CC BY 4.0 · Journal of Health and Allied Sciences NU 2023; 13(02): 278-288
DOI: 10.1055/s-0042-1755352
Original Article

Assessment of Dentofacial Characteristics and Pharyngeal Airway in Children with Class II Malocclusion and Mouth Breathing

Swathi Shetty
1   Department of Pediatric and Preventive Dentistry, A.J. Shetty Institute of Dental Sciences, Mangalore, Karnataka, India
,
2   Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
,
Meghna Bhandary
2   Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
› Author Affiliations

Abstract

Background In growing patients with skeletal discrepancies, early diagnosis, evidence-based explanation of etiology, and assessment of functional factors can be vital for the restoration of normal craniofacial growth and the stability of treatment needs.

Aims The aim of the study was to assess dentofacial characteristics as well as upper and lower pharyngeal airway in children with skeletal class II malocclusion with mouth breathing, and to investigate possible significant relationships and correlations among the studied cephalometric variables and the airway morphology in these children.

Materials and Methods Sixty untreated children, aged 9 to 13 years, were divided into three groups according to clinical findings and cephalometric analysis of dentofacial characteristics as well as the presence of mouth breathing habit: Group I (20 children with normal jaw relation/class I), Group II (20 children with skeletal class II), and Group III (20 children with skeletal class II with confirmed mouth breathing habit). Cephalometric variables and upper/lower airway widths were recorded. Intergroup comparison of all measurements was performed by post hoc Tukey test, and Pearson's correlation was used to determine the correlation among the variables.

Results Significant changes existed in more than half of the dentofacial measurements among the three groups. Significantly greater skeletal anteroposterior jaw discrepancy and mandibular retrognathism were found in both groups II and III as determined by specific anteroposterior determinants. Children in group III showed significantly increased angle between Sella-Nasion and mandibular plane (SN-MP) angle, y-axis, and a vertical growth pattern. Significant increases in dental measurements, namely upper incisor to Nasion- point A (NA), lower incisor to Nasion - point B (NB), and overjet, were found in group II and group III, while overbite showed a significant decrease. Upper pharyngeal airway width was found to be significantly decreased in group III followed by a smaller though significant decrease in group II. No significant differences were found in lower pharyngeal airway width between the groups. There were statistically significant dentofacial characteristics that showed fair to good correlation with the upper airway width.

Conclusion Children with skeletal class II malocclusion with and without mouth breathing showed significant differences in dentofacial measurements and a significantly narrower upper pharyngeal airway as compared with children with normal jaw/class I relation.



Publication History

Article published online:
13 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Proffit WR. Contemporary Orthodontics. 3rd ed. Mosby, St Louis: Elsevier; 2000: 248
  • 2 McNamara Jr JA. Influence of respiratory pattern on craniofacial growth. Angle Orthod 1981; 51 (04) 269-300
  • 3 O'Ryan FS, Gallagher DM, LaBanc JP, Epker BN. The relation between nasorespiratory function and dentofacial morphology: a review. Am J Orthod 1982; 82 (05) 403-410
  • 4 Ricketts RM. Respiratory obstruction syndrome. Am J Orthod 1968; 54 (07) 495-507
  • 5 Vickers PD. Respiratory obstruction and its role in long face syndrome. Northwest Dent 1998; 77 (05) 19-22
  • 6 Tomer BS, Harvold EP. Primate experiments on mandibular growth direction. Am J Orthod 1982; 82 (02) 114-119
  • 7 Katyal V, Kennedy D, Martin J, Dreyer C, Sampson W. Paediatric sleep-disordered breathing due to upper airway obstruction in the orthodontic setting: a review. Aust Orthod J 2013; 29 (02) 184-192
  • 8 Huynh NT, Morton PD, Rompré PH, Papadakis A, Remise C. Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations. Am J Orthod Dentofacial Orthop 2011; 140 (06) 762-770
  • 9 Ozbek MM, Miyamoto K, Lowe AA, Fleetham JA. Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. Eur J Orthod 1998; 20 (02) 133-143
  • 10 Tourné LP. Growth of the pharynx and its physiologic implications. Am J Orthod Dentofacial Orthop 1991; 99 (02) 129-139
  • 11 Arun T, Isik F, Sayinsu K. Vertical growth changes after adenoidectomy. Angle Orthod 2003; 73 (02) 146-150
  • 12 Kirjavainen M, Kirjavainen T. Upper airway dimensions in Class II malocclusion. Effects of headgear treatment. Angle Orthod 2007; 77 (06) 1046-1053
  • 13 Martin O, Muelas L, Viñas MJ. Nasopharyngeal cephalometric study of ideal occlusions. Am J Orthod Dentofacial Orthop 2006; 130 (04) 436.e1-436.e9
  • 14 Lopatiene K, Babarskas A. [Malocclusion and upper airway obstruction]. Medicina (Kaunas) 2002; 38 (03) 277-283
  • 15 Massler M, Zwemer JD. Mouth breathing. II. Diagnosis and treatment. J Am Dent Assoc 1953; 46 (06) 658-671
  • 16 Paiva JB. Identificando o respirdorbucal (entervista). Revsta Da APCD. 1999; 53 (04) 265-274
  • 17 Ucar FI, Uysal T. Orofacial airway dimensions in subjects with Class I malocclusion and different growth patterns. Angle Orthod 2011; 81 (03) 460-468
  • 18 Thomas Rakosi. An Atlas and Manual of Cephalometric Radiology. London: Wolfe Medical Publications; 1979
  • 19 McNamara Jr JA. A method of cephalometric evaluation. Am J Orthod 1984; 86 (06) 449-469
  • 20 Linder-Aronson S, Leighton BC. A longitudinal study of the development of the posterior nasopharyngeal wall between 3 and 16 years of age. Eur J Orthod 1983; 5 (01) 47-58
  • 21 Ceylan I, Oktay H. A study on the pharyngeal size in different skeletal patterns. Am J Orthod Dentofacial Orthop 1995; 108 (01) 69-75
  • 22 Warren DW. Effect of airway obstruction upon facial growth. Otolaryngol Clin North Am 1990; 23 (04) 699-712
  • 23 Lyberg T, Krogstad O, Djupesland G. Cephalometric analysis in patients with obstructive sleep apnoea syndrome: II. Soft tissue morphology. J Laryngol Otol 1989; 103 (03) 293-297
  • 24 Bacon WH, Turlot JC, Krieger J, Stierle JL. Cephalometric evaluation of pharyngeal obstructive factors in patients with sleep apneas syndrome. Angle Orthod 1990; 60 (02) 115-122
  • 25 Hussels W, Nanda RS. Analysis of factors affecting angle ANB. Am J Orthod 1984; 85 (05) 411-423
  • 26 Oktay H. A comparison of ANB, WITS, AF-BF, and APDI measurements. Am J Orthod Dentofacial Orthop 1991; 99 (02) 122-128
  • 27 Ishikawa H, Nakamura S, Iwasaki H, Kitazawa S. Seven parameters describing anteroposterior jaw relationships: postpubertal prediction accuracy and interchangeability. Am J Orthod Dentofacial Orthop 2000; 117 (06) 714-720
  • 28 Handelman CS, Osborne G. Growth of the nasopharynx and adenoid development from one to eighteeen years. Angle Orthod 1976; 46 (03) 243-259
  • 29 Paul JL, Nanda RS. Effect of mouth breathing on dental occlusion. Angle Orthod 1973; 43 (02) 201-206
  • 30 Subtelny JD. Malocclusions, orthodontic corrections and orofacial muscle adaptation. Angle Orthod 1970; 40 (03) 170-201
  • 31 Akcam MO, Toygar TU, Wada T. Longitudinal investigation of soft palate and nasopharyngeal airway relations in different rotation types. Angle Orthod 2002; 72 (06) 521-526
  • 32 Ferrario VF, Sforza C, Miani Jr A, Tartaglia GM. The use of linear and angular measurements of maxillo-mandibular anteroposterior discrepancies. Clin Orthod Res 1999; 2 (01) 34-41
  • 33 Muto T, Yamazaki A, Takeda S. A cephalometric evaluation of the pharyngeal airway space in patients with mandibular retrognathia and prognathia, and normal subjects. Int J Oral Maxillofac Surg 2008; 37 (03) 228-231
  • 34 Oulis CJ, Vadiakas GP, Ekonomides J, Dratsa J. The effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits. J Clin Pediatr Dent 1994; 18 (03) 197-201
  • 35 Vig KW. Nasal obstruction and facial growth: the strength of evidence for clinical assumptions. Am J Orthod Dentofacial Orthop 1998; 113 (06) 603-611