The effect of adenoid hypertrophy on maxillofacial development: an objective photographic analysis

Differential impact of chronic intermittent hypoxia and stress changes on condylar development

OBJECTIVES

This study aimed to determine the effects of chronic intermittent hypoxia (CIH) and stress change (SC) on the development of the condyle in mouth breathing rats.

DESIGN

A total of 120 4-week-old rats were randomly assigned to one of five groups. The control (Ctrl) group was the blank control and the intermittent nasal obstruction (INO) group was the positive control. Mild CIH (mCIH) and severe CIH (sCIH) groups were developed by adjusting environmental oxygen concentration and monitoring real-time blood oxygen saturation (SpO2). The SC group was developed using INO, increased environmental oxygen concentration, and real-time SpO2 monitoring. Six rats from each group were sacrificed for analysis at 0, 1, 2, or 4 weeks.

RESULTS

Similar to the INO group, condyle and mandibular body development in the sCIH group, but not in the mCIH group, was significantly inhibited compared with the Ctrl group. The SC group had inhibited development of the condyle, especially of the posterior zone, but had minimal impact on the growth of the mandible.

CONCLUSION

The inhibitory effects of CIH on the development of the condyle and mandibular body were SpO2-dose-dependent. When SC occurred, inhibited development was observed in the posterior zone of condyle but not the whole mandible. These findings provide important insights for targeted interventions that address the consequences of mouth breathing in children.

Association between adenotonsillar hypertrophy and dentofacial characteristics of children seeking for orthodontic treatment: A cross-sectional study

OBJECTIVE

To compare the dentofacial characteristics of children with and without adenoid and/or tonsillar hypertrophy.

METHODS

A consecutive sample of orthodontic patients aged 6-12 that took pre-treatment lateral cephalograms were included in this study. Those with history of previous orthodontic treatment, adenoidectomy or tonsillectomy, or craniofacial anomalies were excluded. The diagnosis of adenoid and tonsillar hypertrophy was based on Fujioka's and Baroni's methods, according to which the subjects were divided into four groups: the adenoid hypertrophy only (AHO) group; tonsillar hypertrophy only (THO) group; combined adenoid and tonsillar hypertrophy (AH+TH) group; and no adenoid or tonsillar hypertrophy (NH) group. Cephalograms were used for skeletal and dental measurement. Data were analyzed using one-way ANOVA, LSD post-hoc tests and Chi-square test.

RESULTS

A total of 598 patients were included. Compared with the NH group, the THO group had significantly larger SNB angle (P < 0.001), as well as significantly smaller ANB angle (P<0.001) and Wits value (P = 0.001). The U1-L1 angle of AHO group was significantly smaller than that in the NH group (P = 0.035). The proportion of adenoid hypertrophy in Class II patients was significantly higher than that in Class III patients (P = 0.001). The proportion of tonsillar hypertrophy in Class III patients was significantly higher than that in Class I patients (P < 0.001) and Class II patients (P < 0.001).

CONCLUSION

Over 80 % of children seeking orthodontic treatment had either adenoid or tonsillar hypertrophy. Children with adenoid hypertrophy tend to have skeletal Class II malocclusion, while those with tonsillar hypertrophy tend to have skeletal Class III malocclusion.

Numerical and experimental evaluation of nasopharyngeal aerosol administration methods in children with adenoid hypertrophy

Administering aerosol drugs through the nasal pathway is a common early treatment for children with adenoid hypertrophy (AH). To enhance therapeutic efficacy, a deeper understanding of nasal drug delivery in the nasopharynx is essential. This study uses an integrated experimental, numerical modelling approach to investigate the delivery process of both the aerosol mask delivery system (MDS) and the bi-directional delivery system (BDS) in the pediatric nasal airway with AH. The combined effect of respiratory flow rates and particle size on delivery efficiency was systematically analyzed. The results showed that the nasopharyngeal peak deposition efficiency (DE) for BDS was approximately 2.25-3.73 times higher than that for MDS under low-flow, resting and high-flow respiratory conditions. Overall nasopharyngeal DEs for MDS were at a low level of below 16 %. For each respiratory flow rate, the BDS tended to achieve higher peak DEs (36.36 % vs 9.74 %, 37.80 % vs 14.01 %, 34.58 % vs 15.35 %) at smaller particle sizes (15 µm vs 17 µm, 10 µm vs 14 µm, 6 µm vs 9 µm). An optimal particle size exists for each respiratory flow rate, maximizing the drug delivery efficiency to the nasopharynx. The BDS is more effective in delivering drug aerosols to the nasal cavity and nasopharynx, which is crucial for early intervention in children with AH.

Adenoid Hypertrophy and Orthodontic Complications: An Assessment of Parental Knowledge in Saudi Arabia

Background Adenoid hypertrophy is a common condition that can cause upper airway obstruction in children and adolescents, leading to various complications, including dental and maxillofacial abnormalities. However, parents may have limited knowledge of the orthodontic complications associated with this condition. Objective This study aimed to assess the knowledge and attitude of parents toward the orthodontic complications of untreated adenoid hypertrophy and to promote their awareness about this problem. Method This descriptive cross-sectional study involved 824 parents from all regions of Saudi Arabia. An online questionnaire was used to collect data on parents' demographics, their children's information, and their general knowledge about adenoid hypertrophy, including its symptoms, complications, and treatment. Results The study included 824 parents with a mean age of 36.78 ± 10.87 years, 73.2% of whom were women. Overall, only 6.2% (51.1 parents) had a good level of knowledge about adenoid hypertrophy. Conclusion The study highlights the importance of promoting awareness and educating parents about the orthodontic complications associated with adenoid hypertrophy. Greater awareness and understanding can help parents make better decisions for their children's health and well-being.

Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevance

Adenoids (nasopharyngeal tonsils), being part of Waldeyer's ring, are masses of lymphoid tissues located at the junction of the roof and the posterior wall of the nasopharynx. Adenoids play an important role in the development of the immune system and serve as a defence against infections, being the first organs that come into contact with respiratory and digestive antigens. The causes of adenoid hypertrophy are not fully known. They are most likely associated with aberrant immune reactions, infections, environmental exposures and hormonal or genetic factors. The aim of this review is to summarise the current knowledge of adenoid hypertrophy in children and associated diseases. Adenoid hypertrophy has many clinical manifestations that are frequent in the paediatric population and is accompanied by various comorbidities.

The Effects of Orofacial Myofunctional Therapy on Children with OSAHS’s Craniomaxillofacial Growth: A Systematic Review

Orofacial myofunctional therapy (OMT) is one of the therapeutic methods for neuromuscular re-education and has been considered as one of the auxiliary methods for obstructive sleep apnea hypopnea syndrome (OSAHS) and orthodontic treatment. There is a dearth of comprehensive analysis of OMT’s effects on muscle morphology and function. This systematic review examines the literature on the craniomaxillofacial effects of OMT in children with OSAHS. This systematic analysis was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards, and the research was scanned using PICO principles. A total of 1776 articles were retrieved within a limited time, with 146 papers accepted for full-text perusing following preliminary inspection and 9 of those ultimately included in the qualitative analysis. Three studies were rated as having a severe bias risk, and five studies were rated as having a moderate bias risk. Improvement in craniofacial function or morphology was observed in most of the 693 children. OMT can improve the function or morphology of the craniofacial surface of children with OSAHS, and its effect becomes more significant as the duration of the intervention increases and compliance improves. In the majority of the 693 infants, improvements in craniofacial function or morphology were seen. The function or morphology of a kid’s craniofacial surface can be improved with OMT, and as the duration of the intervention lengthens and compliance rises, the impact becomes more pronounced.

Diagnostic value of upper airway morphological data based on CT volume scanning combined with clinical indexes in children with obstructive sleep apnea syndrome

Background and purpose

Early diagnosis is important for treatment and prognosis of obstructive sleep apnea (OSA)in children. Polysomnography (PSG) is the gold standard for the diagnosis of OSA. However, due to various reasons, such as inconvenient implementation, less equipped in primary medical institutions, etc., it is less used in children, especially in young children. This study aims to establish a new diagnostic method with imaging data of upper airway and clinical signs and symptoms.

Methods

In this retrospective study, clinical and imaging data were collected from children ≤10 years old who underwent nasopharynx CT scan(low-dose protocol)from February 2019 to June 2020,including 25 children with OSA and 105 non-OSA. The information of the upper airway (A-line; N-line; nasal gap; upper airway volume; upper and lower diameter, left and right diameter and cross-sectional area of the narrowest part of the upper airway) were measured in transaxial, coronal, and sagittal images. The diagnosis of OSA and adenoid size were given according to the guidelines and consensus of imaging experts. The information of clinical signs, symptoms, and others were obtained from medical records. According to the weight of each index on OSA, the indexes with statistical significance were screened out, then were scored and summed up. ROC analysis was performed with the sum as the test variable and OSA as the status variable to evaluate the diagnostic efficacy on OSA.

Results

The AUC of the summed scores (ANMAH score) of upper airway morphology and clinical index for the diagnosis of OSA was 0.984 (95% CI 0.964–1.000). When sum = 7 was used as the threshold (participants with sum&gt;7 were considered to have OSA), the Youden’s index reached its maximum at which point the sensitivity was 88.0%, the specificity was 98.1%, and the accuracy was 96.2%.

Conclusion

The morphological data of the upper airway based on CT volume scan images combined with clinical indices have high diagnostic value for OSA in children; CT volume scanning plays a great guiding role in the selection of treatment scheme of OSA. It is a convenient, accurate and informative diagnostic method with a great help to improving prognosis.

Effect of oral Xiao-xian decoction combined with acupoint application therapy on pediatric adenoid hypertrophy: A randomized trial

BACKGROUND

This study aimed to observe the clinical effects of Xiao-xian decoction combined with acupoint application therapy (AAT) for treating pediatric adenoid hypertrophy (AH).

METHODS

We randomly divided 93 AH children into 3 groups: AAT alone; Xiao-xian decoction + AAT; control: Montelukast oral therapy. All participants were treated for a month. We used the traditional Chinese medicine syndrome score to evaluate the clinical efficacy and the obstructive sleep apnea-18 scale to evaluate the quality of life.

RESULTS

The major symptoms (nasal congestion, open mouth breathing, snoring, and tongue image) and secondary symptoms of patients treated with Xiao-xian decoction + AAT significantly improved compared to before treatment. The pairwise comparison between groups showed that snoring, tongue, secondary symptoms, and total effective rate of the combined treatment group were better than the control and AAT alone. Additionally, the open-mouth breathing, quality of life, and recurrence rate did not differ after treatment.

CONCLUSION

Oral Xiao-xian decoction combined with AAT significantly improved the symptoms and signs of nasal congestion, open-mouth breathing, snoring, tongue, and quality of life of AH children and may be used as a long-term treatment for AH.

Influences of Airway Obstruction Caused by Adenoid Hypertrophy on Growth and Development of Craniomaxillofacial Structure and Respiratory Function in Children

Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while long-term open-mouth breathing may cause craniofacial bone development disorders and dull facial expressions, the so-called adenoid face. The purpose of this work is to analyze the influence of AH-induced airway obstruction (AO) on the growth and development of craniomaxillofacial structure and respiratory function (RF) in children. The clinical data of 56 AH children (observation group) and 42 healthy children with physical examination (control group) who visited the Hebei Eye Hospital during the same period were retrospectively analyzed. All children received acoustic rhinometry and X-ray cephalometric measurements. The upper airway structure, sleep disorder score, and A/N value of nasopharyngeal lateral X-ray images were compared between cases and controls. For AH children, sleep tests were also performed to assess their RF. X-ray cephalometric measurements of facial morphology showed obvious vertical growth, mandibular retrognathia, and enlarged mandibular angle in AH children. AH mainly affects the size of the nasopharyngeal and oropharyngeal airway. AH children presented with higher nasal airway resistance (5.11 ± 1.95 cmH₂O/L min) and lower nasopharyngeal volume (NPV) (16.86 ± 3.93 cm³) than controls. Of the AH children, 45 had abnormal RF, including 4 with obstructive sleep apnea syndrome. The A/N value of nasopharyngeal lateral X-ray images was significantly higher in AH children than in controls. Besides, worse sleep quality was found in AH children. The above differences were all of statistical significance. The above indicates that AH can affect the size of the nasopharyngeal and oropharyngeal airway, change children's respiratory mode and RF, increase nasal resistance, and decrease NPV, resulting in upper respiratory tract stenosis, as well as craniomaxillofacial and oral malformations, which affects children's normal growth and development.

Effect of adenoid hypertrophy and adenoidectomy on bite force in children: Twelve month follow-up, case-control study

OBJECTIVE

The effects of adenoid hypertrophy (AH) and adenoidectomy on maximal bite force (MBF) in patients were evaluated by comparing them with healthy controls.

METHODS

A total of 118 children diagnosed with AH and undergoing adenoidectomy (Group A), and healthy controls (Group B) were included. The MBF and nasopharyngeal airway passage distance (NAPD) were recorded.

RESULTS

There was a correlation between NAPD and MBF at the beginning of the study (r = -0.675 and p < 0.001). The initial mean MBF of Groups A and B were 318.37 ± 70.76 N and 344.04 ± 64.14 N, respectively (p = 0.041). However, there was no significant difference between the groups due to the increase in the MBF of Group A at 12 months (p = 0.165).

CONCLUSION

The MBF may be negatively affected in proportion to decreased NAPD, and it could also be an indicator for monitoring the status of children with AH.

Influence of Adenoid Hypertrophy on Malocclusion and Maxillofacial Development in Children

Objective

To investigate the effect of adenoid hypertrophy on malocclusion and maxillofacial development in children.

Methods

Total of 102 children with malocclusion or maxillofacial dysplasia admitted to our hospital from March 2017 to June 2020 were selected as the research subjects. All children were divided into a control group (50 cases with adenoid hypertrophy) and an observation group (52 cases without adenoid hypertrophy) according to the presence or absence of adenoid hypertrophy. The incidence of malocclusion was compared between the two groups, and lateral cranial radiographs were taken in both groups to measure and compare the malocclusion angle, jaw angle, and jaw length indexes between the two groups.

Results

The incidence of malocclusion in the observation group (71.15%) was higher than that in the control group (42.00%), and the difference was statistically significant (P < 0.05). The angle between the long axis of the upper central incisor and the nasal root point and the upper alveolar base point (U1-NA), the angle between the long axis of the lower central incisor and the nasal root point and the lower alveolar base point (L1-NB), the angle between mandibular plane and anterior cranial base plane (MP-SN), the angle between the long axis of upper central incisor and anterior cranial base plane (U1-SN), the angle between the long axis of lower central incisor and mandibular plane (L1-MP), the angle of Y axis, the overall height (N-Me), lower height (ANS-Me), overall height/back height (N-Me/S-Go), and lower height/overall height (ANS-Me/N-Me) values in the observation group were higher than those in the control group, while the mandibular length (Go-Gn) values in the observation group were lower than those in the control group (P < 0.05).

Conclusion

Adenoid hypertrophy can increase the incidence of malocclusion in children and can also increase the steepness and overall height and lower height of the mandible, resulting in the lengthening of the facial shape and the development of the maxillofacial deformity.

A National Analysis of Inpatient Pediatric Adenoidectomy

OBJECTIVE

Hospital admission following pediatric adenoidectomy without tonsillectomy is not well characterized. The objective of our study is to better characterize risk factors for post-operative complications in younger children undergoing inpatient adenoidectomy.

METHODS

A cross-sectional analysis using data derived from the Kid's Inpatient Database (KID) was performed. Study participants included children <3 years of age who underwent an adenoidectomy and were admitted to hospitals participating in the KID for years 1997, 2000, 2003, 2006, 2009, and 2012. Descriptive statistical analysis and a multivariate logistic regression analysis were performed to identify risk factors for post-operative complication.

RESULTS

A total of 3406 children (mean age 1.1 ± 0.7 years) were included. The overall post-operative bleeding and respiratory complication rates were 0.6% and 5.4%, respectively. Children less than 18 months of age demonstrated increased rates of post-operative respiratory complications (P = .009), but not bleeding complications (P = .857). Presence of cardiopulmonary congenital malformations (OR 1.54, 95% CI 1.07-2.20), chronic respiratory disease of the newborn (OR 5.03, 95% CI 2.86-8.85), and neuromuscular disorders (OR 1.97, 95% CI 1.09-3.57) were associated with post-operative respiratory distress.

CONCLUSIONS

This analysis of a national dataset suggests that otherwise healthy children less than 18 months of age and children 18 months to 3 years of age with certain comorbidities may benefit from overnight observation following adenoidectomy.

Aerodynamic characteristics in upper airways among orthodontic patients and its association with adenoid nasopharyngeal ratios in lateral cephalograms

BACKGROUND

Adenoid hypertrophy among orthodontic patients may be detected in lateral cephalograms. The study investigates the aerodynamic characteristics within the upper airway (UA) by means of computational fluid dynamics (CFD) simulation. Furthermore, airflow features are compared between subgroups according to the adenoidal nasopharyngeal (AN) ratios.

METHODS

This retrospective study included thirty-five patients aged 9-15 years having both lateral cephalogram and cone beam computed tomography (CBCT) imaging that covered the UA region. The cases were divided into two subgroups according to the AN ratios measured on the lateral cephalograms: Group 1 with an AN ratio < 0.6 and Group 2 with an AN ratio ≥ 0.6. Based on the CBCT images, segmented UA models were created and the aerodynamic characteristics at inspiration and expiration were simulated by the CFD method for the two groups. The studied aerodynamic parameters were pressure drop (ΔP), maximum midsagittal velocity (V_ms), maximum wall shear stress (P_ws), and minimum wall static pressure (P_w).

RESULTS

The maximum V_ms exhibits nearly 30% increases in Group 2 at both inspiration (p = 0.013) and expiration (p = 0.045) compared to Group 1. For the other aerodynamic parameters such as ΔP, the maximum P_ws, and minimum P_w, no significant difference is found between the two groups.

CONCLUSIONS

The maximum V_ms seems to be the most sensitive aerodynamic parameter for the groups of cases. An AN ratio of more than 0.6 measured on a lateral cephalogram may associate with a noticeably increased maximum V_ms, which could assist clinicians in estimating the airflow features in the UA.

Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children

We aimed to investigate the oral health of children in terms of the presence of dental caries, periodontal health, halitosis, and dentofacial changes in patients who had adenotonsillar hypertrophy related to mouth breathing and compared these findings with nasal breathing healthy and adenotonsillectomy-operated children. The patient group comprised 40 mouth-breathing children who were diagnosed with adenotonsillar hypertrophy, while the control group consisted of 40 nasal breathing children who had no adenotonsillar hypertrophy. Forty children who had undergone an adenotonsillectomy operation at least 1 year prior to the study were included in the treatment group. Oral examinations of all children were conducted, and the parents were asked about medical and dental anamnesis, demographic parameters, toothbrushing and nutrition habits, oral health-related quality of life (OHRQoL), and symptoms of their children. Demographic parameters, toothbrushing and nutrition habits, and the presence of bad oral habits did not differ between groups (p > 0.05). Adenotonsillectomy is associated with a remarkable improvement in symptoms; however, some symptoms persist in a small number of children. The salivary flow rate, dmft/s, DMFT/S index, plaque, and gingival index scores did not differ between groups (p > 0.05). The patient group showed higher rates of halitosis when compared with the treatment and control groups (p < 0.001). Mouth breathing due to adenotonsillar hypertrophy caused various dentofacial changes and an increase in Class II division 1 malocclusion (p < 0.001). It was shown that adenotonsillar hypertrophy does not negatively affect OHRQoL, it could be a risk factor for dental caries, periodontal diseases, and halitosis, but by ensuring adequate oral health care, it is possible to maintain oral health in children with adenotonsillar hypertrophy. Also, it is recommended that orthodontic treatment should start as soon as possible if it is required. In this context, otorhinolaryngologists, pedodontists, and orthodontists should work as a team in the treatment of children with adenotonsillar hypertrophy.

Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis

BACKGROUND

Mouth breathing is closely related to the facial skeletal development and malocclusion. The purpose of this systematic review and meta-analysis was to assess the effect of mouth breathing on facial skeletal development and malocclusion in children.

METHODS

An electronic search in PubMed, the Cochrane Library, Medline, Web of Science, EMBASE and Sigle through February 23rd, 2020, was conducted. Inclusion criteria were children under 18 years of age with maxillofacial deformities due to mouth breathing. The risk of bias in nonrandomized studies of interventions (ROBINS-I) tool for controlled clinical trials. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used for the quality assessment. The included indicators were SNA, SNB, ANB, SN-OP, SN-PP, PP-MP, SNGoGn, MP-H, 1-NA, 1. NA, 1. NB, 1-NB, Overjet, Overbite, SPAS, PAS, and C3-H. Data concerning the mean difference in mesial molar movement and extent of canine retraction were extracted for statistical analysis. The mean differences and 95% confidence intervals were analyzed for continuous data. Review Manager 5.3, was used to synthesize various parameters associated with the impact of mouth breathing on facial skeletal development and malocclusion.

RESULTS

Following full-text evaluations for eligibility, 10 studies were included in the final quantitative synthesis. In Sagittal direction, SNA (MD: - 1.63, P < 0.0001), SNB (MD: - 1.96, P < 0.0001) in mouth-breathing children was lower than that in nasal-breathing children. ANB (MD: 0.90, P < 0.0001), 1. NA (MD: 1.96, P = 0.009), 1-NA (MD: 0.66, P = 0.004), and 1-NB (MD: 1.03, P < 0.0001) showed higher values in children with mouth breathing. In vertical direction, SN-PP (MD: 0.68, P = 0.0050), SN-OP (MD: 3.05, P < 0.0001), PP-MP (MD: 4.92, P < 0.0001) and SNGoGn (MD: 4.10, P < 0.0001) were higher in mouth-breathing individuals. In airway, SPAS (MD: - 3.48, P = 0.0009), PAS (MD: - 2.11, P < 0.0001), and C3-H (MD: - 1.34, P < 0.0001) were lower in mouth breathing group.

CONCLUSIONS

The results showed that the mandible and maxilla rotated backward and downward, and the occlusal plane was steep. In addition, mouth breathing presented a tendency of labial inclination of the upper anterior teeth. Airway stenosis was common in mouth-breathing children. Trial registration crd-register@york.ac.uk, registration number CRD42019129198.

Correlation between craniofacial structures, anthropometric measurements, and nasopharyngeal dimensions in black adolescents

OBJECTIVES

To evaluate the correlation between craniofacial structures, anthropometric measurements, and bony and soft tissue nasopharyngeal dimensions in African Black adolescents.

METHODS

This retrospective cross-sectional study was conducted on 483 healthy adolescents (250 females and 233 males), randomly selected from one dental clinic. The inclusion criteria were skeletal and dental Class I, Black ethnicity, pubertal growth period as determined by the Greulich and Pyle atlas criteria, and no history of orthodontic treatment. Anthropometric measurements (stature, upper body height, lower body height, and BMI) and radiographic records (hand-wrist radiographs, and lateral cephalograms) were obtained. One investigator traced and analysed all cephalograms to determine three skeletal craniofacial parameters (maxillary length [Ar- ANS], mandibular length [Ar-Gn], and lower anterior facial height [ANS-Me]), and 14 (8 skeletal and 6 soft tissue) nasopharyngeal parameters. Pearson correlation coefficients and stepwise multiple linear regression analyses were conducted.

RESULTS

The mean skeletal ages of females and males were 11.31±2.31y and 12.66±1.85y, respectively. Multiple linear regression analyses showed that stature, posterior height of nasal cavity (S-PNS), length of nasal floor (AA-PNS), and mean area of bony nasopharynx (Area 1) were significantly correlated with maxillary length, P<.001. Stature, BMI, S-PNS, vertical angle of nasopharynx (Ba-S-PNS), Area 1, adenoid height (AD), and linear hyoid bone measurements (H-AA, H-RGN, H-Ax) were all correlated with mandibular length, P<.05. Lower facial height showed sexual dimorphism and was significantly associated with vertical nasopharyngeal measurements, BMI and upper body height.

CONCLUSIONS

Craniofacial structures were significantly associated with stature and upper body height. Maxillary growth was associated with bony nasopharyngeal variables. Mandibular growth and lower facial height were associated with bony and soft tissue nasopharyngeal variables. The sexual dimorphism in lower facial height warrants future studies to fully understand and manage the craniofacial complex and nasopharyngeal airway in African Black adolescents.

Factors influencing different types of malocclusion and arch form-A review

AIM

This review intends to highlight malocclusion as a multifactorial issue and review the different factors that influence different types of malocclusion and arch form.

METHODS

An online article search was performed on the factors influencing malocclusion and arch form from January 1990 through April 2020. The search was performed within the Google, Rutgers library, PubMed, MEDLINE databases via OVID using the keywords mentioned in the PubMed and MeSH headings for the English language published articles January 1990 through April 2020, which evaluated different factors that influence malocclusion and arch form.

RESULTS

Of the 300 articles found in initial search results, 31 articles met the inclusion criteria set for this review. These 31 studies were directly related to the factors that impact malocclusion and different arch forms.

CONCLUSION

Genetic inheritance, genetic mutations, age, gender, ethnicity, dental anomalies like macrodontia, congenital diseases, muscular diseases, hormone imbalance, and human behaviour are all factors that influence malocclusion and arch forms. The elements within the individual's control like behaviours can aid in preventing malocclusion. However, it seems as if the underlying reason for most of these factors indicates that malocclusion is a by-product of genetics and pathology.

Mouth breathing impairs the development of temporomandibular joint at a very early stage

OBJECTIVES

The study aimed to explore the effects of mouth breathing and hypoxia on the condyle of temporomandibular joint (TMJ) via two animal models.

METHODS

24 four-week-old rats were randomly separated into three groups, consisting of eight control rats, eight intermittent hypoxia (IH) rats, and eight intermittent nasal obstruction (INO) rats. We use the IH model and the INO model to simulate children suffering from hypoxia and mouth breathing. After 16 days, the condyle of TMJ and surrounding white adipose tissue (WAT) and skeletal muscle tissue were obtained for further staining and qRT-PCR. Finally, RNA-seq was used to verify the results.

RESULTS

The intermittent hypoxia cannot significantly change the overall structure in the cause of short-term hypoxia stimulation, but the intermittent nasal obstruction can alter the condyle, WAT, and muscle, while also introducing noticeable structural changes in tissue hypoxia and macrophage infiltration. Sequencing data verified these findings and also suggested that this process might involve the Hif-1α/Vegf axis.

CONCLUSIONS

Our findings reveal the very early structural impact of mouth breathing on condyle reconstruction in rat models, and hypoxia does not induce evident alteration on condyle. However, since these results are mainly focused on rats, further studies are needed to understand its effects on humans.

Are pediatricians and otolaryngologists well prepared to identify early signs of vertical facial growth?

BACKGROUND

The prevalence of vertical facial growth is very high in the developed world. Most authors agree that mouth breathing is its main cause. Even though care is mainly conducted by odontologists, the professionals who first see these patients are pediatricians and otolaryngologists. The objective of this study is to analyze the ability of pediatricians and otolaryngologists to identify early signs of vertical facial growth among children.

METHODS

60 participant aged 4.1-13.7 years were analyzed subjectively by 9 otolaryngologists, 9 pediatricians and two specialists in dentofacial orthopedics. They were also assessed objectively with cephalometric analysis.

RESULTS

Otolaryngologists showed 34.78% sensitivity, 92.86% specificity and 48.33% efficiency. Pediatricians showed 13.04% sensitivity, 100% specificity and 33.33% efficiency. Using a linear regression model compared against the objective measurements we found a weak positive correlation both for otolaryngologists and pediatricians.

CONCLUSION

The sensitivity was very low for both groups. We believe it is of paramount importance to increase the awareness and the ability of otolaryngologists and pediatricians to recognize signs of disrupt facial growth.

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.

Effect of topical mometasone furoate on adenoidal lymphoid tissue: a light microscopic study

Background

Adenoid hypertrophy is a common cause of upper airway obstruction, and adenoidectomy is one of the most frequently performed operations in children. Topical nasal steroids can act directly on nasopharyngeal lymphoid tissue to decrease its reactive inflammatory changes and potentially reduce its size.

Objective

To study the light microscopic changes in adenoidal lymphoid tissue after one month of topical steroid use.

Methods

Twenty-six children with adenoid hypertrophy grade 3 scheduled for adenoidectomy were randomly divided into two equal groups: one group received mometasone furoate aqueous nasal spray (Nasonex) 100 mcg/day for four weeks, and a control group received nasal normal saline 0.9 per cent for four weeks. The removed adenoids were examined histopathologically.

Results

Adenoidal tissue from the mometasone group had less reactive germinal centres and less spongiosis compared to the control group. The latter showed proliferating, reactive, variable sized and shaped lymphoid follicles, with congested blood vessels in the interfollicular areas.

Conclusion

The use of intranasal mometasone furoate aqueous nasal spray (Nasonex) for one month reduced adenoidal tissue reactive cellular changes and its vascularity. This is, however, a pilot study; a longer treatment period is needed to assess the effect of treatment on adenoidal size.

CYSLTR1 promotes adenoid hypertrophy by activating ERK1/2

Cysteinyl leukotriene receptor 1 (CYSLTR1) serves a pivotal role in allergic reactions, which is one of the main causes of adenoid hypertrophy. The present study aimed to investigate the function of CYSLT1 within adenoid hypertrophy. A total of 40 patients with adenoid hypertrophy were recruited between January 2014 and January 2016 at the Children's Hospital of Hebei Province, China. The patients were divided into either the mild-moderate group or the severe group according to their disease severity. The expression of CYSLT1 in the adenoid tissue and whole blood of all patients and healthy controls was detected by reverse transcription-quantitative polymerase chain reaction. Associations between the expression level of CYSLT1 and the clinical characteristics of patients were analyzed. Primary human adenoid epithelial cells (HAECs) with CYSLT1 knockdown and overexpression were constructed. The levels of extracellular signal-regulated kinase (ERK)2 and phosphorylated-ERK1/2 in adenoid tissue and HAECs were detected by western blot analysis. The expression of CYSLT1 in adenoid tissue and whole blood of all patients with adenoid hypertrophy was significantly higher compared with the healthy controls (P<0.05). In addition, the expression level of CYSLT1 was significantly higher in the severe group compared with the mild-moderate group (P<0.05). The highest level of p-ERK1/2 in adenoid tissue was observed in the severe group, followed by the mild-moderate group and then the control group (P<0.05). CYSLT1 expression was positively associated with the severity of disease. CYSLT1 knockdown significantly decreased the level of p-ERK1/2 in HAECs (P<0.05), while CYSLT1 overexpression significantly increased the level of p-ERK1/2. It was concluded that CYSLT1 may contribute to the progression of adenoid hypertrophy by activating ERK1/2.

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.