Dentofacial Abnormalities May Arise From Adenoid Hypertrophy

The Effects of Enlarged Adenoids on Dentofacial Developments

The Effects of Enlarged Adenoids on Dentofacial Developments - Adenoid Hypertrophy and Its Negative Health Effects Depending on the adenoid hypertrophy in children, the following changes may occur in the jaw and tooth structure - The Mouth Breathing Syndrome (MBS) - How to Evaluate the Size of The Adenoid? - Adenoid graphy (lateral cephalometic radiograph) - How should the lateral cephalometic radiograph be? - How Should Treatment Be Berformed in Patients With Changes in The Jaw and Tooth Structure Due to Adenoid Hypertrophy? - When Does Adenoid Growth Stop Spontaneously? - Don't Wait To Structural Change For Treatment of Severe Adenoid Hypertrophy!

Adenoid Hypertrophy and Its Negative Health Effects

During the child's development, active immunological processes can be caused by tonsils and adenoid hypertrophy, especially between 1-4 years of age (up to 6 years of age). Tonsiller and adenoid hypertrophy are the most common causes of upper airway obstruction in young children. Occlusion decreases the depth of the oropharynx and thus reduces the posture of the hypoid bone, which forces the tongue to stand out and causes a compensatory change in the child's breathing mode. Furthermore, upper airway obstruction and altered breathing pattern can potentially affect the tooth surface growth of the child.
Dentofacial changes associated with nasal airway obstruction have been identified by CV Tomes in 1872 as an "adenoid face" (see source links below). Prolonged mouth causes different effects in teeth and jaw bones in children due to sleep. Information on adenoid hypertrophy-related symptoms and adenoidectomy operation can be found at the end of the page.

With the mouth open, the lower jaw lagging behind may cause the tongue position to be lower and lower than normal. The pressure in the tongue and the imbalance between the muscles on the cheeks cause the cheek muscles to press the alveolar pro- cess in the premolar region. Simultaneously, it causes the lower jaw position to be reversed, which is called the "compressor theory". The jaw structure and tooth structure changes caused by nasal obstruction are tried to be explained with different theories.

Depending on the adenoid hypertrophy in children, the following changes may occur in the jaw and tooth structure

• Orthodontic problems (anterior open bite and posterior crossbite) such as the upper teeth leading to the lower teeth and the jaw failure malocclusion (pseudo-skeletal discrepancies)

• The narrow jaw and the deep jaw (dome palate) - increased palate depth and narrowing of the upper dental arch

• When looking at the front, children with large nasal fever, a meaningless and dull facial expression may occur. This condition, which is referred to as Adenoid face, is caused by the fact that air cannot be taken from the nose for a long time.

• Teeth distortion, dental caries and gum diseases

The relationship between airway obstruction and tooth surface structures / malocclusion and its effect on face growth is still being investigated.

The Mouth Breathing Syndrome (MBS)

Mouth Respiratory Syndrome (MBS) is characterized by chronic mouth breathing (MB) or mixed breathing pattern caused by nasal obstruction or inflammatory factors that may be present in half of school children.

Respiration is one of the vital functions of the body and under physiological conditions breathing occurs through the nose. Only oral breathing patterns are rare or absent. MBS usually causes facial abnormalities, abnormal positioning of teeth and body postures, and cardiorespiratory and endocrine diseases, sleep and mood disorders, and a decrease in school performance in children. In addition, MBS is associated with genetic factors, unhealthy oral habits and nasal obstructions, and its severity and duration may vary according to these factors.

How to Evaluate the Size of The Adenoid?

The size of the nasopharyngeal space and adenoid can be evaluated using different assessment methods:

1. Determination of X-ray (lateral cephalometric) of x-rayographic adenoid / nasopharyngeal
2. Flexible optical endoscopes
3. Acoustic rhinometry
4. Direct measurements during surgery

Generally, pediatric endoscopes or flexible endoscopes can be used in children, and the rate at which the nasal vein closes the airway hole at the back of the nose can be seen.

Roughly in the nasal endoscopic examination, in a patient without any previous airway stenosis, if there is severe nasal congestion, there is usually a generalized flesh growth (rarely cysts and a condition called choanal atresia, the nose may be obstructed due to a problem at the back).

Adenoid graphy (lateral cephalometic radiograph)

A lateral cephalometic radiograph is a value-added diagnostic tool for the orthodontist to assess children with upper airway obstruction. Attention should be paid not to take unnecessary films about the evaluation of children using thyroid and neck imaging techniques. On the above radiograph, adenoid hypertrophy seems to completely close the airway.

How should the lateral cephalometic radiograph be?

For the evaluation of the adenoid, a lateral x-ray is taken in the soft tissue dose and the mouth in the open position. Clinical evaluation is not easy to visualize indirectly adenoid tissue in children and is sometimes impossible. Therefore, the radiographic image in the nasopharynx profile provides objective, precise and easy measurements. Accurate positioning of the patient during radiography is paramount; patients should not cry or swallow because they cause softening of the palate. Adenoid palpation is not a reliable method of measurement and is very traumatic for children. Radiological imaging provides more information compared to palpation. Because of the radiation, instead of graphy taken, more frequent endoscopic examination is preferred.

How Should Treatment Be Berformed in Patients With Changes in The Jaw and Tooth Structure Due to Adenoid Hypertrophy?

Depending on the adenoid hypertrophy, it is true that patients who have had long-term exhaled breathing and who have undergone the aforementioned changes follow the following path:

• Treatment of nasal obstruction and other nasal congestion

• Dentistry (rapid maxillary expander) placement and orthodontic dental treatment, where the patient is seen by a dentist and if necessary expanding the upper jaw sideways

• Appropriate removal of obstructive factors, normalization of respiratory patterns, positive stimulation of balanced tooth growth, and increased stability of orthodontic treatment

• Adenoidectomy for children with severe airway obstruction or obstructive sleep apnea syndrome and tonsillectomy (tonsillectomy) are recommended.

• In studies conducted on patients with changes in the tooth and jaw structure, no definitive results have been reported for normalizing the size of the tooth arch after adenoidectomy or tonsillectomy in children with respiratory tract obstruction. Since the effect of surgery is limited, other treatments such as functional training or orthodontic maxillary enlargement should be considered after the removal of blockages in the airways. In other words, normalization of airways and obstructions must be eliminated before these negative changes occur in children.

When Does Adenoid Growth Stop Spontaneously?

Lymphoid tissue usually develops rapidly after birth; It reaches the peak size in early childhood and begins to decline at about 8 to 10 years of age. Excessive growth in some children may cause obstruction in the pharyngeal airway which may cause respiratory, sleep, feeding, speech and swallowing disorders. Any upper airway obstruction (such as nasal sinus pathologies or hypertrophy of Waldeyer's lymphatic ring) may cause the patient to breathe through the mouth. Oral respiration creates an imbalance between the forces applied by the cheek's cheek and tongue; thus it causes morphological and growth-related changes in the craniofacial complex.

Don't Wait To Structural Change For Treatment of Severe Adenoid Hypertrophy!

In other words, it is always possible that if there is adenoid hypertrophy in your child, it is likely that there will be relief after 8-10 years of age and if all the patients with jaw-tooth structural changes can be removed with surgical treatment Note that there will not be.

A common effort by the, orthodontist, otolaryngologist and pediatrician is necessary to reduce the continuing detrimental effects of the facial features of respiratory disorders.

Similar links about "tonsil and adenoid disease" >>

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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