Induced oral breathing and craniocervical postural relations: an experimental study in healthy young adults

Thoracic-lumbar-sacral spine sagittal alignment and cranio-mandibular morphology in adolescents

PURPOSE

The relationship between thoracic-lumbar-sacral spine sagittal alignment and craniofacial morphology is still controversial. Evidence-based results are difficult to obtain and scientific studies are inhomogeneous. The aim of this study was to investigate the difference of thoracic-lumbar-sacral spine posture and cephalometric values comparing two groups of subjects with different cranial structure in the sagittal plane.

METHODS

Eighty-one subjects were consecutively selected and divided into two groups, according to the orientation of the condyle-orbital plane (CoOr) with respect to the superior maxilla (SpP): Group1: 49 subjects 11.6 (2.1) years showing posterior-rotation of CoOr: SpP^CoOr ≤ -2°, -4.1°(2.1°); Group2: 32 subjects 12.9 (2.3)years showing anterior-rotation of CoOr: SpP^CoOr ≥ 2°, 3.7°(1.9°). Each patient underwent in blinding, Spinal Mouse recording and cephalometry of the skull.

RESULTS

Group1 showed a significant forward tilting of the spine 4.4°(1.8°) with respect to Group2 2.4°(1.3°) (p < 0.0001) and higher values related to the vertical dimension of the skull: higher maxillary divergency (p < 0.0001), steep occlusal plane (p < 0.0007), higher gonial angle (p < 0.001).

DISCUSSION

The results of this study showed a difference in the thoracic-lumbar-sacral spine inclination between groups with different craniofacial morphology. The achievement of this outcome is important to improve our multidisciplinary evaluation and treatment planning.

Nasal patency and craniocervical posture in scholar children

ABSTRACT Changes in head posture have been observed as a compensatory mechanism for the nasal airflow impairment. This study aimed to compare the craniocervical posture between children with normal and decreased nasal patency and correlate nasal patency with craniocervical posture. Children aging from six to twelve years went through nasal patency and craniocervical assessments. The biophotogrammetric measures of craniocervical posture used were Cervical Distance (CD), Head Horizontal Alignment (HHA) and Flexion-Extension Head Position (FE), evaluated by SAPO software (v.0.68). Nasal patency was measured using Peak Nasal Inspiratory Flow meter (PNIF) and Nasal Obstruction Symptom Evaluation (NOSE) scale. One hundred thirty-three children were distributed into two groups: G1 (normal nasal patency - PNIF higher than 80% of predicted value) with 90 children; G2 (decreased nasal patency - PNIF lower than 80% of predicted value) with 43 children. Differences between groups were not found in CD and HHA measures. FE was significantly higher in G2 than G1 (p=0.023). Negative weak correlation between FE and %PNIF (r=-0.266; p=0.002) and positive weak correlation between CD and PNIF (r=0.209; p=0.016) were found. NOSE scores negatively correlated with PNIF (r=-0.179; p=0.039). Children with decreased nasal patency presented greater head extension. This postural deviation is prone to increase as nasal airflow decreases, thus indicating the relationship between craniocervical posture and nasal patency. Lower values of PNIF reflected on additional problems caused by nasal obstruction symptoms.

The measurement of craniocervical posture: a simple method to evaluate head position

OBJECTIVE

Some studies have correlated craniocervical posture (CCP) with pharyngeal airway space diameter, breathing conditions, neck pain, headache, dentofacial structures and temporomandibular disorders. Several methods have been suggested in an attempt to establish the best way of evaluating head position using teleradiographs and cephalometric analysis. The objectives of this study therefore were to describe a method of measuring the natural head position (NHP) without exposure to radiation or fixture of the cephalostat, and then to test whether there might be a simple method of reproducing this position in the cephalostat to make lateral cephalograms in the study of CCP.

METHODS

The sample consisted of 50 healthy children (28 females and 22 males with a mean age of 10.9+/-4.9 years). Each subject was asked to place their feet in a standardized positions (a 30 degrees angle between the medial border of the feet with heels together using a V-podalic stabilizer), to tilt the head backwards and forwards to a decreasing extent until a natural head balance was reached, to adopt a natural posture of the shoulders, and to allow both arms to hang free. A self-adhesive circular reflecting cutaneous marker was applied to three points to enable a better view of the landmarks: the most anterior point of the frontonasal suture (N), the auricular tragus (Tr) and the most prominent spinous process of the seventh cervical vertebra (C(7)). An operator marked the specific anatomical points of the children's profiles with a felt-tip pen on a mirror placed to one side of the patient and fixed on the wall: the N point, the Tr point, the most inferior point of the chin in the lateral view (Me) and the deepest point on the posterior contour of the cervical lordosis. A digital body posture measuring system captured a first image of each subject in NHP (T0). Five minutes later, with the same position and orientation of the feet, the operator placed the head of the subject in the cephalostat so that the new head position coincided with the head position previously registered in the mirror and a second picture was taken (T1). After a further 5min, the subject was asked to place himself in NHP again, similarly repositioning their own feet to check the precision of the method of positioning, and a third picture was taken (T2). Three craniocervical angular measurements were taken for head posture measurement: N-Tr-Vert, determined by the extended line from the N point to the Tr point and the vertical line projected onto the image by a line (Vert); C(7)-Tr-Vert, determined by the extended line from C(7) to Tr and Vert; and C(7)-Tr-N, the angle between C(7)-Tr line and Tr-N line. In order to determine the stability of all the measurements of head position at T1, T2 and T3, a paired-sample t-test was used using an alpha of 0.05 and a power of 0.90.

RESULTS

It was found that there were no statistically significant differences in head position between the pictures at T0, T1 and T2 (N-Tr-Vert, C(7)-Tr-Vert and C(7)-Tr-N, P>0.05).

CONCLUSION

This method was a good procedure for evaluating head posture without exposure to radiation. The results also suggest that a simple and rapid method can be used to apply a craniostat to the patient when a radiograph is required without modifying the NHP.

Clinical estimation of mouth breathing

INTRODUCTION

Breathing mode was objectively determined by monitoring airflow through the mouth, measuring nasal resistance and lip-seal function, and collecting information via questionnaire on the patient's etiology and symptoms of mouth breathing.

METHODS

The expiratory airflow through the mouth was detected with a carbon dioxide sensor for 30 minutes at rest. Fifteen men and 19 women volunteers (mean age, 22.4 +/- 2.5 years) were classified as nasal breathers, complete mouth breathers, or partial mouth breathers based on the mean duration of mouth breathing. Nasal resistance, lip-sealing function, and the subjective symptoms of mouth breathing ascertained by questionnaire were statistically compared by using 1-way and 2-way analysis of variance (ANOVA) and the chi-square test in the breathing groups.

RESULTS

Nasal resistance was significantly (P <0.05) greater for the mouth breathers than for the nasal breathers, and significantly (P <0.05) greater for the partial mouth breathers than for the complete mouth breathers. There were no significant differences in the subjective responses to questions about mouth breathing among the 3 groups.

CONCLUSIONS

Detecting airflow by carbon dioxide sensor can discriminate breathing mode. Degree of nasal resistance and subjective symptoms of mouth breathing do not accurately predict breathing mode.

Oral breathing and head posture

OBJECTIVE

To determine the head posture and cephalometric characteristics in oral breathing children.

MATERIALS AND METHODS

Lateral cephalograms taken in natural head posture of 35 oral breathing patients (OB) (mean age 8.8 +/- 2.2 years SD; range 5-13 years) and of 35 patients with varied malocclusions and physiological breathing (PB) (mean age 9.7 +/- 1.6 years SD; range 7-13 years) were examined.

RESULTS

A Student's t-test showed that an increase in angles NSL/OPT (P = .000), NSL/CVT (P = .001), FH/OPT (P = .000), FH/CVT (P = .005), and NSL/VER (P = .000); a decrease in the distance MGP-CV1p (P = .0001); and a decrease in the angles MGP/OP (P = .000) and OPT/ CVT (P = .036) were found in the OB group. A low position of the hyoid bone (H-MP, P = .009), a major skeletal divergence (ANS-PNS/Go-Me, P = .000), and an increased value of the ANB angle (P = .023) were present in OB patients. To ascertain if the changes in posture were connected with posterior obstruction of the upper respiratory airways, the OB group was divided into two subgroups based on the distance Ad2-PNS being greater than or less than 15 mm. No significant differences were found between these two groups.

CONCLUSIONS

Our data suggest that OB children show greater extension of the head related to the cervical spine, reduced cervical lordosis, and more skeletal divergence, compared with PB subjects.