selected. Records comprised three lateral cephalograms taken at the start of CTB treatment, after CTB removal and at the end of fixed appliance treatment, and were compared with 32 controls from the Bolton-Brush study. Friedman test was used to compare pre-treatment, mid-treatment and post-treatment pharyngeal dimensions. Wilcoxon signed rank test was used to compare the airway between pre-treatment and post follow-up controls. Mann-Whitney U test was applied to compare the mean changes in pharyngeal dimensions between treatment group and controls from T2 to T0. Post-hoc Dunnet T3 test was used for multiple comparisons of treatment outcomes after CTB and fixed appliances, taking a p-value of ≤ 0.05 as statistically significant.
  
  
  RESULTS
  Superior pharyngeal space (p < 0.001) and upper airway thickness (p = 0.035) were significantly increased after CTB, and the change in superior pharyngeal space remained stable after fixed mechano-therapy.
  
  
  CONCLUSIONS
  CTB can have a positive effect in improving pharyngeal space and the resultant increase in airway remains stable on an average of two and a half years.
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Batool
authors.initials: B
authors.lastname: Ali
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Attiya
authors.initials: A
authors.lastname: Shaikh
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Mubassar
authors.initials: M
authors.lastname: Fida
mesh_terms: D002508:Cephalometry; D002648:Child; D006801:Humans; D008312:Malocclusion, Angle Class II / Q000628:therapy; D008334:Mandible; D017289:Orthodontic Appliances, Functional; D010614:Pharynx