The influence of mouth breathing on skeletal and dental features of splanchnocranium.

OBJECTIVE: This study was performed to investigate changes in dentofacial characteristics associated with mouth breathing (MB) and adenoidectomy. BACKGROUND: MB is considered to be an etiological factor of malocclusion. Adenoidectomy is supposed to have the ability to prevent the development of dentofacial deformities. METHODS: This retrospective study included 123 patients, namely 57 nose breathers, 19 former mouth breathers, who have undergone adenoidectomy, and 47 mouth breathers. The groups were compared according to their skeletal and dental characteristics. The measurements of each individual were obtained from lateral cephalograms and dental casts. The comparison was done using one-way ANOVA, Bonferroni post-hoc, Mann-Whitney U and Kruskal-Wallis tests. The statistically significant difference was defined as p<0.05. RESULTS: The MB group showed an increase in ArGoMe (p=0.02) angle. No difference was found in the sagittal parameters among the groups. Upper dental arch compression was positively correlated with MB(p=0.00), even in adenoidectomy cases (p=0.01). CONCLUSION: MB alters the vertical and transverse growth of the craniofacial complex. It is associated with longer lower anterior facial height and decreased maxillary intermolar distance. However, it does not influence the sagittal parameters. Airway clearance via adenoidectomy promotes the normalization of vertical parameters (Tab. 1, Fig. 2, Ref. 20).

[Preliminary study on efficacy and safety of submucosal plasma ablation of inferior turbinate in children with allergic rhinitis complicated with obstructive sleep apnea syndrome].

Objective:This study aimed to investigate the long-term clinical efficacy and safety of inferior turbinate submucosal plasma ablation combined with or without tonsillar and adenoid surgery in children with allergic rhinitis（AR） combined with obstructive sleep apnea syndrome（OSAS） who were ineffective after conservative systemic treatment. Methods:A total of 43 children with AR complicated with OSAS who met the inclusion criteria among 68 children hospitalized from January 2019 to February 2022 were retrospectively analyzed. The data were collected, including the clinical characteristics, surgical methods perioperative management and prevention and treatment of complications. Moreover, one year follow-up was performed to compare the VAS scores of children before and after surgery, and to evaluate their mid-term and long-term outcomes. Results:The average operation time was 36 minutes, meanwhile, the intraoperative blood was limited. The symptoms of nasal congestion, runny nose, sleep snoring, and mouth breathing were significantly improved after operation, and the results were satisfactory after one-year follow-up without complications such as bleeding, hematoma, intraoperative adhesion, and nasal dryness. Conclusion:Submucosal plasma ablation of inferior turbinate with or without tonsillectomy adenoidectomy in children with AR can effectively improve the clinical symptoms of AR combined with OSAS children who are ineffective after conservative treatment. It can improve the symptoms of sleep-disordered breathing such as sleep snoring and mouth breathing, with good mid-and long-term curative effects and fewer complications, which is an effective and safe treatment for children with AR combined with OSAS.

Changes in facial morphology after adenotonsillectomy in mouth-breathing children.

BACKGROUND: Morphological and dentofacial alterations have been attributed to impaired respiratory function. OBJECTIVE: To examine the influence of mouth breathing (MB) on children facial morphology before and after adenoidectomy or adenotonsillectomy. METHODS: Thirty-three MB children who restored nasal breathing (NB) after surgery and 22 NB children were evaluated. Both groups were submitted to lateral cephalometry, at time 1 (T1) before and at time 2 (T2) 28 months on average postoperatively. RESULTS: Comparison between the MB and NB groups at T1 showed that mouth breathers had higher inclination of the mandibular plane; more obtuse gonial angle; dolichofacial morphology; and a decrease in the total and inferior posterior facial heights. Twenty-eight months after the MB surgical intervention, they still presented a dolichofacial morphologic pattern. During this period, MB altered the face growth direction and decreased their mandible plane inclination, with reduction in the SN.GoGn, PP.MP, SNGn, and ArGo.GoMe parameters as well as an increase in BaN.PtGn. CONCLUSION: After the MB rehabilitation, children between 3 and 6 years old presented significant normalization in the mandibular growth direction, a decrease in the mandible inclination, and an increase in the posterior facial height. Instead, they still persisted with a dolichofacial pattern when compared with nasal breathers.

Impact of adenotonsilectomy on nasal airflow and pulmonary blood pressure in mouth breathing children.

INTRODUCTION: Adenotonsillar hyperplasia (ATH) causing upper airway obstruction (UAO) may increase pulmonary artery systolic pressure (PASP). Early diagnosis and mouth breathing (MB) management may help in cases of high PASP. Total inspiratory nasal airflow (TINAF) obtained by active anterior rhinomanometry (AARM) is a means to quantify nasal patency. This study aimed to correlate TINAF with high PASP. METHODS: This is a prospective study involving 30 children between two and twelve years of age, with indication for adenotonsillectomy due to ATH, evaluated before and six months after surgery; and 29 nasal breathing (NB) children in the same age group. We obtained the PASP, calculated for tricuspid regurgitation, by means of a transthoracic echocardiography. We assessed nasal patency using the AARM to estimate the TINAF. RESULTS: The mean PASP among mouth breathing children was 25.99 mmHg, with a Standard Deviation of (±) 3.27, p = 0.01 in the preoperative period; and 21.79 mmHg (±2.48; p = 0.01) in the postoperative period. Among nasal breathers, this mean value was 21.64 mmHg (±3.87, p = 0.01). The mean pre-operative TINAF was 266.76 cm3/s (±112.21, p = 0.01); and 498.93 cm3/s (±137.80, p = 0.01) after surgery. Among nasal breathers it was 609.37 cm3/s (±109.16; p = 0.01). The mean nasal patency in the preoperative period was 42.85% (±17.83; p = 0.01); and 79.33% (±21.35; p = 0.01) in the post-op. Among nasal breathers it was 112.94% (±15.88, p = 0.01). There was a significant Spearman correlation value between TINAF and PASP (r = -0.459; p = 0.01) when we analyzed all the groups. CONCLUSION: PASP and TINAF values improved postoperatively and had an inverse correlation. This study suggests that by improving TINAF there was a decrease in PASP.

The effect of adenotonsillectomy on the position of head, cervical and thoracic spine and scapular girdle of mouth breathing children.

The clinical decision for surgical treatment of children diagnosed with mouth breathing depends on the percentage of mechanical obstruction correlated with exacerbation of upper respiratory tract infections and systemic changes. The benefits of adenotonsillectomy include changes in the nasopharyngeal space, the mandibular plane and myofunctional alterations. Post-adenotonsilectomy postural benefits have not yet been described. OBJECTIVES: To investigate the kinematics of the shoulder girdle, cervical and thoracic spine in children with mouth breathing before and after adenotonsillectomy. METHODS: Forty-nine mouth breathing children (6.3 ±â€¯1.8 years) of both sexes participated in the study. The measures of thoracic kyphosis, forward head position, shoulders protrusion and abduction, elevation, anterior tilt and internal rotation of the scapula were evaluated before and after surgery. The kinematic data were obtained using the system Qualysis ProReflex®. RESULTS: There was a significant decrease in forward head position, shoulders protrusion, elevation and anterior tilt of the scapula after surgery compared to the pre-operative. CONCLUSION: One of adenotonsillectomy results is the improvement of the posture of the head and the shoulder girdle of mouth breathing children. Clinically these findings are important and will contribute to improving the quality of life of mouth breathing children.

Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose.

INTRODUCTION: Rapid maxillary expansion can change the form and function of the nose. The skeletal and soft tissue changes can influence the esthetics and the stability of the results obtained by the procedure. OBJECTIVE: The aim of this retrospective study was to evaluate the short-term effects of rapid maxillary expansion on the skeletal and soft tissue structures of the nose, in mouth-breathing patients, using a reliable and reproducible, but simple methodology, with the aid of computed tomography. METHODS: A total of 55 mouth-breathing patients with maxillary hypoplasia were assessed and were divided into an experimental group treated with rapid maxillary expansion(39 patients, 23 of which were male and 16 female, with an average age of 9.7 years and a standard deviation of 2.28, ranging from 6.5 to 14.7 years) and a control group (16 patients, 9 of which were male and 7 female, with an average age of 8.8 years, standard deviation of 2.17, ranging from 5.11 to 13.7 years). The patients of the experimental group were submitted to multislice computed tomography examinations at two different points in time: (T1) pre-rapid maxillary expansion and (T2) three months after the procedure. The control group underwent to the same exams at the same intervals of time. Four skeletal and soft tissue variables were assessed, comparing the results of T1 and T2. RESULTS: There was in the experimental group a significant increases in all the skeletal and soft tissue variables (p<0.05) but no significant alteration was found in the control group. When comparing the experimental group and the control group, the most important change occurred in the width of the pyriform aperture (p<0.001). CONCLUSION: Rapid maxillary expansion is capable of altering the shape and function of the nose, promoting alterations in skeletal and soft tissue structures. This kind of study may, in the future, permit the proper planning of esthetic procedures at the tip and base of the nose and also the performance of objective measurements in early or late surgical outcomes.

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.

Maxillary dentoskeletal changes 1-year after adenotonsillectomy.

OBJECTIVE: To measure the maxillary dentoskeletal and soft tissue changes of severely obstructed mouth breathing (MB) young children who had their mode of breathing normalized after adenotonsillectomy (T&A), in comparison with a matched group of severely obstructed untreated MB children (CG). METHODS: Seventy patients who had an Ear, Nose, and Throat examination (ENT), including flexible nasal endoscopy, to confirm the severe obstruction of the upper airways and the indication of T&A composed the sample. Cephalograms and dental casts were available from the patient's orthodontic records. Treatment group (TG) and CG included 35 children each. Groups were matched by gender (24 males and 11 females in each group), age (TG, 6.7 ± 1.8 years; CG, 6.9 ± 2.3 years), tooth development (TG, 13 primary dentition, 22 mixed dentition; CG, 14 primary dentition, 21 mixed dentition), and skeletal maturation status. Records were taken at baseline (T0) and 1-year after T&A (T1) for TG; while CG records were taken with a 1-year interval. Dentoskeletal measurements were performed in the lateral cephalograms, and dental casts were used to assess the palatal volume and occlusal changes. RESULTS: TG showed a significant increase (503.3 mm(3), P < 0.001) in the palatal volume (10% of change), while CG palatal volume was stable. No dimensional occlusal changes were detected between T0 and T1 in both groups. Significant downward (point A, 2.1 mm; ANS, 2.1 mm) and forward displacements (point A, 0.7 mm; ANS, 1 mm) of the anterior region of the maxilla were observed in the TG, but CG presented only significant downward displacement (point A, 1.8 mm; ANS, 1.4 mm). The maxillary posterior region (PNS, PTM, and Molar) displaced downward in both groups (P < 0.05), however no sagittal change was found. The palatal plane inclination was stable in both groups. CONCLUSIONS: TG presented significant increase in the palatal volume and in the forward displacement of the maxilla. No other significant maxillary dentoskeletal changes were found.

Is the difference in the volume of the pharyngeal space, as measured by acoustic pharyngometry, before and after tonsillectomy proportional to the volume of the excised tonsils?

OBJECTIVE: Adenotonsillectomy is recognized as an effective therapy for snoring and sleep disorders in children. It is important to understand whether adenotonsillectomy significantly increases the volume of the pharyngeal space. The goal of this study was to evaluate the change in oropharyngeal volume after adenotonsillectomy and the correlation of this change with the objective volume of the tonsils and body mass index. METHODS: We included 27 subjects (14 males) with snoring caused by tonsil and adenoid hypertrophy. The mean age of the subjects was 7.92 (±2.52) years. Children with craniofacial malformations or neuromuscular diseases or syndromes were excluded. The parents/caregivers answered an adapted questionnaire regarding sleep-disordered breathing. All patients were subjected to weight and height measurements and body mass index was calculated. The subjects underwent pharyngometry before and after adenotonsillectomy and the volume of both excised tonsils together was measured in cm3 in the operating room. RESULTS: Pharyngometric analysis showed that the mean pharyngeal volume was 28.63 (±5.57) cm3 before surgery and 31.23 (±6.76) cm3 after surgery; the volume of the oropharynx was significantly increased post-surgery (p=0.015, Wilcoxon test). No correlation was found between the objective tonsil volume and the post-surgical volume increase (p=0.6885). There was a fair correlation between the oropharyngeal volume and body mass index (p=0.0224). CONCLUSION: Adenotonsillectomy increases the volume of the pharyngeal space, but this increase does not correlate with the objective tonsil size. Furthermore, greater BMI was associated with a smaller increase in the pharyngeal volume. Oropharyngeal structures and craniofacial morphology may also play a role in the increase in oropharyngeal volume.

Long-term effects of intracapsular partial tonsillectomy (tonsillotomy) compared with full tonsillectomy.

OBJECTIVE: To compare the long-term effects (six years after surgery) of two techniques for pediatric tonsil surgery with respect to snoring, apneas, eating difficulties, infections and general health. The two methods were intracapsular partial tonsillectomy (tonsillotomy, "TT") using CO(2)-laser technique and traditional (total) blunt dissection tonsillectomy (TE). STUDY DESIGN: A questionnaire distributed by mail to the parents of children, who, in 1998, were included in a prospective clinical randomized study in one tertiary care ENT clinic. METHOD: A 10 question survey follow-up of 41 children, between 9 and 15 years of age, who originally, six years earlier had been randomized to either TT with CO(2)-laser (n=21) or TE (n=20). The main indication for the surgery was a history of sleep related breathing distress (SRBD). Before the present study, all of the children had participated in earlier follow-ups at six months and one year after surgery. RESULTS: All the children in both groups answered the questionnaire. There were no significant differences between the answers from the two groups in any respects: the effect on snoring and apneas was equally stable for both groups. The number of children who remained free from snoring decreased from 40 after the first year to 25 after six years (11 TT, 14 TE). Snoring in the recurrent cases was not rated to be as frequent or as loud as before the surgery. Infections of the upper respiratory tract (URI) that had been treated with antibiotics occurred to the same extent in both groups. None had eating difficulties. The patients' satisfaction with the results of the surgery was high or very high in 18/21 TT and 20 TE cases, and the vast majority of the parents rated their children's present health status as improved compared with the preoperative condition. CONCLUSION: Tonsillotomy with CO(2)-laser seems to be a reliable method for tonsil surgery with substantially less primary morbidity than conventional tonsillectomy and with the same positive long-term effects after six years.

[Clinicofunctional parallels in posttraumatic deformities of the nasal tip].

The analysis of different posttraumatic deformities of the nasal tip gave evidence for a close correlation of internal nose deformities with nasal breathing ranging from common changes in the internal nose (hypertrophy of the inferior turbinated bone) to atresia when nasal breathing is completely blocked. Because of tissue edema, respiration improved and normalized only 1 and 3 months after surgery. It is concluded that functional examinations before and after surgery are beneficial for patients and warrant optimal terms of surgery.

Muscular and functional changes following adenotonsillectomy in children.

BACKGROUND: It is recognized that adenotonsillar hypertrophy leads to muscular and functional changes in face, and that adenotonsillectomy is associated to improvement in this condition. However, the ideal interval one should wait until this spontaneous recovery is not well defined, neither if this recovery is expected to be complete or partial. OBJECTIVE: To compare the muscular and functional changes in face of children prior and after adenotonsillectomy in a monthly evaluation. METHODS: 8 children aged from 4 to 6 years were prospectively studied. All patients underwent adenotonsillectomy, and were assessed before and monthly-after surgery up to 6 months, through the Protocol of Orofacial Myofunctional Evaluation with Scores (OMES). RESULTS: There was a progressive improvement in OMES score in all measured parameters, including the "mobility" and "posture" sub-tests; this improvement was significant at the first month after surgery. The sub-test "function" was not affected by surgery. Improvement continued from the first to the sixth month after surgery, although it was not significant between these two periods. Additionally, all parameters remained altered after the final evaluation at six months. There was a significant correlation between the improvement in "mobility" sub-test and in total score of OMES. CONCLUSION: We observed a partial recovery in facial muscular and functional changes following adenotonsillectomy, particularly during the first month after surgery. This improvement was especially observed in the "mobility" and "posture" sub-tests. We conclude that waiting for a spontaneous muscular and functional facial recovery during the first month post-operatively seems reasonable. Nevertheless, after this period, if the patient fails to achieve recovery, it may be advised that this child should undergo myofunctional therapy.

Three-dimensional evaluation of superior airway space after orthognathic surgery with counterclockwise rotation and advancement of the maxillomandibular complex in Class II patients.

OBJECTIVE: The aim of this study was to assess changes in the superior airway space (SAS) in Class II patients undergoing orthognathic surgery with counterclockwise rotation of the maxillomandibular complex (MMC). STUDY DESIGN: A total of 23 patients (15 females and 8 males; mean age, 33 years) with symptoms of respiratory disease (mouth breathing) were studied. The patients were subjected to computed tomography analyses at two time intervals: T1 (preoperatively) and T2 (postoperative minimum of 6 months). The computed tomography images were exported to Dolphin Imaging 11.5 software to measure the surface area, minimum axial area, and volume of the SAS. RESULTS: The surgery (including a median mandibular advancement of 14 mm with an average rotation of 8 degrees) significantly increased the static SAS, with mean postoperative increases of 178 mm(2) in SA, 76.67 mm(2) in minimum axial area, and 10118.5 mm(3) in volume. A significant increase was also observed in the three-dimensional airspace following orthognathic surgery, which provided a greater permeability of the SAS in Class II patients. CONCLUSIONS: This confirmed the efficacy of this technique in the treatment of respiratory disorders.

Nasal and sinus polyposis in children.

Nasal and sinus polyposis in the pediatric population is uncommon and its etiology is unclear. In this 11-year retrospective study, the authors describe the etiologic features and evaluate the effectiveness of endoscopic sinus surgery in 46 children. Patients were divided into three groups according to whether nasal and sinus polyposis was isolated (n = 14), or associated with either asthma (n = 5) or cystic fibrosis (n = 27). An allergy was present in 10% of patients with isolated polyposis, 80% of patients with polyposis associated with asthma, and 22% of patients with polyposis associated with cystic fibrosis. The indications for surgery were disabling symptoms, especially chronic nasal obstruction, rhinorrhea, and mouth breathing, and failure to respond to medical treatment. No surgical complications were encountered. Most patients reported improvement in quality of life with reduction of nasal obstruction in 83% of cases and rhinorrhea in 61%. Minor asymptomatic recurrence (i.e., a few micropolyps localized on the roof of the ethmoid cavity) was observed in 24% of the cases in this series, and major recurrence with the same functional symptoms as before surgery in 12%. However, recurrences were higher in patients with cystic fibrosis, because minor recurrence with no clinical manifestation was observed in 32% of these cases and major recurrence in 16%. Endoscopic sinus surgery must be decided in collaboration with the pediatric and pulmonary physicians, and must be performed skillfully. With a mean follow-up of 3.7 years, results in this series are encouraging.

The nasal passage following rhinoplastic surgery.

A follow-up examination has been carried out of 238 patients suffering from nasal obstruction and mouth-breathing. Only 75 per cent of the patients achieved normal nasal passages. The results were significantly poorer in patients suffering from allergic or vasomotor rhinitis, in cases of long-standing mouth-breathing, and in those cases in which the patient had been subjected to earlier rhinoplastic surgery. Our investigation has indicated that a re-evaluation of the indications for surgery in the above-mentioned cases is necessary, and that a more cautious attitude should be taken regarding the possibility of achieving a normal nasal passage following rhinoplastic surgery.

Early lingual frenectomy assisted by CO2 laser helps prevention and treatment of functional alterations caused by ankyloglossia.

Incorrectly produced speech sounds, the presence of dentofacial alterations and acquired functional adaptations may be due to a short and inadequate lingual frenum. When frenectomy is indicated, it should be performed as early as possible to prevent functional alterations. This study presents a literature review on correct lingual positioning in relation to orthodontic and phonetic function as well as an assessment of 15 patients who underwent frenectomy utilizing the carbon dioxide laser. The results demonstrated that this technique is safe, effective and perfect for use in young children and can be performed in an outpatient unit.

[Combined nose deformities and the restoration of nasal breathing by a surgical method]. / Kombinirovannye deformatsii nosa i vosstanovlenie nosovogo dykhaniia khirurgicheskim sposobom.

Disorders in nasal respiration after posttraumatic combined deformations depend on deformation of the septum, pathological changes in the mucosa, and deformation of the external nose. Restoration of nasal breathing is determined by the type of surgical intervention. The nasal respiratory function recovered in 20 days to 5 months in the majority (47) of patients operated for traumatic combined deformations of the nose with impairment of nasal respiration.

Características do sono de crianças respiradoras orais encaminhadas para realização de adenoidectomia e/ou amigdalectomia / Sleep characteristics in oral breathers pre adenoidectomy and/or tonsillectomy / Características del sueño de los niños respiradores orales encaminados para la realización de adenoidectomía y/o amigdalectomía

Introdução: A respiração oral acarreta diversas modificações na vida das crianças sendo uma delas as alterações na qualidade do sono, podendo ter impacto no desenvolvimento infantil. Objetivo: Compreender as características do sono de crianças com diagnóstico de respiração oral encaminhadas para a realização de cirurgias de adenoidectomia e/ou amigdalectomia prescritas pelo médico otorrinolaringologista, a partir das informações da família e das próprias crianças. Método: Estudo observacional, analítico, transversal e quantitativo, realizado com 100 crianças de ambos os sexos, com faixa etária entre cinco e 12 anos, divididas em dois grupos, sendo 50 crianças com respiração oral (GP) e 50 crianças sem diagnóstico de alteração respiratória (GC). A avaliação foi baseada no protocolo MBGR, classificação de Mallampati. Após a coleta, os dados foram tabulados e analisados estatisticamente a partir das variáveis queixa, qualidade e características do sono e classificação de Mallampati. Resultados: Os pais e/ou responsáveis não referiram espontaneamente informações relacionadas ao sono. Quando indagados sobre a qualidade do sono houve predomínio de sintomas para o GP. As principais queixas relacionadas ao sono foram ronco, sialorreia, agitação, boca seca, boca aberta, sono fragmentado, com maior ocorrência para o GP. Quanto à classificação de Mallampati houve predomínio dos graus II e III para o GP e grau I para o GC. Conclusão: Crianças respiradoras orais apresentam maior número de queixas referidas por pais/responsáveis em relação à qualidade do sono quando comparadas às crianças respiradoras nasais.

Introduction: Oral breathing entails several changes in the life of children, one of them being changes in sleep quality, which may have an impact on child development. Objective: To understand the sleep characteristics of children diagnosed with oral breathing referred for adenoidectomy and/or tonsillectomy surgeries prescribed by the otorhinolaryngologist, based on information from the family and the children themselves. Method: An observational, analytical, cross-sectional and quantitative study was carried out on 100 children of both sexes, with age range 5 and 12 years, divided into two groups: 50 children with oral breathing (EG) and 50 children without respiratory disorder (CG). The evaluation was based on the MBGR protocol, Mallampati score. After collection, the data were tabulated and analyzed statistically from the variables complaint, sleep quality and characteristics and Mallampati classification. Results: Parents and/or caregivers did not spontaneously report sleep-related information. When asked about sleep quality there was a predominance of symptoms for the EG. The main complaints related to sleep were snoring, sialorrhea, agitation, dry mouth, open mouth, fragmented sleep, with higher occurrence for the EG. Regarding the classification of Mallampati, there was a predominance of classes II and III for the EG and class I for the CG. Conclusion: Oral breathing children have a higher number of complaints reported by parents / guardians regarding sleep quality compared to nasal breathing children.

Introducción: La respiración oral acarrea diversas modificaciones en la vida de los niños siendo una de ellas las alteraciones en la calidad del sueño pudiendo tener impacto en el desarrollo infantil. Objetivo: Comprender las características del sueño de niños con diagnóstico d respiración oral encaminadas para la realización de cirugías de adenoidectomía y/o amigdalectomía prescritas por el médico otorrinolaringólogo, a partir de las informaciones de la familia y de los propios niños. Método: estudio observacional, analítico, transversal y cuantitativo, realizado con 100 niños de ambos sexos, con rango de edad entre cinco y 12 años, divididos en dos grupos, siendo 50 niños con respiración oral (GE) y 50 niños sin diagnóstico de cambio respiratorio (GC). La evaluación se basó em el protocolo MBGR, la clasificación de Mallampati. Después de la recolección, los datos fueron tabulados y analizados estadísticamente de las variables queja, calidad y características del sueño y clasificación de Mallampati. Resultados: Los padres y/o tutores no mencionaron espontáneamente información relacionada con el sueño. Cuando se indagó sobre la calidad del sueño hubo predominio de síntomas para el GE. Las principales quejas relacionadas con el sueño fueron ronquidos, sialorrea, agitación, boca seca, boca abierta, sueño fragmentado, con mayor ocurrencia para el GE. En cuanto a la clasificación de Mallampati hubo predominio de las clases II y III para el GE y clase I para el GC. Conclusión: Los niños con respiración oral tienen un mayor número de quejas reportadas por los padres / tutores con respecto a la calidad del sueño en comparación con los niños con respiración nasal.

Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose / Expansão rápida da maxila em respiradores orais: efeitos esqueléticos e tegumentares do nariz em curto prazo

Abstract Introduction Rapid maxillary expansion can change the form and function of the nose. The skeletal and soft tissue changes can influence the esthetics and the stability of the results obtained by the procedure. Objective The aim of this retrospective study was to evaluate the short-term effects of rapid maxillary expansion on the skeletal and soft tissue structures of the nose, in mouth-breathing patients, using a reliable and reproducible, but simple methodology, with the aid of computed tomography. Methods A total of 55 mouth-breathing patients with maxillary hypoplasia were assessed and were divided into an experimental group treated with rapid maxillary expansion(39 patients, 23 of which were male and 16 female, with an average age of 9.7 years and a standard deviation of 2.28, ranging from 6.5 to 14.7 years) and a control group (16 patients, 9 of which were male and 7 female, with an average age of 8.8 years, standard deviation of 2.17, ranging from 5.11 to 13.7 years). The patients of the experimental group were submitted to multislice computed tomography examinations at two different points in time: (T1) pre-rapid maxillary expansion and (T2) three months after the procedure. The control group underwent to the same exams at the same intervals of time. Four skeletal and soft tissue variables were assessed, comparing the results of T1 and T2. Results There was in the experimental group a significant increases in all the skeletal and soft tissue variables (p < 0.05) but no significant alteration was found in the control group. When comparing the experimental group and the control group, the most important change occurred in the width of the pyriform aperture (p < 0.001). Conclusion Rapid maxillary expansion is capable of altering the shape and function of the nose, promoting alterations in skeletal and soft tissue structures. This kind of study may, in the future, permit the proper planning of esthetic procedures at the tip and base of the nose and also the performance of objective measurements in early or late surgical outcomes.

Resumo Introdução A expansão rápida da maxila pode alterar a forma e a função do nariz. As alterações do esqueleto e dos tecidos moles podem influenciar a estética e a estabilidade dos resultados obtidos através deste procedimento. Objetivo Avaliar, em curto prazo, os efeitos da expansão rápida da maxila sobre as estruturas esqueléticas e tegumentares do nariz em pacientes respiradores orais por meio de uma metodologia confiável e reprodutível, porém simples, com a ajuda da tomografia computadorizada. Método Foram avaliados 55 pacientes respiradores orais com hipoplasia maxilar que foram divididos em grupo experimental tratado com expansão rápida da maxila (39, 23 do sexo masculino e 16 do feminino, com média de 9,7 anos e desvio padrão de 2,28, variação de 6,5 a 14,7 anos) e um grupo controle (16 pacientes, nove do sexo masculino e sete do feminino, com média de 8,8 anos, desvio padrão de 2,17, variação de 5,11-13,7 anos). Os pacientes do grupo experimental foram submetidos a exames de tomografia computadorizada multislice em dois tempos distintos: (T1) pré-expansão rápida da maxila e (T2) três meses após o procedimento. O grupo controle foi submetido aos mesmos exames nos mesmos intervalos de tempo. Foram avaliadas quatro variáveis esqueléticas e quatro tegumentares comparando-se os resultados de T1 e T2. Resultados O grupo experimental apresentou aumentos significativos em todas as variáveis esqueléticas e tegumentares (p < 0,05), mas não houve alterações significativas no grupo controle. Ao compararem-se o grupo experimental e o grupo controle, foi observado que a alteração mais importante ocorreu na largura da abertura piriforme (p < 0,001). Conclusão A expansão rápida da maxila é capaz de alterar a forma e a função do nariz, promove alterações nas estruturas esqueléticas e dos tecidos moles. Esse tipo de estudo pode, no futuro, permitir o planejamento adequado de procedimentos estéticos na ponta e base do nariz e também a feitura de medidas objetivas em resultados cirúrgicos iniciais ou tardios.

Influence of adenotonsillectomy on hard palate dimensions.

OBJECTIVE: To evaluate hard palate width and height in mouth-breathing children pre- and post-adenotonsillectomy. METHODS: We evaluated 44 children in the 3-6 year age bracket, using dental study casts in order to determine palatal height, intercanine width, and intermolar width. The children were divided into two groups: nasal breathing (n=15) and mouth breathing (n=29). The children in the latter group underwent adenotonsillectomy. The study casts were obtained prior to adenotonsillectomy, designated time point 1 (T1), at 13 months after adenotonsillectomy (T2), and at 28 months after adenotonsillectomy (T3). Similar periods of observation were obtained for nasal breathing children. RESULTS: At T1, there was a significantly lower intercanine width in mouth breathing children; intermolar width and palate height were similar between groups. After surgery, there was a significant increase in all the analyzed parameters in both groups, probably due to facial growth. Instead, the increase in intercanine width was substantially more prominent in mouth breathing children than in nasal breathing children, and the former difference failed in significance after the procedure. CONCLUSIONS: There were no significant differences between the nasal-breathing and mouth-breathing children in terms of intermolar width and palatal height prior to or after tonsillectomy. Although intercanine width was initially narrower in the mouth-breathing children, it showed normalization after the surgical procedure. These results confirm that the restoration of nasal breathing is central to proper occlusal development.