Airway adequacy, head posture, and craniofacial morphology

doi:10.1016/0002-9416(84)90373-7

American Journal of Orthodontics

Volume 86, Issue 3, September 1984, Pages 214-223

https://doi.org/10.1016/0002-9416(84)90373-7 Get rights and content

Abstract

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 mandibula 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

References (38)

EB Kern
Rhinomanometry
Otolaryngol Clin North Am
(1973)
RM Watson et al.
Nasal resistance, skeletal classification, and mouth breathing in orthodontic patients
Am J Orthod
(1968)
S Linder-Aronson
Effects of adenoidectomy on dentition and nasopharynx
Am J Orthod
(1974)
FA Sosa et al.
Postpharyngeal lymphoid tissue in Angle Class I and Class II malocclusions
Am J Orthod
(1982)
HG Hershey et al.
Changes in nasal airway resistance associated with rapid maxillary expansion
Am J Orthod
(1976)
A Björk
Cranial base development
Am J Orthod
(1955)
RM Ricketts
Respiratory obstruction syndrome
Am J Orthod
(1968)
PS Vig et al.
Experimental manipulation of head posture
Am J Orthod
(1980)
ZJ Weber et al.
Resistance to nasal airflow related to changes in head posture
Am J Orthod
(1981)
S Siersbaek-Nielsen et al.
Intra- and interexaminer variability in head posture recorded by dental auxiliaries
Am J Orthod
(1982)

H Zwaardemaker

Athembeschlag als Hülfsmittel zur Diagnose der nasalen Stenose

Arch Laryngol

(1891)

R Kayser

Die exackte Messung der Luftdurchgängligkeit der Nase

Arch Laryngol

(1895)

RL Rasmus et al.

Mouth breathing and malocclusion: quantitative technique for measurement of oral and nasal airflow velocities

Angle Orthod

(1969)

S Linder-Aronson

Adenoids: their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition

Acta Otolaryngol (Stockh).

(1970)

S Linder-Aronson

Effects of adenoidectomy on the dentition and facial skeleton over a period of five years

RS Bushey

Adenoid obstruction of the nasopharynx

I Jonas et al.

Hals-Nasen-Ohren-ärztliche Befunde beim offenen Biss

Fortschr Kieferorthop

(1982)

W Mottl et al.

Adenoide — ein kausaler Faktor beim vertikalen Wachstumsmuster?

Fortschr Kieferorthop

(1982)

B Drettner

The nasal airway and hearing in patients with cleft palate

Acta Otolaryngol

(1960)

Cited by (286)

3D evaluation of cranial and dentofacial morphological differences between individuals with mouth breathing and nasal breathing
2024, Journal of Stomatology, Oral and Maxillofacial Surgery
The present study aimed to identify the morphological differences in cranial and dentofacial structures between individuals with mouth-breathing and nasal-breathing.
The study included 120 individuals, 60 each in the nasal breathing (NB) and mouth breathing (MB) groups. 3D stereophotogrammetry, lateral cephalometric radiographs, and intraoral examination results were recorded by the researchers to determine the morphological differences between the MB group and the NB group. The study utilized cephalometric radiographs for 2D hard tissue measurements and 3D stereophotogrammetric records for linear and angular measurements.
Statistically significant differences were found between the NB and MB groups’ SNB angles (respectively, 79.3 ± 3.04, 76.6 ± 4.24, and p = 0.002). Also, the NB group's SN-GoGn angle was lower than the MB group's (respectively, 31.5 ± 5.12, 36.0 ± 5.55, and p = 0.002). Considering the Jarabak ratio, the NB group's Jarabak ratio was higher than the MB group (respectively,65.7 ± 4.16, 62.6 ± 4.10, and p = 0.014). In 3D stereophotogrammetry measurements, increased Li-Me’ was detected in the MB group than in NB group.
Mouth breathing results in significant morphological differences that affect the development of both soft tissues and skeletal structures. Orthodontists utilize these characteristic features observed in mouth-breathing anomalies for early diagnosis and consider referring their patients for medical treatment of mouth breathing.
Effect of palatine tonsil hypertrophy on tongue posture and maxillofacial dentition: A pharyngeal airway computational fluid dynamics study
2023, Pediatric Dental Journal
This study aimed to clarify the effect of palatine tonsil hypertrophy-induced ventilation obstruction on maxillofacial dentition morphology using computational fluid dynamics (CFD) to represent tongue posture and maxillofacial dentition three dimensionally.
We analyzed data of 20 patients with tonsil hypertrophy (tonsil hypertrophy group (TG); 9.0 years old, seven boys) and a comparison group (CG) of 20 patients without tonsil hyperplasia (comparison group; 9.4 years old, 10 boys). Cone-beam computed tomography and CFD data were used to assess the effects of palatine tonsil hypertrophy on pharyngeal airway ventilation, tongue posture, and morphology of the maxillofacial dentition.
The TG exhibited significantly greater depth, narrower width, smaller cross-sectional area of the pharyngeal airway, and narrower maxillary dental arch with Class II than the CG. Additionally, the tongue was positioned significantly more anteriorly and inferiorly in the TG than that in the CG.
Our data suggest that hypertrophy of the palatine tonsils narrows the pharyngeal airway, resulting in a smaller cross-sectional area. Widening of the pharyngeal airway may occur due to compensatory anterior displacement of the tongue to prevent ventilation obstruction. This may decrease palatal support, disturbing the pressure balance of the maxillary molar region between the buccal and palatal sides and resulting in lateral undergrowth of the maxillary bone and narrowing of the maxillary dental arch.
Analysis of maxillary arch morphology and its relationship with upper airway in mouth breathing subjects with different sagittal growth patterns
2023, Journal of Stomatology, Oral and Maxillofacial Surgery
This three-dimensional cone beam computed tomography(CBCT) study assessed pharyngeal airway and maxillary arch in mouth breathing subjects with different skeletal classifications and analyzed the factors associated with the upper airway morphological variations in mouth breathing (MB) and nasal breathing (NB) subjects.
One hundred and five subjects (52 MB and 53 NB children), divided into three skeletal groups: Class I (1° ≤ ANB° ≤ 5°), Class II (ANB° >5°), and Class III (ANB°<1°). An independent t-test and one-way ANOVA test were utilized in the group analysis of normal distributed data. The linear multiple regression test was applied to create a model for the airway volumes based on the maxillary arch parameters in different skeletal groups.
In three skeletal groups, NB individuals had greater oropharyngeal airway volume (OPV) and total pharyngeal airway volume (TPV) than MB. Maxillary arch parameters of intermolar width (IMW), intercanine width (ICW), and maxillary width of canines (MWC) were larger in NB participants than in MB subjects. In the MB group, we discovered that Class II individuals had lower NPV (nasopharyngeal airway volume) than Class I and Class III. MWC was lower in Class II subjects compared to Class I and Class III in both the NB and MB groups.
NB individuals had greater pharyngeal airway and maxillary arch parameters than MB subjects. Our model equation revealed that the inter-molar width (IMW) and palatal area (PA) parameters were the strongest predictors of total pharyngeal airway volume (TPV) in the skeletal Class II and Class I groups.
Effects of rapid maxillary expansion on head and cervical posture in growing patients: A systematic review
2022, International Orthodontics
To identify and qualify the evidence of published studies evaluating whether rapid maxillary expansion (RME) treatment modifies the head and cervical posture in growing patients.
Electronic database searches were conducted until January 2021 using PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and LILACS. Grey literature was explored using ClinicalTrials, OpenGrey and Google Scholar. Trials involving participants who underwent RME were included. Risk of Bias (RoB) assessment was conducted using the Cochrane tool for randomized trials and the Methodological Index for Non-randomized Studies (MINORS) for non-randomized trials. The certainty level of evidence was evaluated through the Grading of Recommendations, Assessment, Development and Evaluation tool (GRADE).
Six clinical trials were included. The RoB scores had unclear and high risks of bias. Low certainty of evidence suggested that the effects following RME include a decrease in craniocervical angulation, as well as a very low certainty of evidence for a decrease in head elevation, an increase in cervical lordosis, and an increase in the inclination of the cervical spine.
There is low and very low evidence that RME alters the head and cervical posture in growing patients. Further investigation regarding long-term effects, possible changes due to somatic growth, and clinical relevance is needed.
Differences on craniocervical posture and facial morphology among two ethnic groups
2021, Revue de Medecine Legale
Cette étude visait à définir, les différences de posture craniocervicale qui influencent l’identité morphologique faciale, chez les filles mélano-ivoiriennes et leuco-libanaises de 11 à 16 ans.
Des radiographies numériques de 34 mélano-ivoiriennes et 32 leuco-libanaises de 11 à 16 ans, ont permis une analyse céphalométrique mettant en relief, des différences morphologiques [t de student (p ≤ 0,05)]. Le test de corrélation de Pearson a analysé les relations entre posture craniocervicale et morphologie faciale.
En condition neutre, les filles leuco-libanaises présentent une tête en extension (PH-Ver = 91,65° et PP-Ver = 93,906°) portée par une courbure cervico-lordotique plus accentuée (CVT/OPT = 5,219°). Chez les filles mélano-ivoiriennes, la flexion de la tête (PH-Ver = 94,074° et PP-Ver = 98,382°) et une faible courbure cervico-lordotique (CVT/OPT = 3,324°) sont observées. L’extension de la posture de la tête chez les filles leuco-libanaises, est corrélée à la proéminence du menton (G-Pog/C-Me) et à la hauteur du tiers facial inférieur (Sn-Po-Me). Par contre chez les filles mélano-ivoiriennes, la flexion de cette posture est associée à la hauteur du nez (N-Po-Sn), au tiers facial inférieur (Sn-Po-Me) et à l’angle fronto-nasal (G-N-Prn).
Cette étude renforce l’idée que, les modifications anatomiques déterminant l’identité morphologique du visage des groupes ethniques, constituent une réponse adaptative aux pressions générées par la posture craniocervicale sur les couches des tissus mous. La connaissance de ces mécanismes physiologiques pourrait optimiser les procédés d’identification comparative et estimative des personnes.
The aim of this study was to define, the differences in craniocervical posture that influence facial morphological identity, among Melano-Ivorian and Leuco-Lebanese girls aged 11 to 16.
Digital radiographs of 34 melano-ivoirians and 32 leuco-lebanese girls from 11 to 16 years old, allowed a cephalometric analysis hilighting morphological differences [t of student (P ≤ 0,05)]. The Pearson correlation test analyzed the relationships between craniocervial posture and facial morphology.
In neutral condition, leuco-lebanese girls have an extended head (PH-Ver = 91,65° and PP-Ver = 93,906°) carried by a more pronounced cervico-lordotic curvature (CVT/OPT = 5,219°). Among melano-ivoirian girls, the flexion of the head (PH-Ver = 94,074° and PP-Ver = 98,382°) and a slide cervico-lordotic curvature (CVT/OPT = 3,324°) are observed. The extension of the head posture in leuco-lebanese girls is correlated with prominence of the chin (G-Pog/C-Me) and height of the lower facial third (Sn-Po-Me). On the other hand, in the melano-ivoirian girls, flexion of the cranial posture is associated with the height of the nose (N-Po-Sn), the lower facial third (Sn-Po-Me) and the fronto-nasal angle (G-N-Prn).
This study reinforces the idea that, the facial anatomical modifications determining the morphological identity of the face of the different ethnic groups, constitute an adaptive response to the pressure generated by the craniocervical posture on the soft tissue layers. Knowledge of these physiological mechanisms could optimize the processes of comparative and estimative identification of people.
Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods
2024, Scientific Reports

View all citing articles on Scopus

^∗: Institute of Orthodontics, Royal Dental College, Copenhagen, Denmark.

^∗∗: Farum Community Orthodontic Clinic, Farum, Denmark.

^∗∗∗: Private orthodontic practice, Strandgade 1, Skelskor, Denmark.

View full text

Original articleAirway adequacy, head posture, and craniofacial morphology

Abstract

Otolaryngol Clin North Am

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Am J Orthod

Athembeschlag als Hülfsmittel zur Diagnose der nasalen Stenose

Arch Laryngol

Die exackte Messung der Luftdurchgängligkeit der Nase

Arch Laryngol

Mouth breathing and malocclusion: quantitative technique for measurement of oral and nasal airflow velocities

Angle Orthod

Adenoids: their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition

Acta Otolaryngol (Stockh).

Effects of adenoidectomy on the dentition and facial skeleton over a period of five years

Adenoid obstruction of the nasopharynx

Hals-Nasen-Ohren-ärztliche Befunde beim offenen Biss

Fortschr Kieferorthop

Adenoide — ein kausaler Faktor beim vertikalen Wachstumsmuster?

Fortschr Kieferorthop

The nasal airway and hearing in patients with cleft palate

Acta Otolaryngol

Original article
Airway adequacy, head posture, and craniofacial morphology