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      Craniofacial skeletal pattern: is it really correlated with the degree of adenoid obstruction?

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          Abstract

          OBJECTIVE:

          The aim of this study was to compare the cephalometric pattern of children with and without adenoid obstruction.

          METHODS:

          The sample comprised 100 children aged between four and 14 years old, both males and females, subjected to cephalometric examination for sagittal and vertical skeletal analysis. The sample also underwent nasofiberendoscopic examination intended to objectively assess the degree of adenoid obstruction.

          RESULTS:

          The individuals presented tendencies towards vertical craniofacial growth, convex profile and mandibular retrusion. However, there were no differences between obstructive and non-obstructive patients concerning all cephalometric variables. Correlations between skeletal parameters and the percentage of adenoid obstruction were either low or not significant.

          CONCLUSIONS:

          Results suggest that specific craniofacial patterns, such as Class II and hyperdivergency, might not be associated with adenoid hypertrophy.

          Translated abstract

          OBJETIVO:

          a presente pesquisa teve como objetivo comparar o padrão cefalométrico de crianças com e sem obstrução adenoidiana.

          MÉTODOS:

          a amostra consistiu de 100 crianças, com idades entre 4 e 14 anos, de ambos os sexos, submetidas a exames cefalométricos para a avaliação de variáveis cefalométricas horizontais e verticais. A amostra também foi submetida à nasofibroendoscopia, por meio da qual o grau de obstrução adenoidiana foi objetivamente aferido.

          RESULTADOS:

          os pacientes avaliados demonstraram tendência ao crescimento vertical acentuado, ao perfil convexo e à retrusão mandibular. No entanto, não houve diferenças entre pacientes portadores e não portadores de obstrução, em relação a todas as variáveis cefalométricas. As correlações estabelecidas entre os parâmetros esqueléticos e os percentuais de hipertrofia foram baixas ou não significativas.

          CONCLUSÕES:

          os resultados sugerem que padrões faciais específicos, tais como Classe II e hiperdivergência, parecem não estar associados à hipertrofia adenoideana.

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          Most cited references40

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          Introdução à bioestatística

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            Muscular, functional and orthodontic changes in pre school children with enlarged adenoids and tonsils.

            Hypertrophy of the adenoids and palatine tonsils is the second most frequent cause of upper respiratory obstruction and, consequently, mouth breathing in children. Prolonged mouth breathing leads to muscular and postural alterations which, in turn, cause dentoskeletal changes. The aim of this study was to determine muscular, functional and dentoskeletal alterations in children aged 3-6 years. Seventy-three children, including 44 with tonsil hypertrophy and 29 controls, were submitted to otorhinolaryngologic, speech pathologic and orthodontic assessment. Otorhinolaryngologic evaluation revealed a higher incidence of nasal obstruction, snoring, mouth breathing, apneas, nocturnal hypersalivation, itchy nose, repeated tonsillitis and bruxism in children with tonsils hypertrophy. Speech pathologic assessment showed a higher incidence of open lip and lower tongue position, and of hypotonia of the upper and lower lips, tongue and buccinator muscle in these children, accompanied by important impairment in mastication and deglutition. Orthodontic evaluation demonstrated a higher incidence of lower mandible position in relation to the cranial base, a reduction in lower posterior facial height, transverse atresia of the palate, and a dolicofacial pattern. Postural and functional alterations anticipate dentoskeletal changes, except for the facial pattern. Postural alterations and the skeletal pattern seem to play an important role in infant dentofacial growth.
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              Airway adequacy, head posture, and craniofacial morphology.

              Previous studies of different samples have demonstrated associations between craniocervical angulation and craniofacial morphology, between airway obstruction by adenoids and craniofacial morphology, and between airway obstruction and craniocervical angulation. A hypothesis to account for the different sets of associations was suggested by Solow and Kreiborg in 1977. In the present study, the three sets of associations were examined in a single group of nonpathologic subjects with no history of airway obstruction. Cephalometric radiographs taken in the natural head position and rhinomanometric recordings were obtained from twenty-four children 7 to 9 years of age. Correlations were calculated between twenty-seven morphologic, eight postural, and two airway variables. A large craniocervical angle was, on the average, seen in connection with small mandibular dimensions, mandibular retrognathism, and a large mandibular inclination. Obstructed nasopharyngeal airways (defined as a small pm-ad 2 radiographic distance and a large nasal respiratory resistance, NRR, determined rhinomanometrically) were, on the average, seen in connection with a large craniocervical angle and with small mandibular dimensions, mandibular retrognathism, a large mandibular inclination, and retroclination of the upper incisors. The observed correlations were in agreement with the predicted pattern of associations between craniofacial morphology, craniocervical angulation, and airway resistance, thus suggesting the simultaneous presence of such associations in the sample of nonpathologic subjects with no history of airway obstruction.
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                Author and article information

                Journal
                Dental Press J Orthod
                Dental Press J Orthod
                Dental Press Journal of Orthodontics
                Dental Press International
                2176-9451
                2177-6709
                Jul-Aug 2015
                Jul-Aug 2015
                : 20
                : 4
                : 68-75
                Affiliations
                [1 ]Associate professor, Universidade São Francisco, Department of Orthodontics, Bragança Paulista, São Paulo, Brazil
                [2 ]Private practice, Bragança Paulista, São Paulo, Brazil
                [3 ] Full professor, Universidade Guarulhos, Department of Orthodontics, Guarulhos, São Paulo, Brazil
                [4 ]Adjunct professor of Otolaryngology, Universidade Federal de São Paulo, Department of Otolaryngology, Head and Neck Surgery, São Paulo, São Paulo, Brazil
                Author notes
                Contact address: Murilo Fernando Neuppmann Feres Av. São Francisco de Assis, 218, Jardim São José, Bragança Paulista/SP - Brazil CEP: 12916-900 - E-mail: murilo.feres@ 123456usf.edu.br

                Author contributionsConceived and designed the study: MFNF, SSNP. Data collection: TSM, SHA. Data analysis: MML, MFNF. Wrote the article: TSM, SHA, MML, SSNP, MFNF. Critical revision of the article: MFNF, MML, SSNP. Final approval of the article: TSM, SHA, MML, SSNP, MFNF.

                Article
                10.1590/2176-9451.20.4.068-075.oar
                4593533
                26352848
                eea28be2-afd0-467c-873d-3e00d1146c4a

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 September 2014
                : 19 January 2015
                Page count
                Figures: 4, Tables: 5, Equations: 0, References: 31, Pages: 8
                Categories
                Articles

                mouth breathing,diagnosis,angle class ii malocclusion

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