Mouth breathing reduces oral function in adolescence.

Although humans breathe naturally through the nostrils, mouth breathing in children has recently gathered attention. In this study, we hypothesized that tongue function and its related maxillofacial morphology would affect breathing in adolescence. To verify this hypothesis, we examined the association between breathing patterns, including mouth and nasal breathing; oral functions, including tongue motor function; and craniofacial morphology during adolescence, which has not been investigated till date. C3-H, which indicates the anteroposterior position of the hyoid bone in relation to the third cervical vertebra, was significantly smaller in mouth-breathers than in nasal-breathers. Lip-closing force, tongue pressure, and masticatory efficiency were lower in the order of nasal-breathers, oronasal-breathers, and mouth-breathers, and the values for mouth-breathers were significantly lower than those for nasal-breathers. Tongue pressure alone was identified as a significant independent variable, with an odds ratio of 1.063 (95% confidence interval, 1.006-1.123; p < 0.05). Our results indicate a relationship between mouth breathing and the lip-closing force, tongue pressure, and masticatory efficiency, as well as the significance of tongue pressure on mouth breathing in adolescents. The findings highlight the importance of clarifying the pathophysiology of mouth breathing and its underlying causes.

[Effects of mouth opening breathing for different reasons on maxillofacial development in children].

Objective:To explore the effects of mouth opening breathing for different reasons on children's maxillofacial development. Methods:One hundred and fifty-one children were selected as the research objects of this experiment. They were divided into 49 cases of adenoid hypertrophy group（group A）, 52 cases of tonsillar hypertrophy group（group B） and 50 cases of adenoid with tonsillar hypertrophy group（Group C）. Healthy children in the same period were selected as the control group, a total of 45 cases. The reflex nasopharyngeal measurement parameters, facial development indexes and cephalometric parameters of group A, group B, group C and control group were analyzed, and the incidence of Angle ClassⅡand Angle Class Ⅲ in group A, group B and group C were studied. Results:Compared with the control group, the reflex nasopharyngeal measurement parameters in group A, group B and group C was significantly different（P<0.05）, and the cephalometric parameters changed with variation in groups（P<0.05）. The incidence of Angle Class Ⅱ facial pattern in group A and group C was higher, but the incidence of Angle Class Ⅲ facial pattern in group B and group C was higher（P<0.05）. Conclusion:Adenoid hypertrophy leads to mandibular retraction; tonsil hypertrophy leads to anterior mandibular arch; adenoid hypertrophy and tonsil hypertrophy are easy to lead to clockwise rotation of the mandible. In clinical practice, to avoid children's uncoordinated maxillofacial development, we should correct the maxillofacial situation of children as soon as possible.

Effects of mouth opening breathing for different reasons on maxillofacial development in children / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the effects of mouth opening breathing for different reasons on children's maxillofacial development. Methods:One hundred and fifty-one children were selected as the research objects of this experiment. They were divided into 49 cases of adenoid hypertrophy group（group A）, 52 cases of tonsillar hypertrophy group（group B） and 50 cases of adenoid with tonsillar hypertrophy group（Group C）. Healthy children in the same period were selected as the control group, a total of 45 cases. The reflex nasopharyngeal measurement parameters, facial development indexes and cephalometric parameters of group A, group B, group C and control group were analyzed, and the incidence of Angle ClassⅡand Angle Class Ⅲ in group A, group B and group C were studied. Results:Compared with the control group, the reflex nasopharyngeal measurement parameters in group A, group B and group C was significantly different（P<0.05）, and the cephalometric parameters changed with variation in groups（P<0.05）. The incidence of Angle Class Ⅱ facial pattern in group A and group C was higher, but the incidence of Angle Class Ⅲ facial pattern in group B and group C was higher（P<0.05）. Conclusion:Adenoid hypertrophy leads to mandibular retraction; tonsil hypertrophy leads to anterior mandibular arch; adenoid hypertrophy and tonsil hypertrophy are easy to lead to clockwise rotation of the mandible. In clinical practice, to avoid children's uncoordinated maxillofacial development, we should correct the maxillofacial situation of children as soon as possible.

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)

The impact of mouth breathing on dentofacial development: A concise review.

Mouth breathing is one of the most common deleterious oral habits in children. It often results from upper airway obstruction, making the air enter completely or partially through oral cavity. In addition to nasal obstruction caused by various kinds of nasal diseases, the pathological hypertrophy of adenoids and/or tonsils is often the main etiologic factor of mouth breathing in children. Uncorrected mouth breathing can result in abnormal dental and maxillofacial development and affect the health of dentofacial system. Mouth breathers may present various types of growth patterns and malocclusion, depending on the exact etiology of mouth breathing. Furthermore, breathing through the oral cavity can negatively affect oral health, increasing the risk of caries and periodontal diseases. This review aims to provide a summary of recent publications with regard to the impact of mouth breathing on dentofacial development, describe their consistencies and differences, and briefly discuss potential reasons behind inconsistent findings.

Skeletal class II malocclusion caused by mouth breathing in a pediatric patient undergoing treatment by interceptive guidance of occlusion.

A 7-year 10-month-old boy was evaluated for mouth breathing and snoring habits. Examination revealed soft convex tissues, maxillary protrusion, mandibular retrusion, and a class II sagittal osteofascial pattern. The patient failed a water holding test. He was clinically diagnosed with skeletal class II malocclusion caused by mouth breathing. Under interceptive guidance of occlusion (iGo), the malocclusion improved with fixed maxillary expansion using functional appliances and interventional treatment of mouth breathing by lip closure exercises. These treatments enabled the patient to gradually return to nasal breathing and guided him to develop physiological occlusion for a coordinated jaw-to-jaw relation. At the 5-year 2-month post-correction follow-up visit (at the age of 13 years), the patient had stable occlusion, a coordinated osteofascial pattern, and normal dentition, periodontium, and temporomandibular joints.

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).

Risk factors for residual mouth breathing in children who had completely resolved obstructive sleep apnea after adenotonsillectomy.

PURPOSE: Adenotonsillectomy is the first-line treatment for pediatric obstructive sleep apnea (OSA). However, although completely resolved OSA after adenotonsillectomy, some children still showed persistence of mouth breathing. Therefore, we attempted to identify risk factors for residual mouth breathing in children with OSA after successful adenotonsillectomy. MATERIALS AND METHODS: This study retrospectively enrolled children who underwent adenotonsillectomy as a treatment of OSA. Additionally, children who showed apnea-hypopnea index ≥ 1 on 1-year postoperative polysomnography or adenoid regrowth on one-year postoperative lateral cephalogram were excluded. The presence of allergic rhinitis, septal deviation, dentofacial abnormalities, the size of tonsil and adenoid was also evaluated in all enrolled children. Dentofacial abnormalities were defied as a high palatal arch, macroglossia, retrognathia, micrognathia, and overcrowding of teeth which assessed by dentists. RESULTS: A total of 62 children were enrolled (no residual mouth-breathing group, n = 18 and residual mouth-breathing group, n = 44) in this study. There were no significant differences in demographic factors, physical examination, and sleep parameters, except age and preoperative adenoid size. On the multiple logistic regression analysis, we found that older age, large adenoid size, and presence of dentofacial abnormalities significantly correlated with residual mouth breathing (adjusted coefficient estimates = 0.3890, 2.3611, and 2.8615, respectively) after successful adenotonsillectomy. CONCLUSIONS: Older age, large adenoid size, and presence of dentofacial abnormalities in children with OSA may be the risk factors for residual mouth breathing after successfully resolved OSA.

Nasal glial heterotopia in children: Two case reports and literature review.

Nasal glial heterotopia is a rare developmental anomaly. We present two cases of nasal glial heterotopia. The presenting symptoms, imaging findings, treatment, histological appearance, and follow-up are described in detail. We additionally reviewed all pediatric cases of nasal glial heterotopia published between 1980 and 2018 in the PubMed and Baidu Scholar databases. We identified 60 pediatric patients (36 [60%] boys). The main symptoms were nasal congestion and open-mouth breathing. Treatment was successful in all patients, and the recurrence rate was low (3/60, 5%). Nasal glial heterotopia requires multidisciplinary management but has a good prognosis.

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.

Maloclusiones dentarias y su relación con los hábitos bucales lesivos / Dental malocclusion and its relationship to harmful oral habits

RESUMEN Introducción: La ruptura del equilibrio de las fuerzas extrabucales e intrabucales debido a una función anómala, desencadena maloclusión. Estas funciones musculares anómalas se conocen como hábitos bucales lesivos. Objetivo: Actualizar conocimientos y analizar los factores relacionados con las maloclusiones dentarias como los hábitos bucales lesivos en niños, en función de la frecuencia y duración de la succión nutritiva y no nutritiva, respiración por la boca y el empuje lingual atípico. Métodos: se realizó una revisión bibliográfica en cuatro bases de datos digitales Pubmed, Lilacs, Ibecs y Cumed correspondiente a los últimos 5 años. Se usó tesauro para el idioma inglés malocclusion, habits, finger sucking, pacifiers, bottle feeding, tongue habit, mouth breathing y en español maloclusión, hábitos, succión del dedo, chupete, biberones, hábitos linguales, respiración por la boca. La búsqueda reveló 65 artículos, de estos solo 19 cumplieron los criterios de inclusión. Análisis e integración de la información: El 89,5 por ciento de los artículos pertenecen a estudios de hábitos de succión no nutritivos solo o en conjunto con otros hábitos; y el 10,5 por ciento realizan investigaciones en niños respiradores bucales. Teniendo en cuenta la duración y frecuencia de los hábitos solo el 26,31 por ciento de las pesquisas seleccionadas tomaron en cuenta estas variables. En hábitos de succión nutritivos presentaron resalte horizontal aumentado, mordida cruzada posterior y escalón distal. Existe una asociación entre períodos cortos de amamantamiento y prevalencia de hábitos de succión no nutritivos; presentan además de maloclusiones anteriormente citadas, mordida abierta anterior. En respiración por la boca citaron clase II, mandíbula corta y retruida y disminución del tercio inferior de la cara. Conclusiones: Numerosas investigaciones se han realizado para asociar la duración de los hábitos de succión nutritivos y no nutritivos con maloclusiones, sin considerar la frecuencia de estos, además existe una reducida información científica en las bases electrónicas exploradas en lo que refiere a estudios de respiración por la boca y empuje lingual atípico en los niños(AU)

ABSTRACT Introduction: Malocclusion is triggered by rupture of the balance between extraoral and intraoral forces as a result of an anomalous function. Such anomalous muscular functions are known as harmful oral habits. Objective: Update knowledge and analyze factors related to dental malocclusions, such as harmful oral habits in children, in terms of the frequency and duration of nutritive and non-nutritive sucking, mouth breathing and atypical tongue thrust. Methods: A bibliographic review was conducted of papers published in the last five years in the digital databases Pubmed, Lilacs, Ibecs and Cumed. The search terms used were malocclusion, habits, finger sucking, pacifiers, bottle feeding, tongue habit and mouth breathing in English, and maloclusión, hábitos, succión del dedo, chupete, biberones, hábitos linguales and respiración por la boca in Spanish. 65 papers were obtained, of which only 39 met the inclusion criteria. Data analysis and integration: 89.5 percent of the papers corresponded to studies about non-nutritive sucking habits alone or in combination with other habits, whereas 10.5 percent dealt with studies about mouth breathing children. Only 26.31 percent of the studies selected took into account the variables duration and frequency of the habits. Nutritive sucking habits were found to be associated with overjet, posterior crossbite and distal step. A relationship was also found between a short breastfeeding period and the prevalence of non-nutritive sucking habits, with the presence of anterior open bite alongside the aforementioned malocclusions. Mouth breathing was related to class II, small retrognathic jaw and a decreased lower third of the face. Conclusions: Numerous studies have been conducted to determine the relationship between malocclusions and the duration of nutritive and non-nutritive sucking habits, without considering the frequency of such habits. On the other hand, the electronic databases consulted contain few studies about mouth breathing and atypical tongue thrust in children(AU)

Férula multifunción en paciente adulto / Multifunction splint in an adult patient

RESUMEN Introducción: El bruxismo del sueño es una parafunción que afecta a más del 20 por ciento de la población en general, produce trastornos en el aparato estomatognático y el resto del organismo. Su multicausalidad dificulta su diagnóstico, control y tratamiento, sobre todo cuando está asociado con el hábito de respiración bucal. Existen aditamentos que son utilizados como coadyuvantes del tratamiento en ambas entidades por separado, pero se torna aún más difícil cuando están combinadas. Objetivo: Comprobar la efectividad de una férula multifunción en el bruxismo del sueño asociado al hábito de respiración bucal. Caso clínico: Paciente masculino de 42 años de edad, con antecedentes de faringitis a repetición y de hipertrofia de adenoides, que acude a la consulta de Trastornos Témporo Mandibulares de la Facultad de Estomatología "Raúl González Sánchez", quien refiere apretamiento de las mandíbulas cuando duerme y dolores en músculos de la cara al despertar. A través de la anamnesis, el examen clínico intrabucal y extrabucal y de diferentes maniobras clínicas, se observó sintomatología relacionada con bruxismo del sueño céntrico combinado con hábito de respiración bucal. Conclusiones: Con la colocación de la férula multifunción se logró disminuir la sintomatología por la cual asistió a consulta el paciente(AU)

ABSTRACT Introduction: Sleep bruxism, a parafunctional habit affecting more than 20 percent of the general population, causes disorders in the stomatognathic system and the rest of the body. Its multicausality makes its diagnosis, control and treatment difficult, particularly when it is associated with mouth breathing. Devices have been created which may be used for the treatment of either condition separately, but therapy becomes more complicated when the two are present. Objective: Verify the effectiveness of a multifunction splint for the treatment of sleep bruxism associated with mouth breathing. Clinical case: A male 42-year-old patient with a history of recurrent pharyngitis and adenoid hypertrophy presents at the temporomandibular disorders service of Raúl González Sánchez Dental School and reports tightening of his jaws during sleep and facial muscle pain upon awakening. Anamnesis, intraoral and extraoral clinical examination, and various clinical maneuvers reveal symptoms of centric sleep bruxism combined with mouth breathing. Conclusions: Placement of a multifunction splint reduced the symptoms that had prompted the patient to attend consultation(AU)

Relationship between mouth breathing etiology and maximum tongue pressure. / Relação entre a etiologia da respiração oral e a pressão máxima da língua.

PURPOSE: To verify the relationship between maximum tongue pressure and the etiology of oral breathing in oral breathing children attended at the Oral Respiratory Outpatient Clinic. METHODS: A descriptive and analytical cross-sectional study was accomplished with 59 mouth breathing children aged 3 to 12 years (mean age 6.5 years and SD: standard deviation= 2.4). To collect tongue pressure, the Iowa Oral Performance Instrument (IOPI) was used and data regarding the etiology of oral breathing and dental occlusion were collected in the records of these patients for analysis. The associations between the maximum tongue pressure and the etiology of oral breathing, age, gender and dental occlusion were verified by the T test, ANOVA, Spearman's coefficient and Tuckey's test, using a significance level of 5%. RESULTS: There was a moderate and positive correlation between age and maximum pressure, it was verified that there was a statistically significant difference between the maximum tongue pressure and the variables pharyngeal tonsil hypertrophy and palatine tonsil hypertrophy. There were no statistical differences between the other variables. CONCLUSION: It was concluded that mechanical obstructions, among them the pharyngeal and palatine tonsil hypertrophy alter the maximum tongue pressure in oral breathing children.

OBJETIVO: Verificar a existência de relação entre pressão máxima da língua e a etiologia da respiração oral em crianças respiradoras orais atendidas em um Ambulatório do Respirador Oral. MÉTODO: Foi conduzido um estudo transversal observacional descritivo e analítico com 59 crianças respiradoras orais com idades entre três e 12 anos (média de 6,5 anos e DP=2,4). Para a coleta da pressão de língua, foi utilizado o Iowa Oral Performance Instrument ­ (IOPI) e dados sobre a etiologia da respiração oral e oclusão dentária foram coletados nos prontuários desses pacientes para análise. As associações entre a pressão máxima da língua e a etiologia da respiração oral, idade, gênero e oclusão dentária foram verificadas pelo teste T, ANOVA, coeficiente de Spearman e Teste de Tuckey, utilizando-se nível de significância de 5%. RESULTADOS: Houve correlação moderada e positiva entre idade e pressão máxima, verificou-se que houve diferença estatisticamente significativa entre a pressão máxima da língua e as variáveis hipertrofia da tonsila faríngea e hipertrofia das tonsilas palatinas. Não foram verificadas diferenças estatísticas entre as outras variáveis. CONCLUSÃO: Conclui-se que as obstruções mecânicas, dentre elas a hipertrofia das tonsilas faríngea e palatinas alteram a pressão máxima de língua em crianças respiradoras orais.

Effectiveness and safety of Chinese herbal medicine for pediatric adenoid hypertrophy: A meta-analysis.

OBJECTIVE: Chinese herbal medicine has been gradually used to treat pediatric adenoid hypertrophy. This meta-analysis were conducted to evaluate the clinical efficacy and safety of Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy. METHODS: Randomized controlled trials involving Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy were identified from Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang Database and VIP Information Database. The methodological quality of trials was evaluated with Cochrane Handbook criteria, and the Cochrane Collaboration's Review Manager 5.3 software was used for Meta-analysis. RESULTS: A total of 13 valid articles involving 1038 patients were included. The meta-analysis showed that: Compared with western medicine treatment, Chinese herbal medicine significantly improved clinical efficacy (RR = 1.33, 95% CI [1.24,1.43]), and significantly decreased A/N ratio (MD = -0.04,95%CI [-0.05,-0.03]). Chinese herbal medicine also prominently improved the quality of life (MD = -4.77,95%CI [-8.35,-1.20]). Meanwhile, it dramatically improved snoring (MD = -0.46,95%CI [-0.62,-0.30]); mouth breathing (MD = -0.52,95%CI [-0.66,-0.39]); nasal obstruction (MD = -0.56,95%CI [-0.68,-0.45]). CONCLUSION: Chinese herbal medicine has good clinical efficacy and safety on pediatric adenoid hypertrophy, which need to be confirmed by high quality, multiple-centre, large sample randomized controlled trials.

The nocturnal-polysomnogram and "non-hypoxic sleep-disordered-breathing" in children.

OBJECTIVE: To characterize sleep-disordered breathing patterns not related to hypoxia resulting in fragmented sleep in children. METHODS: We reviewed the polysomnogram (PSG) data of children with sleep complaints who were being evaluated for sleep-disordered breathing and had an apnea-hypopnea-index ≤ 3. These data were compared to the recordings of the same children with nasal CPAP administered for one night and to 60 control subjects (children without any sleep complaints). A subgroup of children was monitored with esophageal manometry, but nasal cannula flow data was recorded in all cases. RESULTS: Abnormal breathing patterns, particularly flow limitation, could be seen with more severity and frequency compared to apnea or hypopnea. The observed abnormal breathing patterns were associated with EEG disturbances. CONCLUSIONS: Patterns such as flow-limitation, mouth-breathing, changes in inspiratory and expiratory time, rib-cage and expiratory muscle activity, transcutaneous CO2 electrode changes and snoring noises are all variables that should be systematically reviewed when analyzing nocturnal PSG. Current scoring guidelines emphasizes apnea-hypopnea and hypoxic-sleep disordered breathing and therefore treatment is often much delayed in this population of children with evidence of abnormal breathing patterns. Analysis of the various patterns of abnormal breathing noted above allows recognition of "non-hypoxic" sleep-disordered-breathing (SDB).

Relação entre a etiologia da respiração oral e a pressão máxima da língua / Relationship between mouth breathing etiology and maximum tongue pressure

RESUMO Objetivo Verificar a existência de relação entre pressão máxima da língua e a etiologia da respiração oral em crianças respiradoras orais atendidas em um Ambulatório do Respirador Oral. Método Foi conduzido um estudo transversal observacional descritivo e analítico com 59 crianças respiradoras orais com idades entre três e 12 anos (média de 6,5 anos e DP=2,4). Para a coleta da pressão de língua, foi utilizado o Iowa Oral Performance Instrument - (IOPI) e dados sobre a etiologia da respiração oral e oclusão dentária foram coletados nos prontuários desses pacientes para análise. As associações entre a pressão máxima da língua e a etiologia da respiração oral, idade, gênero e oclusão dentária foram verificadas pelo teste T, ANOVA, coeficiente de Spearman e Teste de Tuckey, utilizando-se nível de significância de 5%. Resultados Houve correlação moderada e positiva entre idade e pressão máxima, verificou-se que houve diferença estatisticamente significativa entre a pressão máxima da língua e as variáveis hipertrofia da tonsila faríngea e hipertrofia das tonsilas palatinas. Não foram verificadas diferenças estatísticas entre as outras variáveis. Conclusão Conclui-se que as obstruções mecânicas, dentre elas a hipertrofia das tonsilas faríngea e palatinas alteram a pressão máxima de língua em crianças respiradoras orais.

ABSTRACT Purpose To verify the relationship between maximum tongue pressure and the etiology of oral breathing in oral breathing children attended at the Oral Respiratory Outpatient Clinic. Methods A descriptive and analytical cross-sectional study was accomplished with 59 mouth breathing children aged 3 to 12 years (mean age 6.5 years and SD: standard deviation= 2.4). To collect tongue pressure, the Iowa Oral Performance Instrument (IOPI) was used and data regarding the etiology of oral breathing and dental occlusion were collected in the records of these patients for analysis. The associations between the maximum tongue pressure and the etiology of oral breathing, age, gender and dental occlusion were verified by the T test, ANOVA, Spearman's coefficient and Tuckey's test, using a significance level of 5%. Results There was a moderate and positive correlation between age and maximum pressure, it was verified that there was a statistically significant difference between the maximum tongue pressure and the variables pharyngeal tonsil hypertrophy and palatine tonsil hypertrophy. There were no statistical differences between the other variables. Conclusion It was concluded that mechanical obstructions, among them the pharyngeal and palatine tonsil hypertrophy alter the maximum tongue pressure in oral breathing children.

Oral health status of children with mouth breathing due to adenotonsillar hypertrophy.

OBJECTIVES: Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January-July 2015. METHODS: The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05. RESULTS: Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ±â€¯2.6. Mean dmft was 3.8 ±â€¯3.6, dmfs 9.7 ±â€¯1.1, DMFT 0.4 ±â€¯1.0 and DMFS 0.6 ±â€¯1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p < 0,001). CONCLUSIONS: The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

Effect of Nasal Valve Shape on Downstream Volume, Airflow, and Pressure Drop: Importance of the Nasal Valve Revisited.

OBJECTIVES: The relative importance of the nasal valve relative to the remainder of the nasal airway remains unknown. The goal of this article was to objectively measure the shape of the nasal inlet and its effect on downstream airflow and nasal cavity volume using a physical model and a physiologic flow model. METHODS: A patient who had isolated nasal valve surgery and had pre- and postoperative computed tomography scans available for analysis was studied. Nasal inlet shape measurements, computational fluid dynamics, and nasal volume analysis were performed using the computed tomography data. In addition, a physical model was used to determine the effect of nasal obstruction on downstream soft tissue. RESULTS: The postoperative shape of the nasal inlet was improved in terms of length and degree of tortuosity. Whereas the operated-on region at the nasal inlet showed an only 25% increase in cross-sectional area postoperatively, downstream nonoperated sites in the nasal cavity revealed increases in area ranging from 33% to 51%. Computational fluid dynamics analysis showed that airway resistance decreased by 42%, and pressure drop was reduced by 43%. Intraluminal mucosal expansion was found with nasal obstruction in the physical model. CONCLUSION: By decreasing the degree of bending and length at the nasal valve, inspiratory downstream nonoperated sites of the nasal cavity showed improvement in volume and airflow, suggesting that the nasal valve could play an oversized role in modulating the aerodynamics of the airway. This was confirmed with the physical model of nasal obstruction on downstream mucosa.

Gravitational forces, negative pressure and facial structure in the genesis of airway dysfunction during sleep: a review of the paradigm.

The recent and distant literature has extensive discussion of how sleep apnea, adeno-tonsillar growth, and facial structural deformity are related. Conventionally, the order of cause and effect is as follows: (1) Inflammatory/infectious process→tonsillar/adenoid tissue growth→(2) airway obstruction and mouth breathing/Obstructive Sleep Apnea (OSA)→(3) altered facial structure (adenoid facies). Using this same reasoning, adenotonsillectomy is the first line of treatment in the prevention of structural abnormalities. However, through a lifetime of clinical research Christian Guilleminault and his colleagues have challenged this paradigm. Through multiple articles and studies, Guilleminault et al., teach that even slight (subclinical) facial structure/muscle tone variations may be the inciting event triggering mouth-breathing and the eventual adenotonsillar growth in most patients. Essentially, this is the reverse of the conventional paradigms. Initial treatments therefore shift from simplified removal of inflammatory tissue to limiting mouth-breathing via musculo-skeletal modification. The purpose of this paper is to synthesize and analyze the recent (and distant) relevant literature to provide support for, and provide a potential anatomic mechanism for Guilleminault et al.'s paradigm-questioning clinical observations.

An exploratory study of the factors related to mouth breathing syndrome in primary school children.

OBJECTIVE: Mouth breathing syndrome (MBS) is defined as a set of signs and symptoms that may be completely or incompletely present in subjects who, for various reasons, replace the correct pattern of nasal breathing with an oral or mixed pattern. It is important to identify the relevant factors affecting MBS in order to diagnose its cause since breathing obstructions can result from multiple factors. The purpose of this study is to clarify the relevant factors and the interrelationships between factors affecting MBS among children. DESIGN: We surveyed 380 elementary school children from 6 to 12 years in age. The questionnaire consisted of 44 questions regarding their daily health conditions and lifestyle habits and was completed by the children's guardians. A factor analysis was performed to classify closely related questions into their respective factors and to examine the strength of the correlation between the newly revealed factors. RESULTS: Twenty-six out of the 44 questions were selected, and they were classified into seven factors. Factors 1-7 were defined as "Incompetent lip seal", "Diseases of the nose and throat", "Eating and drinking habits", "Bad breath", "Problems with swallowing and chewing", "Condition of teeth and gums", and "Dry lips", respectively. There were also correlations between these factors themselves. CONCLUSION: MBS was categorized according to 7 major factors. Because Factor 1 was defined as "Incompetent lip seal", which was representative of the physical appearance of mouth breathers and correlated with other factors, we suggested that MBS should consist of 7 factors in total.