Cases reported "Mouth Breathing"

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1/8. 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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2/8. Early orthodontic treatment and long-term observation in a patient with Morquio syndrome.

    Early orthodontic treatment and long-term observation in a patient with Morquio syndrome were demonstrated. To date, there are no case reports describing orthodontic treatment in such a patient. The patient showed spaced maxillary and mandibular arches with a tongue thrust habit at age seven years eight months. She also showed a protruded upper lip, labial inclination of the upper and lower anterior teeth, and thin enamel. The tongue thrust habit disappeared after the application of a removable orthodontic appliance. The spaced dentition in the upper and lower arches improved after treatment with a fixed appliance with closing loop arch wire (0.017 x 0.025") and bands on the upper and lower molars. We did not use an edgewise appliance because of the thin enamel. The protruded upper lip and labial inclination of the upper and lower anterior teeth were also improved after treatment, but optimal intercuspation of the teeth was not achieved. However, optimal intercuspation of the teeth was achieved after long-term observation and the masticatory function was improved. It was suggested that early orthodontic treatment could improve the malocclusion in a patient with Morquio syndrome and that improvement of masticatory function could be achieved during a long-term retention period.
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3/8. 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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4/8. 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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5/8. 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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6/8. 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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7/8. 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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8/8. Centronuclear myopathy and nursing pattern caries: management of a 1 year old.

    The pathognomonic open mouth of centronuclear and other myopathies can also have implications for oral health. These patients are at greater risk for gingivitis, dental caries as a result of the mouth breathing and loss of lip seal. Low tongue posture may impede the lateral expansion of the maxilla resulting in a constricted maxillary arch with resultant posterior crossbites and functional shifts. Excessive molar eruption may also occur, resulting in anterior open bites and increases in the anterior lower vertical height.
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