Interdisciplinary Treatment for the Mouth-Breathing Child: a case report.

Abstract

Mouth breathing exhibits a prevalence ranging from 11- 56% in children. Its primary etiology is adenotonsillar hypertrophy. It is associated with obstructive sleep apnea, nocturnal enuresis, snoring, bruxism, dental caries, and poor academic performance. This condition leads to alterations in facial growth and maxillary development, resulting in narrow dental arches and a high, deep palate. The approach should be interdisciplinary, encompassing symptomatic medical treatment or surgical intervention combined with maxillary expansion (ME), involving pediatricians, otolaryngologists (ENT), and pediatric dentists. Two clinical cases of female patients aged 8 and 9 years are presented. In the first case, palatal disjunction was performed using a Hyrax expander, along with non-surgical treatment by ENT, resulting in improvements in maxillary configuration, mandibular position, facial characteristics, and respiration. In the second case, during the initial phase of treatment, a surgical approach was undertaken: adenotonsillectomy followed by maxillary expansion using a Quad-helix expander; in the second phase, functional orthopedic therapy was implemented, achieving improvements in labial tone and maxillary configuration. Interdisciplinary treatment for mouth-breathing patients is essential, including accurate diagnosis and management of the underlying etiology as well as its consequences on maxillary and facial growth. ME combined with ENT treatment allows for the correction of the airway obstruction's cause initially, subsequently achieving appropriate maxillary configuration that promotes nasal breathing and optimal craniofacial development. The individualization of treatment should consider factors such as etiology, level of obstruction, allergic history, dental occlusion, maxillary morphology, and facial growth patterns. Both reported cases demonstrated satisfactory outcomes with the employed therapies.