Changes in head posture after rapid maxillary expansion in patients with nasopharyngeal obstruction

Abstract

Introduction: Nasopharyngeal obstruction is an important etiologic factor in the development of an extreme vertical growth facial pattern, and insufficient transversal growth of the maxilla. The treatment outcomes associated with rapid maxillary expansion in the literature are mainly discussed in terms of changes in dentofacial morphology, without special reference to changes in the pharyngeal airway, the position of the mandible, hyoid bone and the tongue.

Changes in head posture after rapid palatal expansion in mouth-breathing children.

“…Kjurchieva-Chuchkova et al observed a statistically significant change in the head posture and decrease in craniocervical angulation, especially at the downward opening angle between OPT and palatal lines (4.07, for PP-OPT angle) and angle interaction between the upper part of the cervical spine and palatal plane (4.95 degrees for PP/CVT angle). The findings of this study are not in accordance with our investigation [5].…”

“…In the orthodontic literature, Melvin Moss introduced, for the first time, the "functional matrix". He claimed that the facial development and growth of the individual is correlated to the functional activity of various structures of the head and neck, then it can be stated that oral respiration results in physiological changes of the facial skeleton and in addition in malocclusions [4][5][6].…”

“…Longitudinal studies, for example Linder-Aronson and co-workers have shown that patients with enlarged adenoids, tonsils, or other forms of airway obstruction have different craniofacial growth than patients who do not present airway obstruction in their history. Two months after adenoidectomy, Solow and Greve, as well as Woodside and Linder-Aronson, found a 2-degree decrease in craniocervical angle and the postural discrepancies between the control group and the children with various respiratory diseases were eliminated [8][9][10][11].The typical extraoral appearance of children with respiratory impairment caused by chronic nasopharyngeal obstruction is called ''adenoid facies'', which includes open mouth posture, hypotonic lips, compression of the upper arch, decreased transverse dimension of the maxilla, high palate vault, lateral occlusal bite and increased lower facial height [5]. Given that the typical malocclusion associated with respiratory obstruction is characterized by a transverse decrease in the palatal dimension, the primary method used to treat the insufficient transverse dimension of the maxillary base is rapid maxillary expansion (RME), which was introduced by Angell in the 1860s to treat maxillary compression [12][13][14].…”