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UPPER AIRWAY

    • The airpressure theory described by Kantorowicz (1916) and James & Hastings (1932) holds that a change to mouth breathing causes the normal negative pressure in the anteriorly sealed oral cavity produced by nasal respiration to be lost, and the palate thus is not carried downward with the growth of the maxillary alveolar process.
    • The excavation theory proposed by Bloch (1903) and Michel (1908) states that an upward stream of oral airflow presses on the palate leading to higher palatal vault.
    •     Recent study by Chang proposed that the degree of impact caused by nasal obstruction may vary with different facial types. A brachycephalic or broad faced pattern with strong facial musculature and a deep bite may be less affected by nasal obstruction, whereas dolicocephalic faces with narrow, more elongated pattern may be more susceptible.
  • Although the literature is replete with statements that airway impairment alters facial and dental growth, there is substantial evidence to the contrary. Conversely, Bushey found no relationship between nasal respiration and linear measurements of the adenoids on lateral skull cephalograms before and after surgical removal of the tonsils and adenoids. As opposed to these studies, Kingsley (1989) noted normal craniofacial development in children with severe nasal obstruction and Whitaker described severe palate malformations in patients who had undergone adenoidectomy at an early age.

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