Letícia Paiva Franco

Mouth breathing children and cephalometric pattern: does the stage of dental development matter?

OBJECTIVE To test the hypothesis that there is no difference in the cephalometric pattern between mouth breathing children with primary dentition and mixed dentition. METHODS Cephalometric measurements of 126 mouth breathing children (MB) were compared to 126 nasal breathing controls (NB). Both groups were divided into deciduous dentition (mean age 4 years, 8 months) and mixed dentition (mean age 7 years, 9 months) groups. RESULTS A statistically significant difference was observed in the dentofacial patterns of MB children compared to NB children. The total length of the mandible was smaller in MB compared to NB children. However, this difference was found only in subjects with mixed dentition. The length of the mandibular corpus is similar in MB and NB children, although older MB children with mixed dentition had significantly smaller measurements. The lower anterior facial height was higher in MB compared to NB children, but this difference was evident only in younger children with primary dentition. Mandibular plane angle, Y-axis angle and lower anterior facial height to total anterior facial height ratio were greater, and posterior facial height to total anterior facial height ratio was smaller in MB than NB children, indicating that mouth breathers had a more vertical facial growth pattern. However, no differences were found in the vertical growth pattern associated with the stage of dental development. The ANB angle was not associated with the maturational status of occlusion. Linear measurements and the gonial angle were significantly different between children with primary and mixed dentition, but such differences were associated with normal vertical growth. CONCLUSIONS The present investigation rejected the null hypothesis and showed significant cephalometric differences between primary and mixed dentition MB children. Mouth breathing children in the mixed dentition have a smaller mandible (in terms of total length and corpus length) than nasal breathers. In children with primary dentition, the lower anterior facial height is higher in MB than in NB children. There was no significant association between the stage of dental development of mouth breathing children (either in the primary or mixed dentition) and the other cephalometric patterns.

Eficácia do emprego do espelho de Glatzel na avaliação da permeabilidade nasal

PURPOSE: To compare the measurement of nasal air escape, carried out using the Glatzel mirror, in children with and without upper respiratory tract obstruction, according to sex and age. METHODS: The sample comprised 43 subjects, with mean age of 6.9 years, divided into four groups: children with surgical indication to clearing of the upper respiratory tract (surgical group), allergic children with upper respiratory tract obstruction (allergic group), allergic children with obstruction and surgical indication (surgical and allergic group), and children without obstruction (control group). Nasal air escape measurement was carried out using the Altmanns Millimetered Nasal Mirror, and data was measured in cm2 by the AutoCAD 2002 software. Data was analyzed using descriptive statistics and hypotheses testing, with a significance level of 5%. RESULTS: The control group presented the highest mean (6.53 cm2) of nasal air escape, while surgical and allergic group presented the lowest mean (3.07 cm2). The means of the allergic group and the surgical group were 4.74 cm2 and 5.91 cm2, respectively. Only the surgical and allergic group presented statistically significant difference compared to the control group. CONCLUSION: The Glatzel mirror demonstrated not to be a trustworthy instrument for the evaluation of nasal permeability in the analyzed sample, except in cases of severe nasal obstruction, that is, allergic patients with surgical indication. No correlations were found with the variables sex and age.

Facial soft tissues of mouth-breathing children: Do expectations meet reality?

OBJECTIVE To quantify the differences between the facial soft tissue morphology of severely obstructed mouth breathing (MB) and that of predominantly nasal breathing (NB) children. METHODS Soft tissue measurements were performed in the lateral cephalograms of 64 severely obstructed MB children (mean age 6.7 ± 1.6) compared with 64 NB children (mean age 6.5 ± 1.3). Groups were paired by age, gender, skeletal maturation status and sagittal skeletal pattern. Based on the assumption of normality and homoscedasticity, comparison of the means and medians of soft tissue measurements between the two groups was performed. RESULTS The facial convexity and anterior facial height ratio of MB were similar to NB children. The upper lip of MB children was protruded, and its base was thinner compared with NB; however, the length was not affected. The lower lip was shorter and more protruded in MB children. The nasolabial angle, nasal prominence, and chin thickness were smaller in MB children. CONCLUSIONS The facial soft tissue of severely obstructed MB children is different than in NB children. Changes in lips, nasolabial angle, nasal prominence, and chin thickness are associated with severe airway obstruction in children.

Dental arch dimensional changes after adenotonsillectomy in prepubertal children.

INTRODUCTION The purposes of this study were to investigate the dental arch changes after adenotonsillectomies in prepubertal children and to compare the dental arch dimensions of mouth-breathing and nasal-breathing children. METHODS The sample included 49 prepubertal severely obstructed mouth-breathing children and 46 prepubertal nasal-breathing children. Twenty-four of the 49 mouth-breathing children had an adenotonsillectomy and composed the adenotonsillectomy subgroup. The 25 children in whom the mouth-breathing pattern was unchanged during the 1-year study period composed the control subgroup. RESULTS The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children. After airway clearance, the adenotonsillectomy group showed a significant maxillary transverse width gain compared with the control subgroup. The control subgroup showed a significant deepening of the palatal height when compared with the adenotonsillectomy subgroup after 1 year. CONCLUSIONS The adenotonsillectomy subgroup had a significantly different pattern of arch development compared with the untreated controls. After adenotonsillectomy, the mouth-breathing children showed greater maxillary transverse development than did the controls. The palatal vault deepened in the untreated children. The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children.

Changes in vertical dentofacial morphology after adeno-/tonsillectomy during deciduous and mixed dentitions mouth breathing children—1 year follow-up study

OBJECTIVE The aim of this 1 year follow-up study was to investigate, in mouth breathing children, the impact of respiration normalization on vertical dentofacial growth during two stages of dental development after adeno-/tonsillectomy. METHOD Linear and angular cephalometric measurements, as well as tracing superimposition of serial lateral cephalograms of 39 patients in the treatment group were compared with those of 31 untreated mouth breathing controls. Cephalometric records in the treatment group comprised registrations made at baseline before surgery (T(0)), and then at approximately 1 year post-operatively (T(1)). Corresponding registrations were available for the control group, with a baseline cephalometric radiograph taken approximately 1 year before the second one (T(0) and T(1), respectively). Treatment and untreated groups were divided into deciduous and mixed dentition groups to aid the identification of an optimum timing for normalizing the respiration after T&A, under a vertical dentofacial perspective. RESULTS After 1 year of follow up, no statistically significant difference on vertical dentofacial growth was observed in deciduous or mixed dentitions treatment groups compared to the same occlusal developmental stage of untreated control groups. CONCLUSION The results indicate that regarding the vertical dentofacial growth pattern normalization of the mode of respiration after T&A in young children (deciduous dentition) is not more effective than in older children (mixed dentition).

Are distinct etiologies of upper airway obstruction in mouth-breathing children associated with different cephalometric patterns?

OBJECTIVE To test the null hypothesis that mouth-breathing (MB) children by distinct obstructive tissues present a similar cephalometric pattern. METHODS The sample included 226 prepubescent children (113 MB and 113 nasal breathing (NB) controls). An ENT clinical examination, including flexible nasal endoscopy, orthodontic clinical and cephalometric examinations, was performed on the MB population. MB children were grouped into three categories, according to the obstructive tissues: 1) adenoid group (AG), 2) tonsillar group (TG), and 3) adenotonsillar group (ATG). The NB controls were matched by gender, age, sagittal dental relationship and skeletal maturation status. Lateral cephalometric radiography provided the cephalometric pattern comparisons between the MB and NB groups. RESULTS MB cephalometric measurements were significantly different from those of NB children, exception in the SNB° (P=0.056). All comparisons between the three groups of MB children with the NB children showed a significant difference. Finally, even among the three groups of MB children, a significant difference was observed in the measurements of the SNB° (P<0.036), NSGn° (P<0.028) and PFH/TAFH ratio (posterior facial height/total anterior facial height) (P<0.012). CONCLUSIONS The cephalometric pattern of MB and NB children was not similar. Cephalometric measurements of the MB group differed according to the etiology of upper airway obstruction. Children with isolated hypertrophy of the palatine tonsils presented with a mandible that was positioned more forward and upward compared to children obstructed only by the enlarged adenoid.

Is the growth pattern in mouth breathers comparable with the counterclockwise mandibular rotation of nasal breathers

INTRODUCTION The aim of this longitudinal study was to investigate mandibular rotation and angular remodeling in mouth-breathing children compared with nasal-breathing children. METHODS The sample included 55 severely obstructed mouth-breathing children (mean age, 6.1 years) and 55 nasal-breathing children (mean age, 7.3 years). The cephalograms at baseline and after 1 year were traced and measured, and superimpositions were made to determine true mandibular rotation, apparent rotation, and angular remodeling. The significance level was set at 5%. RESULTS The mouth-breathing children had a longer face cephalometric pattern compared with nasal-breathing children. No cranial deflection differences were observed. No changes in the vertical growth pattern were observed during the 1-year period in either group. There were no statistically significant differences between the groups regarding apparent rotation (mouth breathing, -0.54°, vs nasal breathing, -0.41°). In comparison with the nasal breathers, the mouth breathers showed statistically significant lower yearly rates of counterclockwise true rotation (mouth breathing, -0.60°, vs nasal breathing, -1.31°) and angular remodeling (mouth breathing, 0.06°, vs nasal breathing, 0.87°). CONCLUSIONS Mouth-breathing children had a hyperdivergent cephalometric pattern, but against all expectations, counterclockwise true mandibular and apparent rotations were the average observations. Mouth-breathing children showed less true rotation and angular remodeling than did nasal breathers; however, apparent rotations were similar.

Reliability of subjective, linear, ratio and area cephalometric measurements in assessing adenoid hypertrophy among different age groups

OBJECTIVE To test the validity of four different types of lateral cephalometric radiograph (LCR) measurements as a diagnostic test of adenoid hypertrophy in different age groups of mouth-breathing children. MATERIALS AND METHODS Eighty-six mouth-breathing children (male 54.65%, mean age 7.0 ± 2.2 years) were randomly selected from a hospital population. Adenoid obstruction of the nasopharynx was evaluated by subjective, linear, ratio, and area LCR measurements. Each measurement was compared with flexible fiberoptic endoscopy diagnosis. RESULTS Kendall correlation coefficients for agreement between tests were ≥ 0.67 and kappa scores were substantial (≥ 0.64). Higher correlation coefficients and agreement values were found in older age groups. When the sample was stratified by age, the 3- to 5-year-old age group showed lower correlation coefficients and agreement strength for subjective, linear, and ratio measurements. The sensitivity of LCR varied from 71% (ratio) to 84% (linear). The specificity varied from 83% (linear) to 97% (ratio). The positive predictive value varied from 88% (linear) to 97% (ratio). The negative predictive value varied from 70% (ratio) to 78% (linear). The validity of each measure was different among the age groups. CONCLUSIONS LCR is a valid method for measuring adenoid hypertrophy in children from 6 to 12 years old. The diagnosis of adenoid hypertrophy, based on LCR measurements, in children with primary dentition (3-5 years old) should be made with caution. The combination of linear and ratio LCR measurements is a reliable screening tool to determine the need for an ear, nose, and throat evaluation.

Avaliação endoscópica nasal de crianças e adolescentes com fibrose cística

The main otorhinolaryngological manifestations of CF are chronic rhinosinusitis and nasal polyposis, with different clinical presentations. AIM: To characterize children and adolescents with cystic fibrosis through a questionnaire, an ENT clinical examination and nasal endoscopy. STUDY DESIGN: Cross-sectional clinical descriptive. MATERIAL AND METHOD: Assessment of 100 children and adolescents with cystic fibrosis through a specific questionnaire, ENT physical examination, nasal endoscopy and endoscopic staging of nasal polyps. RESULTS: The most frequent symptoms were: cough (45%), oral breathing (44%), sleep disorders (42%) and nasal obstruction (37%). Twenty-eight patients (28%) had purulent nasal discharge, and 41% had medial bulging of the nasal lateral wall. Nasal polyps were identified in only 14% of cases, none were obstructing. CONCLUSION:The questionnaire, clinical examination and especially nasal endoscopy lead to a detailed assessment of the nasal characteristics of children and adolescents with cystic fibrosis. Some findings were discordant with the literature, particularly the low prevalence of nasal polyps, and appear to be related to specific characteristics of the population studied. The best characterization of this group of patients, from the ENT standpoint, contributes to an appropriate multidisciplinary approach.

Nasal endoscopic evaluation of children and adolescents with cystic fibrosis

UNLABELLED The main otorhinolaryngological manifestations of CF are chronic rhinosinusitis and nasal polyposis, with different clinical presentations. AIM To characterize children and adolescents with cystic fibrosis through a questionnaire, an ENT clinical examination and nasal endoscopy. STUDY DESIGN Cross-sectional clinical descriptive. MATERIAL AND METHOD Assessment of 100 children and adolescents with cystic fibrosis through a specific questionnaire, ENT physical examination, nasal endoscopy and endoscopic staging of nasal polyps. RESULTS The most frequent symptoms were: cough (45%), oral breathing (44%), sleep disorders (42%) and nasal obstruction (37%). Twenty-eight patients (28%) had purulent nasal discharge, and 41% had medial bulging of the nasal lateral wall. Nasal polyps were identified in only 14% of cases, none were obstructing. CONCLUSION The questionnaire, clinical examination and especially nasal endoscopy lead to a detailed assessment of the nasal characteristics of children and adolescents with cystic fibrosis. Some findings were discordant with the literature, particularly the low prevalence of nasal polyps, and appear to be related to specific characteristics of the population studied. The best characterization of this group of patients, from the ENT standpoint, contributes to an appropriate multidisciplinary approach.