The effect of mode of breathing on craniofacial growth--revisited

Abstract

It has been maintained that because of large adenoids, nasal breathing is obstructed leading to mouth breathing and an 'adenoid face', characterized by an incompetent lip seal, a narrow upper dental arch, increased anterior face height, a steep mandibular plane angle, and a retrognathic mandible. This development has been explained as occurring by changes in head and tongue position and muscular balance. After adenoidectomy and change in head and tongue position, accelerated mandibular growth and closure of the mandibular plane angle have been reported. Children with obstructive sleep apnoea (OSA) have similar craniofacial characteristics as those with large adenoids and tonsils, and the first treatment of choice of OSA children is removal of adenoids and tonsils. It is probable that some children with an adenoid face would nowadays be diagnosed as having OSA. These children also have abnormal nocturnal growth hormone (GH) secretion and somatic growth impairment, which is normalized following adenotonsillectomy. It is hypothesized that decreased mandibular growth in adenoid face children is due to abnormal secretion of GH and its mediators. After normalization of hormonal status, ramus growth is enhanced by more intensive endochondral bone formation in the condylar cartilage and/or by appositional bone growth in the lower border of the mandible. This would, in part, explain the noted acceleration in the growth of the mandible and alteration in its growth direction, following the change in the mode of breathing after adenotonsillectomy.

Evaluation of maxillary arch dimensions and palatal morphology in mouth-breathing children by using digital dental casts

“…Although numerous studies have investigated the skeletal and occlusal characteristics of mouth-breathing individuals [2][3][4][6][7][8], no study evaluated the morphology of the palatal vault in mouth-versus nasal-breathing subjects by means of digital 3D dental casts. 3D images can be used to assess linear and angular measurements that describe the arch form and the palatal morphology [21].…”

“…This will result in an imbalance of forces between the cheeks and the tongue, which can directly affect the growth and development of the upper and the lower jaws [3]. In mouth-breathing patients the tongue does not exert any force on the upper teeth, which allows the upper arch to remain undeveloped, directly influencing the skeletal development in preschool children [4]. Although mouthbreathing etiology is multifactorial, the most common causes are anatomical obstruction, such as palatine and pharyngeal tonsil hypertrophy, allergic rhinitis, nasal septal deviation, nasal polyps and nasal turbinate hypertrophy [5].…”

“…In the literature the effects of the alteration of the normal breathing pattern on dental arches have generally been described as dimensional changes in intercanine and intermolar width and arch lengths by using traditional methods on dental casts measured with calipers [3][4][5]7,8]. Vieira et al [3] and Harari et al [6] found that a change in the breathing pattern of children can induce dental changes such as a narrowing of the maxillary arch at the level of the canine.…”

Transverse craniofacial dimensions in Angle Class II, Division 1 malocclusion according to breathing mode

“…1,2 These individuals also present the long face or adenoid facies syndrome, showing an elongation of the inferior facial height, slightly open lips, narrow maxillary arch, deep palate and Class II malocclusion. 3,4 However, these clinical signs have been queried, since not all individuals who presented them were predominantly mouth breathers, and this facial type could also be a congenital trait, not necessarily related to the breathing mode. 5,6 Muscle patterns and skeletal growth are influenced only slightly by the breathing mode, since they are genetically transmitted and the facial type could be a congenital trait.…”

Padrão morfológico e características oclusais de crianças respiradoras bucais após cirurgia para hipertrofia de tonsilas

“…A obstrução nasal é conhecida por representar um importante fator etiológico das deformidades morfológicas, dento-faciais, alterações posturais e miofuncionais durante a fase de crescimento dos indivíduos (Cheng et al, 1988;Valera et al, 2006;Cuccia et al, 2008;Cattoni et al, 2007;Peltomäki, 2007).…”