[Effect of maxillary expansion combined with orofacial myofunctional therapy on the position of the tongue of children with mouth breathing].

Objective:This study aimed to investigate the change of the position of the tongue before and after combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion. Methods:A total of 30 children with skeletal class Ⅱ malocclusion and unobstructed upper airway were selected. The 30 children were divided into mouth-breathing group（n=15） and nasal-breathing group（n=15） and CBCT was taken. The images were measured by Invivo5 software. The measurement results of the tongue position of the two groups were analyzed by independent samples t-test. 15 mouth-breathing children with skeletal class Ⅱ malocclusion were selected for maxillary expansion and orofacial myofunctional therapy. CBCT was taken before and after treatment, the measurements were analyzed by paired sample t test with SPSS 27.0 software package. Results:The measurement of the tongue position of the mouth-breathing and nasal-breathing groups were compared, the differences were statistically significant（P<0.05）. The measurement of the tongue position showed significant difference after the combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion（P<0.05）. Conclusion:Skeletal class Ⅱ malocclusion children with mouth-breathing have low tongue posture. The combined treatment of maxillary expansion and orofacial myofunctional therapy can change the position of the tongue.

Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis.

AIM: To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma. METHODS: Fifty-three MB children/adolescents (aged 7-14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance). RESULTS: A significant reduction in the CARATkids score occurred in the RAD (-4.06; p < 0.05), similarly when patient and parent/guardian scores were evaluated (-3.28 and -3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm3, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them. CONCLUSION: In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.

Effect of maxillary expansion combined with orofacial myofunctional therapy on the position of the tongue of children with mouth breathing / 临床耳鼻咽喉头颈外科杂志

Objective:This study aimed to investigate the change of the position of the tongue before and after combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion. Methods:A total of 30 children with skeletal class Ⅱ malocclusion and unobstructed upper airway were selected. The 30 children were divided into mouth-breathing group（n=15） and nasal-breathing group（n=15） and CBCT was taken. The images were measured by Invivo5 software. The measurement results of the tongue position of the two groups were analyzed by independent samples t-test. 15 mouth-breathing children with skeletal class Ⅱ malocclusion were selected for maxillary expansion and orofacial myofunctional therapy. CBCT was taken before and after treatment, the measurements were analyzed by paired sample t test with SPSS 27.0 software package. Results:The measurement of the tongue position of the mouth-breathing and nasal-breathing groups were compared, the differences were statistically significant（P<0.05）. The measurement of the tongue position showed significant difference after the combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion（P<0.05）. Conclusion:Skeletal class Ⅱ malocclusion children with mouth-breathing have low tongue posture. The combined treatment of maxillary expansion and orofacial myofunctional therapy can change the position of the tongue.

Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis

Aim: To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma. Methods: Fifty-three MB children/adolescents (aged 7–14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance). Results: A significant reduction in the CARATkids score occurred in the RAD (−4.06; p < 0.05), similarly when patient and parent/guardian scores were evaluated (−3.28 and −3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm3, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them. Conclusion: In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies (AU)

A non-randomized concurrent controlled trial of myofunctional treatment in the mixed dentition children with functional mouth breathing assessed by cephalometric radiographs and study models.

OBJECTIVES: This study aimed to examine the clinical effects of myofunctional treatment on children with functional mouth breathing by cephalometric radiographs and study models. METHODS: A total of 224 children (6-10 years old; 114 males and 110 females; SNA°: 82.24 ± 1.67°; ANB°: 2.79 ± 0.80°, 28° < SN-GoGn° < 37°) formed three groups: MB-M group (mouth breathers with myofunctional treatment,n = 75); MB-N group (mouth breathers with no treatment,n = 70); NB group (nasal breathers with no treatment, n = 79). A blind evaluation of cephalometric radiographs and study models was conducted at T1(pre-study) and T2 (post-study), respectively. RESULTS: Two hundred four children (MB-M:66, MB-N:68, NB:70) completed the present study. At T1, MB-M and MB-N groups, compared to their NB counterpart, had greater anterior lower facial height(P < 0.01) and overjet(P < 0.001) but shorter overbite and maxillary canines width (P < 0.001). At T2, the MB-N group exhibited a higher ANB angle, anterior lower facial height, and overjet, but shorter overbite and maxillary canines width (P < 0.001). From T1 to T2, the anterior lower facial height increased, overbite and the maxillary canines width further decreased in the MB-N group (P < 0.001). However, in the MB-M group, the incisors were retracted, overbite increased (P < 0.001), anterior lower facial height increased insignificantly (P > 0.05), and maxillary canines width increased slightly (P < 0.05). In the NB and MB-M groups, the mandible showed a normal tendency to grow forward, whereas, in the MB-N group, the mandible showed a tendency to grow downward (P < 0.001). CONCLUSIONS: Mouth breathers demonstrated increased anterior facial height and overjet but reduced overbite and maxillary arch width, which improved significantly following myofunctional treatment. TRIAL REGISTRATION: TCTR: TCTR20220401001 . Registered 1stApril 2022-Retrospectively registered.

Trastorns respiratoris obstructius del son: necessitat d’un enfocament precoç i interdisciplinari / Trastornos respiratorios obstructivos del sueño: necesidad de un enfoque precoz e interdisciplinario / Obstructive sleep-disordered breathing: the need for an early and interdisciplinary approach

Fonament. Els trastorns respiratoris obstructius del son (TROS) són un gradient de patologies extremament infradiagnosticades malgrat la seva alta prevalença, en especial als països industrialitzats. La necessitat d’una deteccióprecoç i d’un tractament en equip interdisciplinari han fet que el nombre de publicacions de totes les especialitatsrelacionades no hagi parat de créixer en l’última dècada.És per això que creiem necessària una revisió de la bibliografia publicada fins al moment, que ens permeti tenir unavisió més global i donar recomanacions a l’hora de diagnosticar i tractar aquests trastorns.Objectiu. Conèixer la fisiopatologia, els signes i símptomes més característics, i les tècniques de diagnòstic, prevenció i tractament descrits fins al moment en relació amb els TROS.Mètode. Revisió de la bibliografia internacional publicada per totes les especialitats involucrades, fins al 2020.Resultats. Existeix una àmplia bibliografia que tracta sobre la fisiopatologia, el diagnòstic i el tractament des del punt de vista de les diferents especialitats. Encara avui és un tema d’actualitat científica bastant desconegut i malauradament poc present en la pràctica pediàtrica diària.Conclusions. Els trastorns respiratoris obstructius del sontenen un impacte directe o indirecte en l’evolució correcta dels infants. La col·laboració de totes les especialitats pediàtriques per prevenir-los, detectar-los i tractar-los abans dels 5 anys és imprescindible. (AU)

Fundamento. Los trastornos respiratorios obstructivos del sueño (TROS) son un gradiente de patologías extremadamente infradiagnosticadas a pesar de su alta prevalencia, especialmente en lospaíses industrializados. La necesidad de una detección precoz y un tratamiento en equipo interdisciplinar han hecho que el número de publicaciones de todas las especialidades relacionadas no haya parado de crecer en la última década. Por ello, creemos necesaria una revisión de la bibliografía publicada hasta el momento, que nos permita tener una visión más global y dar recomendaciones a la hora de diagnosticar y tratar estos trastornos.Objetivo. Conocer la fisiopatología, los signos y síntomas más característicos, y las técnicas de diagnóstico, prevención y tratamiento descritas hasta el momento en relación con los TROS.Método. Revisión de la bibliografía internacional publicada por todas las especialidades involucradas, hasta 2020.Resultados. Existe una amplia bibliografía sobre la fisiopatología,diagnóstico y tratamiento, desde el punto de vista de las diferentes especialidades. Aún hoy, es un tema de actualidad científica bastante desconocido y desgraciadamente poco presente en la práctica pediátrica diaria.Conclusiones. Los trastornos respiratorios obstructivos del sueño tienen un impacto directo o indirecto en la correcta evolución de los niños. La colaboración de todas las especialidades pediátricas para prevenirlos, detectarlos y tratarlos antes de los 5 años es imprescindible. (AU)

Background. Obstructive Sleep-disordered Breathing (SDB) includes a spectrum of extremely underdiagnosed sleep disorders despite their high prevalence, particularly in industrialized countries.The need for early detection and interdisciplinary treatment has resulted in a significant increase in the number of published papers from all related specialties over the last decade. For this reason, a review of the literature published so far may be necessary to provide a more comprehensive perspective and recommendations for the diagnosis and treatment of these disorders.Objective. To describe the pathophysiology, the most characteristic signs and symptoms, and the diagnosis, prevention and treatment techniques described so far related to SDB.Method. Review of the published literature on the subject at an international level, from the point of view of all the specialties involved, until 2020.Results. There is extensive scientific literature about the pathophysiology, diagnosis, and treatment of SDB. It is still a subject of active scientific discussion, but with little knowledge and awareness in the daily paediatric practice.Conclusions. Obstructive sleep-disordered breathing may have a direct or indirect impact on the growth and development of dren. A multidisciplinary approach is critical to prevent, diagnose and treat SDB before the age of five. (AU)

Comparison of rapid maxillary expansion and pre-fabricated myofunctional appliance for the management of mouth breathers with Class II malocclusion.

OBJECTIVE: Pre-fabricated myofunctional appliances and rapid maxillary expansion (RME) has been used for the treatment of mouth-breathers with Class-II malocclusion. This study aimed to compare the treatment effects of hyrax and pre-fabricated myofunctional appliance (T4K) for the management of mouth breathers with Class II Malocclusion in mixed dentition stage. PATIENTS AND METHODS: Case records of mouth breathers with Class II Division 1 malocclusion patients treated at our institute with T4K or hyrax appliance between June 2015 to May 2019 were retrieved. The Pancherz analysis was used to compare the treatment effects. RESULTS: Data of 28 patients (14 in each group) were compared. Significant advancement of maxilla was seen in both groups while mandibular length improved only with the T4K appliance. SNA and SNB changes were significantly greater in the T4K group. Molar relationship improved in both groups. Molar correction was obtained by 55.6% skeletal change and 44.4% dental change with RME. In the T4K group the corresponding values were 48.1% and 51.9% respectively. CONCLUSIONS: Our results suggest that both pre-fabricated myofunctional appliance and RME are suitable for the treatment of mouth breathers with Class II malocclusion in the mixed dentition period. Sagittal correction of maxilla and mandible may be somewhat better with the T4K appliance. Although the dental compensation may be slightly more with the T4K appliance and it may inhibit the skeletal remodeling.

The effects of heated humidification to nasopharynx on nasal resistance and breathing pattern.

BACKGROUND: Mouth breathing could induce not only dry throat and eventually upper respiratory tract infection, but also snoring and obstructive sleep apnea, while nasal breathing is protective against those problems. Thus, one may want to explore an approach to modify habitual mouth breathing as preferable to nasal breathing. The aim of this study was to investigate the physiological effects of our newly developed mask on facilitation of nasal breathing. METHODS: Thirty seven healthy male volunteers were enrolled in a double blind, randomized, placebo-controlled crossover trial. Participants wore a newly developed heated humidification mask or non-heated-humidification mask (placebo) for 10-min each. Subjective feelings including dry nose, dry throat, nasal obstruction, ease to breathe, relaxation, calmness, and good feeling were asked before and after wearing each mask. In addition, the effects of masks on nasal resistance, breathing pattern, and heart rate variability were assessed. RESULTS: Compared with the placebo mask, the heated humidification mask improved all components of subjective feelings except for ease to breathe; moreover, decreased nasal resistance and respiratory frequency accompanied a simultaneous increase in a surrogate maker for tidal volume. However, use of the heated humidification mask did not affect heart rate variability. CONCLUSION: Adding heated humidification to the nasopharynx could modulate breathing patterns with improvement of subjective experience and objective nasal resistance.

Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion / Avaliação em curto prazo das alterações tegumentares do nariz em respiradores orais submetidos à expansão rápida da maxila

Abstract Introduction Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure. Objective The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography. Methods A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent rapid maxillary expansion (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software. Results In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p < 0.05), whereas, changes did not occur in the control group (p > 0.05). In the treatment group, mean alar base width increased by 4.87% (p = 0.004), mean alar width increased by 4.04% (p = 0.004), mean height of the soft tissues of the nose increased by 4.84% (p = 0.003) and mean length of the soft tissues of the nose increased by 4.29% (p = 0.012). Conclusion In short-term, rapid maxillary expansion provided a statistically significant increase in the dimensions of the soft tissues of the nose.

Resumo Introdução A expansão rápida da maxila é um procedimento ortodôntico e ortopédico que pode alterar a forma e a função do nariz. Os tecidos moles do nariz e suas alterações podem influenciar na estética e na estabilidade dos resultados obtidos por esse procedimento. Objetivo O objetivo desse estudo foi avaliar as alterações nas dimensões do nariz após expansão rápida da maxila em respiradores orais com atresia maxilar, usando uma metodologia confiável e reprodutível com o auxílio de tomografia computadorizada. Método Um total de 30 pacientes respiradores orais com atresia maxilar foram avaliados e divididos em um grupo de tratamento, submetidos à expansão rápida da maxila (20 pacientes, 10 dos quais do sexo masculino e 10 do sexo feminino, com média de idade de 8,9 anos e DP de 2,16, variando de 6,5 a 12,5 anos) e um grupo controle (10 pacientes, sendo 5 do sexo masculino e 5 do sexo feminino, com média de idade de 9,2 anos, DP de 2,17, variando de 6,11 a 13,7 anos). No grupo tratado, foram realizados exames de tomografia computadorizada multislice no início do tratamento (T1) e 3 meses após a expansão (T2). Os pacientes do grupo controle foram submetidos aos mesmos exames nos mesmos intervalos de tempo. Foram analisadas quatro variáveis relacionadas às estruturas dos tecidos moles do nariz (largura da base alar, largura alar, altura do tecido mole do nariz e comprimento do tecido mole do nariz) e os resultados entre T1 e T2 foram comparados, utilizando-se o software Osirix MD. Resultados No grupo tratado (GT), os tecidos moles do nariz apresentaram aumentos significativos em todas as variáveis estudadas (p < 0,05), enquanto isso não ocorreu no GC (p > 0,05). No GT, a largura média da base alar aumentou 4,87% (p = 0,004), a largura média alar aumentou 4,04% (p = 0,004), a altura média dos tecidos moles do nariz aumentou 4,84% (p = 0,003) e o comprimento médio dos tecidos moles do nariz aumentou 4,29% (p = 0,012). Conclusão A curto prazo, a expansão rápida da maxila proporcionou um aumento estatisticamente significativo nas dimensões dos tecidos moles do nariz.

Relief of Upper Airway Obstruction Using a Cervical Splint for Young Patients with Cerebral Palsy.

13-year old boy with spastic quadriplegia cerebral palsy visited dental clinic with chief complaints of mouth breathing and malocclusion. His mouth was constantly open at the resting position, with his mandible and tongue displaced downward. He breathed through his mouth, making a constant gurgling sound, a sign of upper airway obstruction. To enhance his mandible position, vertical chin cap was first considered, but it was not sufficient to reduce the gurgling sound or ease breathing. Then, cervical splint was considered, which effectively decreased the gurgling sound by repositioning his mandible to the anterior-superior position. Oxygen saturation was increased when the cervical splint was used. Cervical splint can effectively assist breathing in patients with cerebral palsy, but it should be carefully applied as long-term use can result in unexpected complications. Under instruction by a physician regarding proper usage, a cervical splint can be applied to assist breathing in patients with cerebral palsy.

Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion.

INTRODUCTION: Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure. OBJECTIVE: The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography. METHODS: A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent rapid maxillary expansion (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software. RESULTS: In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p<0.05), whereas, changes did not occur in the control group (p>0.05). In the treatment group, mean alar base width increased by 4.87% (p=0.004), mean alar width increased by 4.04% (p=0.004), mean height of the soft tissues of the nose increased by 4.84% (p=0.003) and mean length of the soft tissues of the nose increased by 4.29% (p=0.012). CONCLUSION: In short-term, rapid maxillary expansion provided a statistically significant increase in the dimensions of the soft tissues of the nose.

[Treatment management of a case of class I bialveolar protrusion with mouth breathing]. / Gestion du traitement d'un cas de classe I biproalvéolie avec ventilation buccale.

This is the case of a 12-year-old African young girl with bialveolar protrusion and night mouth breathing. Orthodontic treatment without dental extraction consisted after tonsillectomy in retraction of anterior teeth in the diastema spaces. The normalization of the angle of the upper incisor has improved bialveolar protrusion without alteration to the prior balance of soft tissue.

Efetividade de um programa de terapia miofuncional no tratamento da respiração oral em indivíduos com má oclusão dentária: ensaio clínico / Effectiveness of a myofunctional therapy program in the treatment of mouth breathing in subjects with malocclusion: a clinical trial

A impossibilidade de respirar pelo nariz leva o indivíduo a desenvolver uma respiração oral que pode gerar modificações na postura lingual, labial e mandibular, bem como desarmonia dos tecidos moles, com consequente mudança na morfologia craniofacial, induzindo à má oclusão. Poucos trabalhos científicos descreveram as propostas terapêuticas empregadas ou utilizaram exames objetivos para mensurar a efetividade do tratamento miofuncional orofacial em casos de respiração oral. Sendo assim, esta pesquisa teve como objetivo verificar a efetividade de um programa miofuncional orofacial voltado ao tratamento da função respiratória em adultos com má oclusão dentária, considerando parâmetros respiratórios e a qualidade de vida em saúde oral. Participaram da pesquisa 13 indivíduos adultos em tratamento ortodôntico com má oclusão classe II, os quais foram divididos aleatoriamente em grupo experimental (GE) (n=9) e grupo controle (GC) (n=4). Foram aplicados os protocolos de qualidade de vida em saúde oral (OHIP-14) e de Sintomas Respiratórios. Além disto, foi feita a avaliação miofuncional da função respiratória, presente no protocolo MBGR, a qual envolve o tipo e modo respiratórios, fluxo nasal e possibilidade de uso nasal. Também foram avaliadas as medidas de tempo máximo de fonação (TMF) de /s/, pico do fluxo inspiratório nasal (peak-flow) e análise da medida da área de embaçamento da placa metálica, relacionada ao fluxo nasal expiratório. Foi possível observar que, após o processo terapêutico, os pacientes do GE apresentaram melhora estatisticamente significante quanto aos sintomas respiratórios (p<0,001), escore do Protocolo MBGR (p<0,001), tipo respiratório (p=0,041), modo respiratório (p=0,029), tempo máximo de fonação (p=0,002) e pico do fluxo inspiratório nasal (p=0,002), modificando os padrões que se encontravam alterados no momento pré-terapia. Já o GC permaneceu com os aspectos funcionais e sintomáticos alterados, apresentando piora quanto aos sintomas respiratórios (p=0,003) e TMF (p=0,013). Além disto, no período pré-terapia os grupos eram semelhantes entre si, sendo que após o tratamento, estes ficaram distintos no que diz respeito aos sintomas respiratórios (p=0,047), escore do protocolo MBGR (p=0,000), TMF (p=0,010) e pico do fluxo inspiratório nasal (p=0,001). Conclui-se assim, que após a aplicação do programa de terapia miofuncional orofacial para o tratamento da respiração oral, em indivíduos com má oclusão dentária, houve melhora dos parâmetros respiratórios no que diz respeito ao tipo e modo respiratório, bem como no pico inspiratório, aumento do TMF e diminuição dos sintomas respiratórios.(AU)

The inability to breathe through the nose leads the individual to develop oral breathing that can initiate changes in lingual, labial and mandibular posture, as well as soft tissue disharmony, with consequent changes in craniofacial morphology, leading to malocclusion. Few scientific papers have described the therapeutic proposals or used objective tests to measure the effectiveness of orofacial myofunctional therapy in cases of oral breathing. Thus, this research aimed to verify the effectiveness of an orofacial myofunctional program focused to the treatment of respiratory function in adults with malocclusion, considering respiratory parameters and quality of life in oral health. A total of 13 adult individuals undergoing orthodontic treatment with Class II malocclusion were randomly divided into experimental group (EG) (n=9) and control group (CG) (n=4). Oral health Impact Profile (OHIP-14) and Respiratory Symptoms protocols were applied. In addition, the myofunctional evaluation of the respiratory function, present in the MBGR protocol was performed, which involves respiratory type and mode, nasal flow and possibility of nasal use. The measures of maximum phonation time (MPT) of /s/, inspiratory peak of the nasal flow and analysis of the measurement of the haze area of the metal plate, related to the expiratory nasal flow were also evaluated. It was possible to observe that, after the therapeutic process, the EG patients had a statistically significant improvement in respiratory symptoms (p<0.001), MBGR Protocol (p<0.001), respiratory type (p=0.041), respiratory mode (p=0.029), maximal phonation time (p=0.002) and inspiratory peak flow (p=0.002), modifying patterns that were altered at the pre-therapy period. On the other hand, the CG remained with the functional and symptomatic aspects altered, presenting worsening of respiratory symptoms (p=0.003) and MPT (p=0.013). In addition, in the pre-therapy period, the groups were similar to each other, and after treatment, these were different concerning respiratory symptoms (p=0.047), MBGR Protocol (p=0.000), MPT (p=0.010) and inspiratory peak of the nasal flow (p=0.001). As conclusion, after the application of the orofacial myofunctional therapy program for the treatment of oral breathing, in individuals with malocclusion, there was an improvement in respiratory parameters regarding respiratory type and mode, as well as inspiratory peak, increased MPT and decreased respiratory symptoms.(AU)

Reavaliação de um indivíduo portador de síndrome do respirador bucal, após cinco anos do tratamento multidisciplinar ativo / The mouth breathing syndrome: a five-year multidisciplinary active treatment evaluation

A respiração bucal pode originar-se de diversas causas, tais como: hipertrofia de adenoide, rinite alérgica, desvio de septo, bronquite, entre outros, podendo apresentar características como olhar triste, lábios hipotônicos e ressecados, alterações posturais cefálico-corporais e orofaciais, boca aberta, atresia maxilar e acentuação do crescimento facial vertical. O presente trabalho teve por objetivo avaliar se o tratamento multidisciplinar da síndrome do respirador bucal, após cinco anos de sua finalização, mantém a estabilização e a eficácia de quando encerrado. De acordo com a análise documental do tratamento efetuado e reavaliado decorridos cinco anos, concluiu-se que o tratamento multidisciplinar em respirador bucal tem resultados positivos, se realizado de forma correta, na dependência da cooperação do paciente, e que os resultados obtidos logo após o tratamento também são observados em longo prazo.

The mouth breathing syndrome (MBS) can originate from several causes including adenoid hypertrophy, allergic rhinitis, septa deviation, bronchitis, as well as a sad aspect, hypotonic/dry lips, orofacial and cephalo-corporal changes, open moth, maxillary atrophy and vertical growth excess. This paper evaluate whether the proposed treatment for MBS was effective after a five-year period. According to the documentation presented, it can be concluded that this multidisciplinary treatment had positive results when performed in a correct way and with patient cooperation. Also, these results were also observed in the long-term.

Compromised Airway and Atypical Facial Growth in The Adult Patient: A Case Study in the Redirection of Facial Growth.

This case history is an adult patient with a compromised upper airway, soft tissue dysfunction, and atypicalfacial growth. The nasal deviation and enlarged turbinates resulted in mouth-breathing and soft tissue dysfunction. Atypical growth occurs when the biological balance between bone remodeling and positional displacement is disrupted Following septoplasty and turbinate reduction to reestablish nasal respiration and myofunctional therapy to retrain the muscles, the atypical growth was redirected to normal. The final result was an overall improvement in general health, esthetics, and well-being.

A randomized clinical trial of salivary substitute as an adjunct to scaling and root planing for management of periodontal inflammation in mouth breathing patients.

We investigated the outcome of conventional periodontal treatment in mouth breathing patients with chronic periodontitis, and compared the efficacy of applying salivary substitute to the anterior sextants as an adjunct to conventional treatment in such patients. In this randomized, investigator-blind, clinical study involving parallel groups, 40 mouth breathing patients were divided into two groups: a control group (CG, n = 20) comprising patients who received scaling and root planing (SRP), and a test group (TG, n = 20) who received salivary substitute as an adjunct to SRP for treatment of chronic periodontitis. The patients were followed up at various time intervals, and improvement of the gingival index (GI) was examined as the primary outcome. Student's t-test, repeated-measures ANOVA and Mann-Whitney U test were applied for statistical analysis. Although periodontal parameters were improved in both groups after 8 weeks of follow-up, the test group showed better improvement in terms of GI and percentage bleeding on probing. Within the limits of this study, our results suggest that the use of salivary substitute has a beneficial adjunctive effect for improvement of periodontal parameters in mouth breathing patients with chronic periodontitis.

Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers.

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia.

Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia. .

OBJETIVO: avaliar, por meio de tomografias, as mudanças em curto prazo nas vias aéreas superiores e na qualidade de vida em pacientes respiradores bucais, após expansão rápida da maxila (ERM). MÉTODOS: foram avaliados 25 pacientes respiradores bucais com atresia maxilar, com idade média de 10,5 anos, por meio de tomografia computadorizada de feixe cônico (TCFC) e questionário padronizado de qualidade de vida submetido aos pais/responsáveis, antes e imediatamente após a ERM. RESULTADOS: a ERM promoveu uma expansão, de forma semelhante e significativa, tanto na largura do soalho nasal anterior (2,8mm, p < 0,001) quanto na largura do soalho nasal posterior (2,8mm, p < 0,001). No volume aéreo da nasofaringe e fossas nasais, houve aumento significativo (+1646,1mm3 p < 0,001); entretanto, no volume aéreo da orofaringe, houve aumento não significativo (+1450,6 mm3 p = 0,066). Os resultados do questionário de qualidade de vida indicaram melhora significativa na qualidade de vida dos pacientes após a ERM, em comparação ao questionário inicial. CONCLUSÕES: a ERM promoveu aumento dimensional significativo nas fossas nasais e na nasofaringe, bem como melhorou significativamente a qualidade de vida dos pacientes. .

Effect of rapid maxillary expansion on monosymptomatic primary nocturnal enuresis.

OBJECTIVE: To evaluate the effects of rapid maxillary expansion (RME) on nocturnal enuresis (NE) related to the nasal airway, nasal breathing, and plasma osmolality (as an indicator for antidiuretic hormone). MATERIALS AND METHODS: Nineteen patients with monosymptomatic primary NE, aged 6-15 years, were treated with RME for 10-15 days. To exclude a placebo effect of the RME appliance, seven patients were first treated with a passive appliance. Computed tomography of nasal cavity, rhinomanometric, and plasma osmolality measurements were made 2-3 days before and 2-3 months after the RME period. RME effects on NE were followed for three more years. RESULTS: Two to three months after the expansion there were significant improvements in the breathing function and a decrease in the plasma osmolality. NE decreased significantly in all patients after the RME period, and all patients showed full dryness after 3 years. CONCLUSIONS: This study demonstrates that RME causes complete dryness in all patients, with significant effects on pathophysiological mechanisms related to NE.