Facial morphological characteristics of mouth breathers vs. nasal breathers: A systematic review and meta‑analysis of lateral cephalometric data

Zheng,Weiying; Zhang,Xi; Dong,Jiazeng; He,Jianming

doi:10.3892/etm.2020.8611

Facial morphological characteristics of mouth breathers vs. nasal breathers: A systematic review and meta‑analysis of lateral cephalometric data

Authors:
- Weiying Zheng
- Xi Zhang
- Jiazeng Dong
- Jianming He
View Affiliations

Affiliations: Department of Stomatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
Published online on: March 19, 2020 https://doi.org/10.3892/etm.2020.8611
Pages: 3738-3750
Copyright: © Zheng et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present systematic review and meta‑analysis was performed to assess the association between mouth breathing and facial morphological characteristics in children and adolescents. PubMed, Medline, Scopus and Google Scholar databases were searched for cross‑sectional case‑control studies published between 1st January 1980 and 1st April 2019. Studies comparing cephalometric data of mouth breathers and nasal breathers were included, while studies on adults were excluded. Meta‑analysis was performed regarding 11 angular and 4 linear measurements. A total of 19 studies were included in the systematic review and data from 18 studies were extracted for the meta‑analysis. The results indicated statistically significant decreases in Sella‑Nasion‑Point A (SNA) angle [mean difference (MD)=‑1.33; 95% CI ‑2.03 to ‑0.63; P=0.0002] and Sella‑Nasion‑Point B (SNB) angle of mouth breathers as compared to nasal breathers (MD=‑1.33; 95% CI ‑2.18 to ‑0.49; P=0.002). There was no difference in Point A‑Nasion‑Point B (ANB) angle between the two groups (MD=0.25; 95% CI ‑0.26 to 0.75; P=0.34). Mouth breathers demonstrated an increased mandibular plane angle, total and lower anterior facial height and decreased posterior facial height. Within the limitations of the study, the results indicated that mouth breathers tended to have a retrognathic maxilla and mandible, vertical growth pattern with high mandibular plane angle, downward and backward rotation of the mandible and an increase in total and lower anterior facial height and decrease in posterior facial height. Further high‑quality studies are required to strengthen the evidence on this subject.

View Figures

View References

1	Warren DW: Effect of airway obstruction upon facial growth. Otolaryngol Clin North Am. 23:699–712. 1990.PubMed/NCBI
2	Moss ML and Salentijn L: The primary role of functional matrices in facial growth. Am J Orthod. 55:566–577. 1969.PubMed/NCBI View Article : Google Scholar
3	Bakor SF, Enlow DH, Pontes P and De Biase NG: Craniofacial growth variations in nasal-breathing, oral-breathing, and tracheotomized children. Am J Orthod Dentofacial Orthop. 140:486–492. 2011.PubMed/NCBI View Article : Google Scholar
4	Harari D, Redlich M, Miri S, Hamud T and Gross M: The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope. 120:2089–2093. 2010.PubMed/NCBI View Article : Google Scholar
5	Sousa JB, Anselmo-Lima WT, Valera FC, Gallego AJ and Matsumoto MA: Cephalometric assessment of the mandibular growth pattern in mouth-breathing children. Int J Pediatr Otorhinolaryngol. 69:311–317. 2005.PubMed/NCBI View Article : Google Scholar
6	Ucar FI, Ekizer A and Uysal T: Comparison of craniofacial morphology, head posture and hyoid bone position with different breathing patterns. Saudi Dent J. 24:135–141. 2012.PubMed/NCBI View Article : Google Scholar
7	Agostinho HA, Furtado IÃ, Silva FS and Ustrell Torrent J: Cephalometric evaluation of children with allergic rhinitis and mouth breathing. Acta Med Port. 28:316–21. 2015.PubMed/NCBI View Article : Google Scholar
8	Basheer B, Hegde KS, Bhat SS, Umar D and Baroudi K: Influence of mouth breathing on the dentofacial growth of children: A cephalometric study. J Int Oral Health. 6:50–55. 2014.PubMed/NCBI
9	Cuccia AM, Lotti M and Caradonna D: Oral breathing and head posture. Angle Orthod. 78:77–82. 2008.PubMed/NCBI View Article : Google Scholar
10	Frasson JM, Magnani MB, Nouer DF, de Siqueira VC and Lunardi N: Comparative cephalometric study between nasal and predominantly mouth breathers. Braz J Otorhinolaryngol. 72:72–81. 2015.PubMed/NCBI View Article : Google Scholar
11	Fields HW, Warren DW, Black K and Phillips CL: Relationship between vertical dentofacial morphology and respiration in adolescents. Am J Orthod Dentofacial Orthop. 99:147–154. 1991.PubMed/NCBI View Article : Google Scholar
12	Vig KW: Nasal obstruction and facial growth: The strength of evidence for clinical assumptions. Am J Orthod Dentofacial Orthop. 113:603–611. 1998.PubMed/NCBI View Article : Google Scholar
13	Welch V, Petticrew M, Tugwell P, Moher D, O'Neill J, Waters E and White H: PRISMA-Equity Bellagio group: PRISMA-equity 2012 extension: Reporting guidelines for systematic reviews with a focus on health equity. PLoS Medicine. 9(e1001333)2012.PubMed/NCBI View Article : Google Scholar
14	Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP and Major PW: Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: A systematic review and meta-analysis. J Am Dent Assoc. 144:269–277. 2013.PubMed/NCBI View Article : Google Scholar
15	Franco LP, Souki BQ, Pereira TB, Meyge de Brito G, Gonçalves Becker HM and Pinto JA: Is the growth pattern in mouth breathers comparable with the counterclockwise mandibular rotation of nasal breathers? Am J Orthod Dentofacial Orthop. 144:341–348. 2013.PubMed/NCBI View Article : Google Scholar
16	Valera FC, Travitzki LV, Mattar SE, Matsumoto MA, Elias AM and Anselmo-Lima WT: Muscular, functional and orthodontic changes in pre school children with enlarged adenoids and tonsils. Int J Pediatr Otorhinolaryngol. 67:761–770. 2003.PubMed/NCBI View Article : Google Scholar
17	Zicari AM, Albani F, Ntrekou P, Rugiano A, Duse M, Mattei A and Marzo G: Oral breathing and dental malocclusions. Eur J Paediatr Dent. 10:59–64. 2009.PubMed/NCBI
18	Lione R, Buongiorno M, Franchi L and Cozza P: Evaluation of maxillary arch dimensions and palatal morphology in mouth-breathing children by using digital dental casts. Int J Pediatr Otorhinolaryngol. 78:91–95. 2014.PubMed/NCBI View Article : Google Scholar
19	Rossi RC, Rossi NJ, Rossi NJ, Yamashita HK and Pignatari SS: Dentofacial characteristics of oral breathers in different ages: A retrospective case-control study. Prog Orthod. 16(23)2015.PubMed/NCBI View Article : Google Scholar
20	Ung N, Koenig J, Shapiro PA, Shapiro G and Trask G: A quantitative assessment of respiratory patterns and their effects on dentofacial development. Am J Orthod Dentofacial Orthop. 98:523–532. 1990.PubMed/NCBI View Article : Google Scholar
21	Jakobsone G, Urtane I and Terauds I: Soft tissue profile of children with impaired nasal breathing. Stomatologija. 8:39–43. 2006.PubMed/NCBI
22	Cheng MC, Enlow DH, Papsidero M, Broadbent BH Jr, Oyen O and Sabat M: Developmental effects of impaired breathing in the face of the growing child. Angle Orthod. 58:309–320. 1988.PubMed/NCBI View Article : Google Scholar
23	Trask GM, Shapiro GG and Shapiro PA: The effects of perennial allergic rhinitis on dental and skeletal development: A comparison of sibling pairs. Am J Orthod Dentofacial Orthop. 92:286–293. 1987.PubMed/NCBI View Article : Google Scholar
24	Faria PT, de Oliveira Ruellas AC, Matsumoto MA, Anselmo-Lima WT and Pereira FC: Dentofacial morphology of mouth breathing children. Braz Den J. 13:129–132. 2002.PubMed/NCBI View Article : Google Scholar
25	Mattar SE, Anselmo-Lima WT, Valera FC and Matsumoto MA: Skeletal and occlusal characteristics in mouth-breathing pre-school children. J Clin Pediatr Dent. 28:315–318. 2004.PubMed/NCBI View Article : Google Scholar
26	Juliano ML, Machado MA, Carvalho LB, Prado LB and do Prado GF: Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome. Arq Neuropsiquiatr. 67:860–865. 2009.PubMed/NCBI View Article : Google Scholar
27	Malhotra S, Pandey RK, Nagar A, Agarwal SP and Gupta VK: The effect of mouth breathing on dentofacial morphology of growing child. J Indian Soc Pedod Prev Dent. 30:27–31. 2012.PubMed/NCBI View Article : Google Scholar
28	Chung Leng Muñoz I and Beltri Orta P: Comparison of cephalometric patterns in mouth breathing and nose breathing children. Int J Pediatr Otorhinolaryngol. 78:1167–1172. 2014.PubMed/NCBI View Article : Google Scholar
29	El Aouame A, Daoui A and El Quars F: Nasal breathing and the vertical dimension: A cephalometric study. Int Orthod. 14:491–502. 2016.PubMed/NCBI View Article : Google Scholar
30	Chambi-Rocha A, Cabrera-Domínguez ME and Domínguez-Reyes A: Breathing mode influence on craniofacial development and head posture. J Pediatr (Rio J). 94:123–130. 2018.PubMed/NCBI View Article : Google Scholar
31	Bresolin D, Shapiro PA, Shapiro GG, Chapko MK and Dassel S: Mouth breathing in allergic children: Its relationship to dentofacial development. Am J Orthod. 83:334–340. 1983.PubMed/NCBI View Article : Google Scholar
32	Lessa FC, Enoki C, Feres MF, Valera FC, Lima WT and Matsumoto MA: Breathing mode influence in craniofacial development. Braz J Otorhinolaryngol. 71:156–160. 2005.PubMed/NCBI View Article : Google Scholar
33	D'Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N and Manzini M: Craniofacial growth in children with nasal septum deviation: A cephalometric comparative study. Int J Pediatr Otorhinolaryngol. 74:1180–1183. 2010.PubMed/NCBI View Article : Google Scholar
34	Souki BQ, Lopes PB, Pereira TB, Franco LP, Becker HM and Oliveira DD: Mouth breathing children and cephalometric pattern: Does the stage of dental development matter? Int J Pediatr Otorhinolaryngol. 76:837–841. 2012.PubMed/NCBI View Article : Google Scholar
35	Linder-Aronson S: Respiratory function in relation to facial morphology and the dentition. Br J Orthod. 6:59–71. 1979.PubMed/NCBI View Article : Google Scholar
36	Ricketts RM: Forum on the tonsil and adenoid problem in orthodontics respiratory obstruction syndrome. Am J Orthod. 54:495–507. 1968.PubMed/NCBI