Устно дишане – функционални и морфологични проблеми критичен анализ на литературата /литературен обзор/

Кранио-фациалното развитието е зависимо от епигенетични и функционални фактори, а също и локално действащи сили. тези нарушения са обект на изследване и лечение от различни здравни специалисти и е необходимо те да са запознати със съвремените методи използвани за диагностика от различните специалности. дишането през устата е един от най- честите вредни орални навици при деца, което най-често е резултат от обструкция в различните отдели на горните дихателни пътища. ортодонтите обикновено са първите специалисти, които регистрират тези проблеми и насочват за консултация към оториноларинголози или педиатри. затова за тях е важна информацията за възрастовите физиологични и патологични промени, които настъпват в развитието на лимфните орални структури. използваните в диагностиката от унг специалисти рентгенови методи в повечето случаи са идентични с тези използвани в ортодонтията, например СвСт. Следователно екипа, които провежда това интердисциплинарното лечение е нужно да изгради единна концепция за лечебния план на базата на общите си познания.

Литературният обзор има за цел да предостави обобщение на последните публикации по отношение на иновативните техники за установяване обструкции в горните дихателни пътища, които ортодонтите трябва да познават, за да насочват правилно своите пациенти, и да опише накратко връзката им с ортодонтската диагностика на проблема.

д-р Емануел Емилиянов
Катедра по Ортодонтия Факултет по Дентална Медицина Медицински Университет, София Бул.“Св. Георги Софийски” No 1 София 1431, България
e-mail: emanuelemilianov@gmail.com

1. Abreu RR, Rocha RL, Lamounier JA, Guerra AF. Prevalence of mouth breathing among children. J Pediatr. (2008) 84:467–70. 2. Alabdullah M, Saltaji H, Abou-Hamed H, Youssef M. Association between facial growth pattern and facial muscle activity: A prospective cross-sectional study. Int Orthod. 2015 Jun;13(2):181-194.
3. Arambula A, Brown JR, Neff L. Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils. World J Otorhinolaryngol Head Neck Surg. (2021) 7:155–60.
4. Bhattacharyya, N., Blake, S. P., Fried, M. P. (2000). Assessment of the airway in obstructive sleep apnea syndrome with 3-dimensional airway computed tomography. Otolaryngology– Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 123(4), 444–449.
5. Bianchini AP, Guedes ZC, Vieira MM. A study on the relationship between mouth breathing and facial morphological pattern. Braz J Otorhinolaryngol. 2007 Jul-Aug;73(4):500-505. 6. Calvo-Henríquez, C., Martins-Neves, S., Faraldo-García, A., Ruano-Ravina, A., Rocha, S., Mayo-Yáñez, M., & Martinez- Capoccioni, G. (2019). Are pediatricians and otolaryngologists well prepared to identify early signs of vertical facial growth? International Journal of Pediatric Otorhinolaryngology, 119, 161–165.
7. Cardoso De Melo, A. C., de Oliveira, A., Gomes, C., Santos Cavalcanti, A., & Justino Da Silva, H. (2015). Acoustic rhinometry in mouth breathing patients: a systematic review, Acoustic rhinometry in mouth breathing patients. Braz J Otorhinolaryngol, 81(2), 212–218.
8. de Backer, J. W., Vanderveken, O. M., Vos, W. G., Devolder, A., Verhulst, S. L., Verbraecken, J. A., Parizel, P. M., Braem, M.J., van de Heyning, P. H., & de Backer, W. A. (2007). Functional imaging using computational fluid dynamics to predict treatment success of mandibular advancement devices in sleep-disordered breathing. Journal of Biomechanics, 40(16), 3708–3714.
9. De Menezes VA, Leal RB, Pessoa RS, Pontes RM. Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-recife, 2005. Braz J Otorhinolaryngol. (2006) 72:394–9.
10. Dixit, U., & Shetty, R. (2013). Comparison of soft-tissue, dental, and skeletal characteristics in children with and without tongue thrusting habit. Contemporary Clinical Dentistry, 4(1), 2–6.
11. Emslie, R. D., London, B. D. S. (, Massler, M., & Zwemer, J. D. (1952). Mouth breathing: I. Etiology and effects (a review). The Journal of the American Dental Association, 44, 506–521.
12. Felcar JM, Bueno IR, Massan AC, Torezan RP, Cardoso JR. Prevalence of mouth breathing in children from an elementary school. Cien Saude Colet. (2010) 15:437–44.
13. Festa, P., Mansi, N., Varricchio, A. M., Savoia, F., Calì, C., Marraudino, C., de Vincentiis, G. C., & Galeotti, A. (2021). Association between upper airway obstruction and malocclusion in mouth-breathing children. Acta Otorhinolaryngologica Italica : Organo Ufficiale Della Societa Italiana Di Otorinolaringologia e Chirurgia Cervico-Facciale, 41(5), 436–442.
14. Fraga WS, Seixas VM, Santos JC, Paranhos LR, Cesar CP.
Mouth breathing in children and its impact in dental malocclusion: a systematic review of observational studies. Minerva Stomatol. (2018) 67:129–38.
15. Fujimoto, S., Yamaguchi, K., & Gunjigake, K. (2009). Clinical estimation of mouth breathing. American Journal of Orthodontics and Dentofacial Orthopedics: Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, 136(5), 630. e1-630.e7.
16. Galeotti A, Festa P, Viarani V, D‘Anto V, Sitzia E, Piga S, et al. Prevalence of malocclusion in children with obstructive sleep apnoea. Orthod Craniofac Res. (2018) 21:242–7.
17. Gokce, G., Veli, I., Kemal Yuce, Y., & Isler, Y. (2020). Efficiency evaluation of rapid maxillary expansion treatment on nasal septal deviation using tortuosity ratio from cone-beam computer tomography images. Computer Methods and Programs in Biomedicine, 188, 105260.
18. Gomez-Gonzalez, C., Gonzalez-Mosquera, A., Alkhraisat, M.H., Anitua, E. Mouth Breathing and Its Impact on Atypical Swallowing: A Systematic Review and Meta-Analysis. Dent. J. 2024, 12, 21.
19. Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R. Association between oral habits, mouth breathing and malocclusion. Acta Otorhinolaryngologica Italica. 2016; 36:386-394.
20. Hartgerink, D. v., Vig, P. S., Orth, D., & Abbott, D. W. (1987). The effect of rapid maxillary expansion on nasal airway resistance. American Journal of Orthodontics and Dentofacial Orthopedics: Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, 92(5), 381–389.
21. Isaacson G, Parikh T. Developmental anatomy of the tonsil and its implications for intracapsular tonsillectomy. Int J Pediatr Otorhinolaryngol. 2008; 72:89 e96.
22. Iwasaki T, Sato H, Suga H, Takemoto Y, Inada E, Saitoh I, et al. Relationships among nasal resistance, adenoids, tonsils, and tongue posture and maxillofacial form in class II and class III children. Am J Orthod Dentofacial Orthop. (2017) 151:929–40. 23. Iwasaki T, Sugiyama T, Yanagisawa-Minami A, Oku Y, Yokura A, Yamasaki Y. Effect of adenoids and tonsil tissue on pediatricobstructive sleep apnea severity determined by computational fluid dynamics. J Clin Sleep Med. (2020) 16:2021–8.
24. Keitoku, M., Yonemitsu, I., Ikeda, Y., Tang, H., & Ono, T. (2022). Differential Recovery Patterns of the Maxilla and Mandible after Eliminating Nasal Obstruction in Growing Rats. Journal of Clinical Medicine, 11(24).
25. Kelly JT, Prasad AK, Wexler AS. Detailed flow patterns in the nasal cavity. J Appl Physiol. 2000;89(1):323–37.
26. Kim, Y. J., Hong, J. S., Hwang, Y. I., & Park, Y. H. (2010). Three-dimensional analysis of pharyngeal airway in preadolescent children with different anteroposterior skeletal patterns. American Journal of Orthodontics and Dentofacial Orthopedics, 137(3), 306.e1-306.e11.
27. Koca, C. F., Erdem, T., & Baylndlr, T. (2016). The effect of adenoid hypertrophy on maxillofacial development: an objective photographic analysis. Journal of Otolaryngology – Head & Neck Surgery = Le Journal d’oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, 45(1).
28. Lin L, Zhao T, Qin D, Hua F and He H (2022) The impact of mouth breathing on dentofacial development: A concise review. Front. Public Health 10:929165.
29. Luzzi V, Ierardo G, Viscogliosi A, Fabbrizi M, Consoli G, Vozza I, et al. Allergic rhinitis as a possible risk factor for malocclusion: a case-control study in children. Int J Paediatr Dent. (2013) 23:274–8.
30. Niinimaa, V., Cole, P., Mintz, S., & Shephard, R. J. (1980). The switching point from nasal to oronasal breathing. Respiration Physiology, 42(1), 61–71.
31. Nosetti, L., Zaffanello, M., de Bernardi di Valserra, F., Simoncini, D., Beretta, G., Guacci, P., Piacentini, G., & Agosti, M. (2023). Exploring the Intricate Links between Adenotonsillar Hypertrophy, Mouth Breathing, and Craniofacial Development in Children with Sleep-Disordered Breathing: Unraveling the Vicious Cycle. Children (Basel, Switzerland), 10(8).
32. Osorio, F., Perilla, M., Doyle, D. J., Palomo, J. M. (2008). Cone beam computed tomography: an innovative tool for airway assessment. Anesthesia and Analgesia, 106(6), 1803–1807.
33. Pawłowska-Seredyńska, K., Umławska, W., Resler, K., Morawska-Kochman, M., Pazdro-Zastawny, K., & Kręcicki, T. (2020). Craniofacial proportions in children with adenoid or adenotonsillar hypertrophy are related to disease duration and nasopharyngeal obstruction. International Journal of Pediatric Otorhinolaryngology, 132.
34. Petraccone Caixeta AC, Andrade I Jr, Bahia Junqueira Pereira T, Franco LP, Becker HM, Souki BQ. Dental arch dimensional changes after adenotonsillectomy in prepubertal children. Am J Orthod Dentofacial Orthop. 2014 Apr;145(4):461- 8.
35. Sano, M., Sano, S., Kato, H., Arakawa, K., Arai, M. (2018). Proposal for a screening questionnaire for detecting habitual mouth breathing, based on a mouth-breathing habit score. BMC Oral Health, 18(1).

36. Santos Barrera, M.;Ribas-Perez, D.; Caleza Jimenez, C.; Cortes Lillo, O.; Mendoza-Mendoza, Oral Habits in Childhood and Occlusal Pathologies: A Cohort Study. Clin. Pract. 2024, 14, 718–728.
37. Shi, H., Scarfe, W. C., & Farman, A. G. (2006). Upper airway segmentation and dimensions estimation from cone-beam CT image datasets. International Journal of Computer Assisted Radiology and Surgery, 1(3), 177–186.
38. Souki, B. Q., Pimenta, G. B., Souki, M. Q., Franco, L. P., Becker, H. M. G., & Pinto, J. A. (2009). Prevalence of malocclusion among mouth breathing children: do expectations meet reality? International Journal of Pediatric Otorhinolaryngology, 73(5), 767–773.
39. Tang H, Liu Q, Lin JH, Zeng H. Three-dimensional morphological analysis of the palate of mouth-breathing children in mixed dentition. Hua Xi Kou Qiang Yi Xue Za Zhi. (2019) 37:389–93.
40. Tso, H. H., Lee, J. S., Huang, J. C., Maki, K., Hatcher, D., & Miller, A. J. (2009). Evaluation of the human airway using cone- beam computerized tomography. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 108(5), 768–776.
41. Urbankowski, T., & Przybyłowski, T. (2016). Methods of airway resistance assessment. Pneumonol Alergol Pol, 84, 134– 141.
42. Valera FC, Travitzki LV, Mattar SE, Matsumoto MAN, Elias AM, Anselmo-Lima WT. Muscular, functional and orthodontic changes in preschool children with enlarged adenoids and tonsils. International Journal of Pediatric Otorhinolaryngology. 2003; 67:761-770.
43. Vig, K. W. L., & Columbus, D. (1998). Nasal obstruction and facial growth: The strength of evidence for clinical assumptions. Am J Orthod Dentofacial Orthop, 113, 603–614.
44. Vogler RC, Ii FJ, Pilgram TK. Age-specific size of the normal adenoid pad on magnetic resonance imaging. Clin Otolaryngol Allied Sci. (2000) 25:392–5.
45. Wang H, Qiao X, Qi S, Zhang X, Li S. Effect of adenoid hypertrophy on the upper airway and craniomaxillofacial region. Transl Pediatr. (2021) 10:2563–72.
46. Xu, C., Sin, S. H., McDonough, J. M., Udupa, J. K., Guez, A., Arens, R., & Wootton, D. M. (2006). Computational fluid dynamics modeling of the upper airway of children with obstructive sleep apnea syndrome in steady flow. Journal of Biomechanics, 39(11), 2043–2054.
47. Zelano, C., Jiang, H., Zhou, G., Arora, N., Schuele, S., Rosenow, J., & Gottfried, J. A. (2016). Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function. Journal of Neuroscience, 36(49), 12448–12467.
48. Zhao, T., Zhou, J., Yan, J., Cao, L., Cao, Y., Hua, F., & He, H. (2021). Automated Adenoid Hypertrophy Assessment with Lateral Cephalometry in Children Based on Artificial Intelligence. Diagnostics (Basel, Switzerland), 11(8).