1/11. 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.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
2/11. Congenital salivary gland anlage tumor of the nasopharynx.OBJECTIVE: Nasal and upper respiratory tract obstruction in the neonatal period can result from a variety of conditions, and may present with variable symptoms. In the absence of dysmorphic features or other abnormalities, causes of nasal obstruction may be difficult to differentiate on initial examination. We report an unexpected and potentially life-threatening condition arising during the work-up of this common neonatal complaint. DESIGN: Case report with literature review. RESULTS: A male neonate presented with complaints of nasal obstruction and feeding difficulties. A common diagnostic approach to neonatal nasal obstruction was performed, resulting in an unexpected and potentially life-threatening, albeit curative, result. Cannulation of the nasal cavity to rule out choanal atresia resulted in a burst of bleeding from the nose and mouth. A finger sweep of the oropharynx produced a dislodged mass lesion. pathology revealed a salivary gland anlage tumor of the nasopharynx. CONCLUSIONS: The diagnosis of a nasopharyngeal mass lesion should be considered in neonates with nasal obstructive symptoms. It is wise to place an index finger in the oropharynx when passing catheters to rule out choanal atresia to feel a dislodged mass lesion before it can become an airway foreign body. Should passage of nasal catheters result in bleeding and/or respiratory distress, the possibility of a displaced mass lesion must be considered immediately to institute prompt intervention.- - - - - - - - - - ranking = 0.5keywords = mouth (Clic here for more details about this article) |
3/11. 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.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
4/11. 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.- - - - - - - - - - ranking = 0.5keywords = mouth (Clic here for more details about this article) |
5/11. 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.- - - - - - - - - - ranking = 2.5keywords = mouth (Clic here for more details about this article) |
6/11. The stability of maxillary expansion.The assessment and treatment by rapid maxillary expansion of 516 cases referred by medical practitioners for the treatment of poor nasal airway is reported. The technique is simple and most suitable for the correction of crossbite and Class III malocclusion and for establishing a nasal airway in habitual mouth breathers with a history of ENT problems.- - - - - - - - - - ranking = 0.5keywords = mouth (Clic here for more details about this article) |
7/11. 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.- - - - - - - - - - ranking = 0.5keywords = mouth (Clic here for more details about this article) |
8/11. Influence of respiratory pattern on craniofacial growth.The purpose of this paper has been to explore the relationship between upper airway obstruction and craniofacial growth. A review of the literature and of a preliminary study by the author in collaboration with investigators at the Children's Hospital of Pittsburgh indicate both the spectrum of skeletal and dental configurations which are associated with upper airway obstruction and the significant changes in patterns of facial growth which are observed following removal of the obstruction. Four clinical cases were presented. While admittedly only case reports, these do illustrate the potential interaction between alterations in respiratory function and craniofacial growth pattern. The four clinical cases are representative of one type of facial problem which has been classically associated with the mouth-breathing individual; that is a steep mandibular plane. We fully recognize that there are many other manifestations of the environmental problem of upper respiratory obstruction. However, these cases do illustrate the relationship between function and form (i.e. obstruction and deviant facial growth). In order for this relationship to be more fully documented, data from controlled randomized clinical trials must be analyzed.- - - - - - - - - - ranking = 0.5keywords = mouth (Clic here for more details about this article) |
9/11. Two Class II, division 1 patients with congenitally missing lower central incisors.Although orthodontic treatment objectives and procedures for apparent protrusion of the maxillary teeth vary among orthodontists and specific cases, the differences are even greater where there is disharmony of jaw relationship between the maxilla and the mandible. The two cases presented in this article resemble each other in appearance, but the growth patterns and reactions to appliance, as well as treatment progress, are quite different. The initial excessive overjet seemed equally severe. Treatment was started at the same age, both patients were eldest daughters, both had a convex type facial pattern and an abnormal perioral muscle function with mouth breathing. In addition to the marked overjet, deep bite, and Class II molar relationship, lower central incisors were missing, and second molars had not erupted. They both had a steep curve of Spee, disharmony between the upper and lower arch forms, and slight diastemata. The facial appearance has been improved significantly in both, and patient satisfaction is high. A Kloehn-type cervical headgear was used in both cases. Case 1 showed improvement in the relationship between the maxilla and the mandible with reduction of the overjet. However, in Case 2, the sagittal relationship became worse, and an open bite developed. The obvious question is why the big difference in treatment response? What role did clearing of the nasopharyngeal airway play?- - - - - - - - - - ranking = 0.5keywords = mouth (Clic here for more details about this article) |
10/11. Cranio-metaphyseal dysplasia.Cranio-metaphyseal dysplasia in two brothers, aged fourteen and twelve, is reported. Both brothers presented with deafness, repeated episodes of cold and cough and mouth breathing. Striking craniofacial configuration consisted of hypertelorism, prominent glabella and zygomatic arches, mandibular prognathism and overgrowth of middle third of face. Both patients had genu valgum deformity. Low intelligence and poor scholastic performance present in both brothers were attributed to deafness. Radiographic features consisted of obtuse mandibular angle, defective dentition, sclerotic frontal sinuses, sclerotic mastoids and temporal bones. Splaying of metaphyses of long bones was associated with mild sclerosis. Mild degree of widening of ribs was also present. One brother also had hallux valgus deformity. The radiographic and clinical differentiation of cranio-metaphyseal dysplasia and metaphyseal dysplasia (Pyle's disease) is highlighted.- - - - - - - - - - ranking = 0.5keywords = mouth (Clic here for more details about this article) |
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