Cases reported "Mouth Breathing"

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1/15. Bilateral congenital choanal atresia and absence of respiratory distress.

    Bilateral congenital choanal atresia is considered a lethal congenital malformation in an obligatory nasal breathing neonate. Described herein are two cases of bilateral choanal atresia associated with craniofacial anomalies who did not present respiratory distress in the neonatal period. Our first patient had a complete unilateral cleft lip which facilitated oropharyngeal respiration. The second patient presented wory distress in the neonatal period by providing an oropharyngeal airway.
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2/15. Orthodontic treatment in handicapped children: report of four cases.

    Mentally and physically handicapped children show in the orofacial system motor-sensitivity disturbances and malocclusions of varying severity. These dysfunctions affect the breathing and speech ability and inhibit the food intake. Myotherapeutic exercises for strengthening of lip and tongue muscles and orthodontic treatment of the malocclusions help provide esthetic and functional improvements in these patients. The limited compliance necessitates a differentiated procedure during the diagnostic and therapeutic process and demands compromises in some cases.
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3/15. Dental malocclusion and upper airway obstruction, an otolaryngologist's perspective.

    INTRODUCTION: This paper, through the presentation of eight case reports and a limited literature review, attempts to illustrate the negative effect that upper airway obstruction can have on developing dental occlusion and the positive effect that upper airway relief can have on the 'normalization' of various malocclusion patterns believed to be related to chronic obligate mouth breathing. OBJECTIVE: To study the effect of airway relief (usually through tonsillectomy and/or adenoidectomy) on various patterns of dental malocclusion. methods: Children coming to the office of the lead author (D.J.W.) found to be obligate mouth breathers and who also had dental malocclusion had Polaroid 'bite' pictures taken at the time of their initial visit. One year or more after their surgery for upper airway relief (tonsillectomy and adenoidectomy in these cases) a second 'bite' photograph was taken and compared to the first. RESULTS: In all cases selected in this study there was observed improvement in their dental occlusion within a year following surgery to improve their breathing. CONCLUSION: It is the opinion of the authors of this paper that upper airway obstruction may have a negative effect on the developing transitional dental occlusion and that eliminating the cause of upper airway obstruction can lead to 'normalization' of occlusion in such children. Further orthodontic corrective modalities may be required for optimal occlusal results.
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4/15. Redirecting the growth pattern with rapid maxillary expander and chin cup treatment: changing breathing pattern from oral to nasal.

    AIM: This study was undertaken to assess the possibility of redirecting the growth pattern by using rapid maxillary expansion and a light-force chin cup for a short period of time, with limited patient cooperation, during the pre-growth and growth-spurt stages. methods: The study included a series of 60 patients, 24 males and 36 females from 7 to 14 years of age, with crossbite or midfacial deficiencies. Treatment involved wearing a chin cup 24 hours a day to force mouth closure during rapid maxillary expansion activation, which was 2 turns per day to rapidly expand the midpalatal suture and enhance nasal breathing. Lateral cephalograms and intraoral and facial photographs were taken 2 years before treatment, at the time of rapid maxillary expansion, 3 weeks following rapid maxillary expansion activation, 3 months after the cessation of rapid maxillary expansion activation, and 1 to 3 years post-rapid maxillary expansion activation. RESULTS: Despite the severity, the crossbite would always improve within 21 days following rapid maxillary expansion activation. The cephalograms and photographs demonstrated forward movement of the nasal bridge and maxilla, with backward rotation of the mandible. The bite depth remained nearly the same as pretreatment. CONCLUSION: The results suggested that 24 hours of light-force chin cup wear, while expanding the midpalatal suture, is the major factor to force mouth closure and enhance nasal breathing. As a result, there is advancement of the maxilla, avoidance of tongue encroachment upon the mandible, and deceleration of horizontal mandibular growth.
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5/15. Dynamic MRI evaluation of tongue posture and deglutitive movements in a surgically corrected open bite.

    tongue thrust usually develops in the presence of anterior open bite in order to achieve anterior valve function. In the literature, tongue thrust is described both as the result and the cause of open bite. If it is an adaptation to malocclusion, then tongue posture and deglutitive tongue movements should change after treatment. In this case report, an adult who had skeletal open bite and Class II malocclusion caused by mandibular retrusion was treated surgically. The mandible was advanced in a forward and upward direction with a sagittal split osteotomy. The open bite and Class II malocclusion were corrected and an increase in the posterior airway space (PAS) was observed. Pretreatment and posttreatment dynamic magnetic resonance imaging (MRI) revealed that tongue tip was retruded behind the incisors and contact of the tongue with the palate increased. It was also determined that the anterior and middle portions descended, whereas the posterior portion was elevated at all stages. Advancement of the mandible, correction of open bite, and an increase in PAS affected not only the tongue posture and deglutitive movements, but also the breathing pattern of the patient.
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6/15. Class I malocclusion with severe open bite skeletal pattern treatment.

    A case report of a Class I malocclusion with a severe skeletal open bite, excessive overjet, a high mandibular plane angle, and a forward maxillary rotation is presented. Treatment has eliminated the causative factors (i.e., mouth breathing, enamel hypoplasia of the first molars, and abnormal tongue posture and function). A normal growth pattern has been restored, ensuring a good and stable orthodontic result.
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7/15. Obligate mouth breathing during exercise. Nasal and laryngeal sarcoidosis.

    A young black man presented with simultaneous nasal and laryngeal sarcoidosis, each uncommon entities. Despite severe upper airway obstruction and emergent tracheostomy, there was an uncharacteristic rapid response to oral steroids alone. The patient's predominant initial complaint of early mouth breathing during routine army physical training demonstrates a symptom complex and an alternate mechanism of dyspnea to consider in sarcoidosis.
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8/15. A dental Class III malocclusion treated to a full-cusp Class II molar relationship.

    A case report of a Class III dental malocclusion superimposed on a straight skeletal pattern is presented. The patient was a 14-year-old girl with limited growth potential. This case included congenitally missing maxillary permanent lateral incisors, impacted maxillary permanent canines, and bilateral posterior open bites. The patient's soft-tissue profile was normally convex. In addition to her malocclusion, the patient had a history of difficulty breathing through the nose. The general treatment included palatal expansion, protraction headgear, and comprehensive edgewise orthodontic therapy.
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9/15. Noses, tongues, and teeth.

    There is a renewed interest in the relationship between breathing patterns, tongue positions, and orthodontic management of patients with malocclusion. The authors address the effects of these factors on arch-form and occlusal contacts.
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10/15. The pharyngeal effect of partial nasal obstruction.

    The case histroy and cinematoradiographic findings of a baby with partial nasal obstruction are presented. This infant's restriction to air entry at the nose led to severe airway obstruction during inspiration by a forward movement of the posterior pharyngeal wall and backward movement of the tongue and lower jaw. At the height of inspiration, there was total airway occlusion in the pharynx. These events can be explained by the pressure drop that takes place behind a restriction if air is sucked through it forcibly from an area of atmospheric pressure. Studies of postpalatal pressures in adults and infants demonstrate such a drop in pressure during nasal breathing if the nose is partly obstructed. If the adult or infant is able to respond to the diminished nasal airway by mouth breathing, there is no postpalatal pressure drop. It is suggested that partial nasal obstruction in a sleeping obligatory nasal-breathing infant could result in a sucking back of the tongue over the larynx in this "cafe coronary" type of situation. This could be the mechanism of the obstructive type of apnea recorded by Steinschneider, and of the asphyxial type of death that is suggested by autopsies on some "cot death" victims. This hypothesis is consistent with the frequency of infection of rhinitis and pharyngitis in victims of sudden infant death syndrome and with the seasonal incidence. Prevention of this obstructive type of apnea would depend on the recognition of infants showing inspiratory and expiratory changes in pharyngeal airway size as can be seen externally by the movements in the carotid triangle of the neck and confirmed by roentgenography or cinematoradiography.
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