Breathing mode influence in craniofacial development

School of Dental Sciences, Ribeirão Preto-USP.
Brazilian journal of otorhinolaryngology (Impact Factor: 0.65). 04/2005; 71(2):156-60. DOI: 10.1016/S1808-8694(15)31304-5
Source: PubMed


The aim of this study was to evaluate the differences in facial proportions of nose and mouth breathing children using cephalometric analysis.
Transversal cohort.
Sixty cephalometric radiographs from pediatric patients aged 6 to 10 years were used. After otorhinolaryngological evaluation, patients were divided into two groups: Group I, with mouth breathing children and group II, with nose breathers. Standard lateral cephalometric radiographs were obtained to evaluate facial proportions using the following measures: SN.GoGn, ArGo.GoMe, N-Me, N-ANS, ANS-Me and S-Go; and the following indexes: PFH-AFH ratio: S-Go/N-Me; LFH-AFH ratio: ANS-Me/N-Me and UFH-LFH ratio: N-ANS/ANS-Me.
It was observed that the measurements for the inclination of the mandibular plane (SN.GoGn) in mouth breathing children were statistically higher than those in nasal breathing children. The posterior facial height was statistically smaller than the anterior one in mouth breathing children (PFH-AFH ratio). Thus, the upper anterior facial height was statistically smaller than the lower facial height (UFH-LFH ratio).
We concluded that mouth breathing children tend to have higher mandibular inclination and more vertical growth. These findings support the influence of the breathing mode in craniofacial development.

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Available from: Murilo Feres, Sep 02, 2014
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    • "This theory is based on the principle that facial growth depends on the functional activity of the different components of the head and neck region. For example, oral breathing imposed by adenoid hypertrophy has been suggested to explain the posterior rotation of the mandible [40]. Thus, oral breathing has been associated with increased mandibular inclination and changes in normal facial proportions, characterised by increased anterior lower facial height and decreased posterior facial height [41–43]. "
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    ABSTRACT: Mammalian, including human, neonates are considered to be obligate nose breathers. When constrained to breathe through their mouth in response to obstructed or closed nasal passages, the effects are pervasive and profound, and sometimes last into adulthood. The present paper briefly surveys neonates' and infants' responses to this atypical mobilisation of the mouth for breathing and focuses on comparisons between human newborns and infants and the neonatal rat model. We present the effects of forced oral breathing on neonatal rats induced by experimental nasal obstruction. We assessed the multilevel consequences on physiological, structural, and behavioural variables, both during and after the obstruction episode. The effects of the compensatory mobilisation of oral resources for breathing are discussed in the light of the adaptive development of oromotor functions.
    Full-text · Article · Jul 2012 · International Journal of Pediatrics
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    • "Adenoid hypertrophy is reported as one of the main causes of respiratory obstruction and, consequently, mouth breathing in children [3] [4] [6] [7]. Prolonged mouth breathing leads to muscular and postural alterations, which in turn, may cause dentoskeletal changes affecting the morphology, position and growth direction of both the maxilla and the mandible [6] [7] [8] [9] [10] [11]. Mouth breathing due to adenoid hypertrophy is frequently associated with retrusion of the mandible relative to the cranial base, increased mandibular and palatine inclination, vertical growth pattern, increased lower facial height, decreased posterior facial height and narrow palate [6,7,12–15]. "
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    ABSTRACT: To compare the skeletal features of subjects with adenoid hypertrophy with those of children with tonsillar hypertrophy using thin-plate spline (TPS) analysis. A group of 20 subjects (9 girls and 11 boys; mean age 8.4 ± 0.9 years) with adenoid hypertrophy (AG) was compared with a group of 20 subjects (10 girls and 10 boys; mean age 8.2 ± 1.1 years) with tonsillar hypertrophy (TG). Craniofacial morphology was analyzed on the lateral cephalograms of the subjects in both groups by means of TPS analysis. A cross-sectional comparison was performed on both size and shape differences between the two groups. AG exhibited statistically significant shape and size differences in craniofacial configuration with respect to TG. Subjects with adenoid hypertrophy showed an upward dislocation of the anterior region of the maxilla, a more downward/backward position of the anterior region of the mandibular body and an upward/backward displacement of the condylar region. Conversely, subjects with tonsillar hypertrophy showed a downward dislocation of the anterior region of the maxilla, a more upward/forward position of the anterior region of the mandibular body and a downward/forward displacement of the condylar region. Subjects with adenoid hypertrophy exhibited features suggesting a more retrognathic mandible while subjects with tonsillar hypertrophy showed features suggesting a more prognathic mandible.
    Full-text · Article · Feb 2011 · International journal of pediatric otorhinolaryngology
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    • "Alterations in the structure of facial skeleton consist in enlarged anteroinferior part of the face and increased inclination angle of the mandibular plane. The anterior and particularly the anteroinferior part of the face become enlarged, whereas the posterior facial height is decreased [7] [8] [9] [10]. "
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    ABSTRACT: Although the harmful influence of nasopharyngeal obstruction on the facial skeleton has been demonstrated, clear criteria to qualify children with adenoid hypertrophy and malocclusion for adenoidectomy have not been established yet. Retrospective analysis of 148 patients qualified for orthodontic treatment (77 females and 71 males) at the age of 9-11 years (the average age was 10 years and 3 months). X-ray images performed with the use of a cephalostat were scanned and submitted for cephalometric assessment. The study investigated the correlation between standard cephalometric parameters and the value of relative nasopharyngeal flow defined as the ratio of the nasopharyngeal flow to the dimension of the entire nasopharynx. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used. The value of relative nasopharyngeal lumen ranged from 0.0943 to 0.5532 with no significant differences between genders. The subjects were divided into decile groups for investigating the correlation with cephalometric parameters. The study demonstrated statistically significant negative correlations between relative nasopharyngeal flow and the following parameters: the angle between lines NA and NB (ANB), the angle between lines SN and ML (SN/ML), the posterior/anterior facial height ratio (Post.Fac.H./Ant.Fac.H.), the difference between the maxillary and mandibular length (difference maxillary/mandibular), the mandibular length (Co-Gn) and the lower anterior facial height (Sn-Me). The correlations generally referred to middle deciles: from the 40th to 80th decile. An apparent lack of significant correlations in patients located below the 40th decile, which corresponded to the value of relative nasopharyngeal flow up to 18%, may indicate, that this value constitutes a threshold and further decreasing it exceeds adaptive capabilities of the body. Relative nasopharyngeal flow below 38% should constitute an indication for adenoidectomy, due to the exceeded adaptive capabilities of the body.
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