Upper airway obstruction and craniofacial morphology

Abstract

Otolaryngologists are being asked with increasing frequency to assess adequacy of the upper airway and to treat upper airway obstructive problems in orthodontic patients. The incentive has been provided by recent studies that purport to relate upper airway obstruction to dental and craniomorphologic changes. It is hypothesized that prolonged oral respiration during critical growth periods in children initiates a sequence of events that commonly results in dental and skeletal changes. In the chronic mouth-breather excessive molar tooth eruption is almost a constant feature, causing a clockwise rotation of the growing mandible, with a disproportional increase in anterior lower vertical face height. Such increases in anterior lower vertical face height are often associated with retrognathia and open bites. Low tongue posture seen with oral respiration impedes the lateral expansion and anterior development of the maxilla. Otolaryngologists have the ability to objectively and accurately assess upper airway patency. Rhinometric assessment before and after application of topical nasal decongestant, in conjunction with clinical examination, provides valuable information regarding upper airway patency and the cause of any existing obstructive pathologic condition. Studies should be designed carefully to control the numerous variables that have an impact on the growing face of a young child so that meaningful data can be obtained in our own field regarding this challenging topic.

Effects of tongue volume reduction on craniofacial growth: A longitudinal study on orofacial skeletons and dental arches

“…A low tongue position may also impede lateral expansion and anterior maxillary development as the mandible rotates to a more downward position. [20][21][22] There is limited information about the effects of altering tongue volume/position on craniofacial growth and dental arch formation. Using rhesus monkeys, Harvold and his colleagues demonstrated that reducing tongue volume by partial glossectomy caused the dental arch to collapse lingually (crowding).…”

Modification of the maxillary bone in adults with nasal polyposis: a CT morphometric study

“…One of the most common causes of nasal obstruction in adults is nasal polyposis (NP) (1, 2). Computed tomography (CT) is the ideal imaging method to investigate nasal and paranasal sinus diseases (4, 5).In paranasal sinus CT scans, we have recently observed that the plane angle between the maxillary alveolar process (MAP) and palatine bone (PB) is increased and the depth of maxillary arch is decreased in many cases with NP.Pediatric orthodontics literature concerning how nasal obstruction relates to dentofacial development is extensive and whether a cause-effect relationship exists has been debated for over a century (6)(7)(8). Although recent studies suggest a relationship between chronic nasal obstruction and dentofacial deformities, many questions remain unanswered (9, 10).…”

Outcome Assessment of 603 Cases of Concomitant Inferior Turbinectomy and Le Fort I Osteotomy

“…Th e sequela of chronic nasal obstruction is mouth breathing, which results in a lower and anteriorly placed tongue and a lower position of the mandible. Th is consequently decreases the tonicity of the facial muscles as a result of decreased fl ow of the nasal airway due to anatomical obstruction (6)(7)(8). Based on functional matrix theory, put forth by Moss et al (9), the lack of nasal breathing can signifi cantly aff ect the development of dentofacial and craniofacial structures.…”