Three-dimensional image study of accelerated maxillary expansion in oral breathing kids

Abstract Objective: To evaluate, by a three-dimensional study, the volumetric and integumentary effects of rapid maxillary expansion on the nose, in mouth breathing kids with maxillary hypoplasia, in the short term, assessing the possible interference of gender, growth and age on the results achieved. Methods: 120 mouth breathing patients with maxilla hypoplasia were divided into an Experimental Group treated by rapid maxillary expansion (n = 104, 62 males and 42 females, mean age 10.1 years, SD = 2.10, ranging from 5.1 to 13.9 years); and Control Group, constituted by 16 patients (9 males and 7 females, mean age 9.3 years, SD = 2.1 years, ranging from 6.1 to 13.2 years). Patients in the experimental group underwent multislice computed tomography examinations at two different times: (T1) pre-expansion and (T2) post-expansion. The control group was submitted to the same tests at the same time intervals. Six soft tissue variables of the nose were studied, besides the volume and area of the nasal cavity, and the measurement and comparison of data between T1 and T2 were performed using the Dolphin Imaging 11.7 Premium software. Results: The experimental group showed significant mean increases in all soft tissue variables studied (p < 0.005), yet there were no significant changes in the control group. In the comparison between groups, only inclination of the nasal dorsum did not present any significant change. Conclusion: Rapid maxillary expansion may alter the nasal shape and physiology, by anatomical changes in the nose soft tissues, making it an important aid in the treatment of mouth breathing in childhood. Level of evidence: The soft tissues of the nose play an important role in nasal shape and physiology and facial esthetics, and since they are directly related to the nasal valves, they are fundamental for maintenance and stability of the nasal breathing pattern.

Avaliação cefalométrica do padrão facial do respirador oral / Cephalometric evaluation of the facial pattern of mouth breathers

Objetivo: na literatura, a respiração oral normalmente é associada com padrão facial hiperdivergente. O objetivo deste estudo foi avaliar o padrão de crescimento facial de crianças respiradoras orais, comparando quatro análises cefalométricas diferentes. Método: um estudo de caso controle foi realizado. Um grupo de 87 crianças respiradoras orais entre quatro e 14 anos e 28 respiradores nasais(controle) foi avaliado pelo otorrinolaringologista. Os sujeitos foram considerados respiradores orais quando apresentavam respiração oral, pelo menos durante a noite, por um período mínimo de seis meses. Radiografias cefalométricas em norma lateral foram utilizadas para avaliar o padrão de crescimento facial através de quatro análises diferentes: Ricketts, Jarabak, USP e McNamara. Resultados: os resultados demonstraram prevalência de indivíduos hiperdivergentes(estudo = 4,42%; controle = 46,42%) comparados com o número de indivíduos normodivergentes (estudo = 24.13%; controle = 17,85%) e hipodivergentes (estudo = 26,43%; controle = 35,78%) em ambos os grupos. A diferença entre os testes de proporção para as análises de Ricketts e Jarabak, comparando os grupos de estudo e controle, não foi significante. Mas, para as análises USP e McNamara, o teste foi significativo. Quando comparados os resultados dos índices de padrão facial das outras três análises, com os índices da análise de Ricketts, não foi encontrada relação significativa. Conclusão: com os resultados encontrados, pôde-se concluir que não existe diferença estatisticamente significativa entre o padrão facial das crianças respiradoras orais e respiradoras nasais, quando a análise de Ricketts é aplicada. Sugere-se que pesquisas futuras considerem análises cefalométricas mais acurada para obtenção do padrão facial de crianças respiradoras orais.

Objective/aim: in literature, mouth breathing is in most cases associated with hiperdivergent face growth pattern. The goal of this study is to evaluate the facial skeletal pattern oi mauth-breathing children, comparing four different cephalometric analyses. Method: a case-control study was performed. A group of 87 mouth-breathing subjects, with average age between 4 - 14 years, and 28 nasal breathing subjects were evaluated. Subjects were considered mouth breathers when presented mouth breathing at least during the night,for a minimum period of 6 months. Cephalometric x-rays in lateral norm were used to evaluate the facial pattern by four different analyses: Ricketts, Jarabak, USP and McNamara. Results: results showed a prevalence of hyperdivergent subjects (E = 49.42%; C = 46.42%) compared to the normodivergent (E = 24.13%; C = 17.85%) and hypodivergent (E = 26.43%; C = 35.78%) facial types in both groups. The differences between proportions tests for Ricketts and Jarabak cephalometric analysis, comparing the study and the control groups, were not significant. But, for USP and McNamara analysis, the test was statistically significant. The results of three other facial pattern indexes in cephalometric analysis were compared to the Ricketts analysis and it was not found a significant relationship. Conclusion: with the achieved results in this research, we conclude that there are no statistically significant differences in facial pattern of mouth breathing and nasal breathing children, when Ricketts analysis is applied. We suggest that Future researches should consider a more accurate cephalometric analysis to obtain facial growth pattern in mouth-breathing children.