Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis
Main Article Content
Keywords
asthma, maxillary atresia, mouth breathing, allergic rhinitis, respiratory system
Abstract
Aim: To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma.
Methods: Fifty-three MB children/adolescents (aged 7–14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance).
Results: A significant reduction in the CARATkids score occurred in the RAD (−4.06; p < 0.05), similarly when patient and parent/guardian scores were evaluated (−3.28 and −3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm3, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them.
Conclusion: In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.
References
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13. Rakosi T, Jonas I, Graber TM. Ortodontia e Ortopedia Facial: Diagnóstico. Porto Alegre: Artes Médicas Sul; 1999, pp. 207–209.
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18. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012;67(1):18–24. 10.1111/j.1398-9995.2011.02728.x
19. Cankurtaran M, Celik H, Coskun M, Hizal E, Cakmak O. Acoustic rhinometry in healthy humans: accuracy of area estimates and ability to quantify certain anatomic structures in the nasal cavity. Ann Otol Laryngol. 2007;116(12):906–916. 10.1177/000348940711601207
20. DICOM – Digital Imaging and Communication in Medicine. Available from: https://www.dicomstandard.org. Accessed: 6 October 2018.
21. Muniz RFL, Gomes RL, Yamamoto LH, Lima LAZ, Cappellette M, Jr. Disjunção da maxila – fase clínica. In: Cappellette M (ed.), Disjunção maxilar. 1a ed. Vol. 9. São Paulo: Santos; 2014, pp. 79–104.
22. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines–2016 revision. J Allergy Clin Immunol. 2017;140(4):950–958. 10.1016/j.jaci.2017.03.050
23. Rubini N, Wandalsen GF, Rizzo MCV, Aun MV, Chong Neto HJ, Solé D. Guia prático sobre controle ambiental para pacientes com rinite alérgica. Arq Asma Alergia Imunol. 2017;1(1):7–22. 10.5935/2526-5393.20170004
24. Sakano E, Sarinho ESC, Cruz AA, Pastorino AC, Tamashiro E, Kuschnir F, et al. IV Brazilian consensus on rhinitis–an update on allergic rhinitis. Braz J Otorhinolaryngol. 2018;84(1):3–14. 10.1016/j.bjorl.2017.10.006
25. Hitos SF, Solé D, Periotto MC, Fernandes ML, Weckx LL, Guedes ZC. Standardization of the registration and analysis of mastication: proposal for clinical application. Int J Orofacial Myol. 2011;37:47–56. 10.52010/ijom.2011.37.1.4
26. Lione R, Franchi L, Ghislanzoni LTH, Primozic J, Buongiorno M, Cozza P. Palatal surface and volumen in mouth-breathing subjects evaluated with three-dimensional analysis of digital dental casts–a controlled study. Eur J Orthod. 2015;37(1): 101–104. 10.1093/ejo/cju018
27. Agostinho HA, Furtado IA, Silva FS, Ustrell Torrent J. Cephalometric evaluation of children with allergic rhinitis and mouth breathing. Acta Med Port. 2015;28(3):316–321. 10.20344/amp.5556
28. Fastuca R, Campobasso A, Zecca PA, Caprioglio A. 3D facial soft tissue changes after rapid maxillary expansion on primary teeth: a randomized clinical trial. Orthod Craniofac Res. 2018;21(3):140–145. 10.1111/ocr.12229
29. Huang J, Li CY, Jiang JH. Facial soft tissue changes after nonsurgical rapid maxillary expansion: a systematic review and meta-analysis. Head Face Med. 2018;14(1):6. 10.1186/s13005-018-0162-8
30. Radescu OD, Colosi HA, Albu S. Effects of rapid palatal expansion (RPE) and twin block mandibular advancement device (MAD) on pharyngeal structures in Class II pediatric patients from Cluj-Napoca, Romania. Cranio. 2018;23:1–8. 10.1080/08869634.2018.1475940
31. Ottaviano G, Maculan P, Borghetto G, Favero V, Galletti B, Savietto E, et al. Nasal function before and after rapid maxillary expansion in children: a randomized, prospective, controlled study. Int J Pediatr Otorhinolaryngol. 2018;115: 133–138. 10.1016/j.ijporl.2018.09.029
32. Biederman W. A hygienic appliance for rapid expansion. J Pract Orthod. 1968;2(2):67–70.
33. Lotfi V, Ghoneima A, Lagravere M, Kula K, Stewart K. Three-dimensional evaluation of airway volume changes in two expansion activation protocols. Int Orthod. 2018;16(1): 144–157. 10.1016/j.ortho.2018.01.001
34. Ohta K, Bousquet PJ, Akiyama K, Adachi M, Ichinose M, Ebisawa M, et al. Visual analog scale as a predictor of GINA-defined asthma control: the SACRA study in Japan. J Asthma. 2013;50:514–521. 10.3109/02770903.2013.786726
35. Bousquet PJ, Combescure C, Neukirch F, Klossek JM, Méchin H, Daures J-P, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy Eur J Allergy Clin Immunol. 2007;62:367–372. 10.1111/j.1398-9995.2006.01276.x
36. Spector SL, Nicklas RA, Chapman JA, Bernstein IL, Berger WE, Blessing-Moore J, et al. Symptom severity assessment of allergic rhinitis: part 1. Ann Allergy Asthma Immunol. 2003;91:105–114. 10.1016/s1081-1206(10)62160-6
37. Meltzer EO, Schatz M, Nathan R, Garris C, Stanford RH, Kosinski M. Reliability, validity, and responsiveness of the rhinitis control assessment test in patients with rhinitis. J Allergy Clin Immunol. 2013;131:379–386. 10.1016/j.jaci.2012.10.022
38. Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, et al. Development and cross-sectional validation of the childhood asthma control test. J Allergy Clin Immunol. 2007;119:817–825. 10.1016/j.jaci.2006.12.662
39. Ottaviano G, Fokkens WJ. Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice. Allergy. 2016;71(2):162–174. 10.1111/all.12778
40. Wandalsen GF, Mendes AI, Solé D. Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis. Braz J Otorhinolaryngol. 2012;78(6):81–86. 10.5935/1808-8694.20120038
41. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59–65. 10.1016/j.jaci.2003.09.008
42. Vidotti BA, Trindade IEK. The effects of rapid maxillary expansion on the nasal patency assessed by rhinomanometry and acoustic rhinometry. R Dental Press Ortodon Ortop Facial. 2008;13(5):59–65. 10.1590/S1415-54192008000600008
43. Doruk C, Sökücü O, Biçakçi AA, Yilmaz U, Tas F. Comparison of nasal volume changes during rapid maxillary expansion using acoustic rhinometry and computed tomography. Eur J Orthod. 2007;29(3):251–255. 10.1093/ejo/cjl069
44. Muñoz-Cano R, Salvador R, Valero A, Berenguer J, Alobid I, Bartra J, et al. Accuracy of acoustic rhinometry versus computed tomography in the evaluation of nasal cavity in patients with nasal polyposis. Rhinology. 2010;48(2):224–227. 10.4193/Rhin09.067
45. Tsolakis IA, Venkat D, Hans MG, Alonso A, Palomo JM. When static meets dynamic: comparing cone-beam computed tomography and acoustic reflection for upper airway analysis. Am J Orthod Dentofacial Orthop. 2016;150(4):643–650. 10.1016/j.ajodo.2016.03.024
46. Zancanella E, Lima WTA. Acousticrhinometry as a diagnosticmethod. Rev Bras Otorrinolaringol. 2004;70(4):500–503. 10.1590/S0034-72992004000400010
2. Garib DG, da Silva Filho OG, Janson G. Etiologia das más oclusões: perspectiva clínica (parte II)–fatores ambientais. Rev Clin Ort Dental Press. 2010;9(3):61–73. Available from: https://br.clinicalorthodontics.net/rcodp-v09n03-2010-61/. Accessed: 21 January 2023.
3. Cappellette M, Jr, Rezende RPDB, Prade KR, Hoppe DPMR, Yamamoto LH, Negrisol S. Controversy: oral or mouth breather, what does the literature say? Ortodontia SPO. 2022;55(4):430–435. Available from: https://fliphtml5.com/wiun/wksj. Accessed: 21 January 2023.
4. Morais-Almeida M, Wandalsen GF, Solé D. Growth and mouth breathers. J Pediatr (Rio J). 2019;95(Suppl. 1):66–71. 10.1016/j.jped.2018.11.005
5. Imbaud TCS, Mallozi MC, Domingos VBTC, Solé D. Frequency of rhinitis and orofacial disorders in patients with dental malocclusion. Rev Paul Pediatr. 2016;34(2):184–8. 10.1016/j.rpped.2015.10.002
6. Valera FC, Anselmo-Lima WT, Tamashiro E. A criança respiradora oral. In: Solé D, Prado E, Weckx LL (Eds.), Obstrução nasal – o direito de respirar pelo nariz. 2nd ed. Rio de Janeiro: Atheneu; 2017, p. 31.
7. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2022. Available from: www.ginasthma.org. Accessed: 22 January 2023.
8. Solé D, Camelo-Nunes IC, Wandalsen GF, Rosario NA, Sarinho EC, Brazilian ISAAC Group. Is allergic rhinitis a trivial disease? Clinics (Sao Paulo). 2011;66(9):1573–1577. 10.1590/s1807-59322011000900012
9. Bousquet J, Anto JM, Bachert C, Baiardini I, Bosnic-Anticevich S, Canonica WG, et al. Allergic rhinitis. Nat Rev Dis Primers. 2020;6(1):95. 10.1038/s41572-020-00227-0
10. Azenha MR, Marzola C, Pereira LC, Pastori CM, Toledo Filho JL. Expansão Rápida da Maxila Cirurgicamente Assistida. Revisão da Literatura, Técnica Cirúrgica e Relato de Caso. Rev Port Estomatol Med Dent Cir Maxil. 2008;49(1):25–30. 10.1016/S1646-2890(08)70031-1
11. Cappellette M, Jr, Fernandes MCPS. Evolução histórica dos aparelhos disjuntores maxilares. In: Cappellette M (Ed.), Disjunção maxilar. 1a ed. Vol. 7. São Paulo: Santos; 2014, pp. 61–63.
12. Menezes VA, Tavares RLO, Granville-Garcia AF. Síndrome da respiração oral: alterações clínicas e comportamentais. Arq Odontol. 2009;45(3):160–165. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-578242.Accessed: 20 January 2023.
13. Rakosi T, Jonas I, Graber TM. Ortodontia e Ortopedia Facial: Diagnóstico. Porto Alegre: Artes Médicas Sul; 1999, pp. 207–209.
14. Silva Filho OG, Silva PRB, Rego MVNN, Capelozza Filho L. Epidemiologia da mordida cruzada posterior na dentadura decídua. J Bras Odontopediatr Odontol Bebê. 2003;6(29): 61–68. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-361663. Accessed: 21 January 2023.
15. Hilberg O, Jackson AC, Swift DL, Pedersen OF. Acoustic rhinometry: evaluation of nasal cavity geometry by acoustic reflection. J Appl Physiol. 1989;66(1):295–303. 10.1152/jappl.1989.66.1.295
16. Amaral R, Carneiro AC, Wandalsen G, Fonseca JA, Solé D. Control of allergic rhinitis and asthma test for children (CARATKids): validation in Brazil and cutoff values. Ann Allergy Asthma Immunol. 2017;118(5):551–556.e2. 10.1016/j.anai.2017.02.007
17. Cappellette M, Jr, Cruz OL, Carlini D, Weckx LL, Pignatari SS. Evaluation of nasal capacity before and after rapid maxillary expansion. Am J Rhinol. 2008;22:74–77. 10.2500/ajr.2008.22.3130
18. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012;67(1):18–24. 10.1111/j.1398-9995.2011.02728.x
19. Cankurtaran M, Celik H, Coskun M, Hizal E, Cakmak O. Acoustic rhinometry in healthy humans: accuracy of area estimates and ability to quantify certain anatomic structures in the nasal cavity. Ann Otol Laryngol. 2007;116(12):906–916. 10.1177/000348940711601207
20. DICOM – Digital Imaging and Communication in Medicine. Available from: https://www.dicomstandard.org. Accessed: 6 October 2018.
21. Muniz RFL, Gomes RL, Yamamoto LH, Lima LAZ, Cappellette M, Jr. Disjunção da maxila – fase clínica. In: Cappellette M (ed.), Disjunção maxilar. 1a ed. Vol. 9. São Paulo: Santos; 2014, pp. 79–104.
22. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines–2016 revision. J Allergy Clin Immunol. 2017;140(4):950–958. 10.1016/j.jaci.2017.03.050
23. Rubini N, Wandalsen GF, Rizzo MCV, Aun MV, Chong Neto HJ, Solé D. Guia prático sobre controle ambiental para pacientes com rinite alérgica. Arq Asma Alergia Imunol. 2017;1(1):7–22. 10.5935/2526-5393.20170004
24. Sakano E, Sarinho ESC, Cruz AA, Pastorino AC, Tamashiro E, Kuschnir F, et al. IV Brazilian consensus on rhinitis–an update on allergic rhinitis. Braz J Otorhinolaryngol. 2018;84(1):3–14. 10.1016/j.bjorl.2017.10.006
25. Hitos SF, Solé D, Periotto MC, Fernandes ML, Weckx LL, Guedes ZC. Standardization of the registration and analysis of mastication: proposal for clinical application. Int J Orofacial Myol. 2011;37:47–56. 10.52010/ijom.2011.37.1.4
26. Lione R, Franchi L, Ghislanzoni LTH, Primozic J, Buongiorno M, Cozza P. Palatal surface and volumen in mouth-breathing subjects evaluated with three-dimensional analysis of digital dental casts–a controlled study. Eur J Orthod. 2015;37(1): 101–104. 10.1093/ejo/cju018
27. Agostinho HA, Furtado IA, Silva FS, Ustrell Torrent J. Cephalometric evaluation of children with allergic rhinitis and mouth breathing. Acta Med Port. 2015;28(3):316–321. 10.20344/amp.5556
28. Fastuca R, Campobasso A, Zecca PA, Caprioglio A. 3D facial soft tissue changes after rapid maxillary expansion on primary teeth: a randomized clinical trial. Orthod Craniofac Res. 2018;21(3):140–145. 10.1111/ocr.12229
29. Huang J, Li CY, Jiang JH. Facial soft tissue changes after nonsurgical rapid maxillary expansion: a systematic review and meta-analysis. Head Face Med. 2018;14(1):6. 10.1186/s13005-018-0162-8
30. Radescu OD, Colosi HA, Albu S. Effects of rapid palatal expansion (RPE) and twin block mandibular advancement device (MAD) on pharyngeal structures in Class II pediatric patients from Cluj-Napoca, Romania. Cranio. 2018;23:1–8. 10.1080/08869634.2018.1475940
31. Ottaviano G, Maculan P, Borghetto G, Favero V, Galletti B, Savietto E, et al. Nasal function before and after rapid maxillary expansion in children: a randomized, prospective, controlled study. Int J Pediatr Otorhinolaryngol. 2018;115: 133–138. 10.1016/j.ijporl.2018.09.029
32. Biederman W. A hygienic appliance for rapid expansion. J Pract Orthod. 1968;2(2):67–70.
33. Lotfi V, Ghoneima A, Lagravere M, Kula K, Stewart K. Three-dimensional evaluation of airway volume changes in two expansion activation protocols. Int Orthod. 2018;16(1): 144–157. 10.1016/j.ortho.2018.01.001
34. Ohta K, Bousquet PJ, Akiyama K, Adachi M, Ichinose M, Ebisawa M, et al. Visual analog scale as a predictor of GINA-defined asthma control: the SACRA study in Japan. J Asthma. 2013;50:514–521. 10.3109/02770903.2013.786726
35. Bousquet PJ, Combescure C, Neukirch F, Klossek JM, Méchin H, Daures J-P, et al. Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy Eur J Allergy Clin Immunol. 2007;62:367–372. 10.1111/j.1398-9995.2006.01276.x
36. Spector SL, Nicklas RA, Chapman JA, Bernstein IL, Berger WE, Blessing-Moore J, et al. Symptom severity assessment of allergic rhinitis: part 1. Ann Allergy Asthma Immunol. 2003;91:105–114. 10.1016/s1081-1206(10)62160-6
37. Meltzer EO, Schatz M, Nathan R, Garris C, Stanford RH, Kosinski M. Reliability, validity, and responsiveness of the rhinitis control assessment test in patients with rhinitis. J Allergy Clin Immunol. 2013;131:379–386. 10.1016/j.jaci.2012.10.022
38. Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, et al. Development and cross-sectional validation of the childhood asthma control test. J Allergy Clin Immunol. 2007;119:817–825. 10.1016/j.jaci.2006.12.662
39. Ottaviano G, Fokkens WJ. Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice. Allergy. 2016;71(2):162–174. 10.1111/all.12778
40. Wandalsen GF, Mendes AI, Solé D. Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis. Braz J Otorhinolaryngol. 2012;78(6):81–86. 10.5935/1808-8694.20120038
41. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59–65. 10.1016/j.jaci.2003.09.008
42. Vidotti BA, Trindade IEK. The effects of rapid maxillary expansion on the nasal patency assessed by rhinomanometry and acoustic rhinometry. R Dental Press Ortodon Ortop Facial. 2008;13(5):59–65. 10.1590/S1415-54192008000600008
43. Doruk C, Sökücü O, Biçakçi AA, Yilmaz U, Tas F. Comparison of nasal volume changes during rapid maxillary expansion using acoustic rhinometry and computed tomography. Eur J Orthod. 2007;29(3):251–255. 10.1093/ejo/cjl069
44. Muñoz-Cano R, Salvador R, Valero A, Berenguer J, Alobid I, Bartra J, et al. Accuracy of acoustic rhinometry versus computed tomography in the evaluation of nasal cavity in patients with nasal polyposis. Rhinology. 2010;48(2):224–227. 10.4193/Rhin09.067
45. Tsolakis IA, Venkat D, Hans MG, Alonso A, Palomo JM. When static meets dynamic: comparing cone-beam computed tomography and acoustic reflection for upper airway analysis. Am J Orthod Dentofacial Orthop. 2016;150(4):643–650. 10.1016/j.ajodo.2016.03.024
46. Zancanella E, Lima WTA. Acousticrhinometry as a diagnosticmethod. Rev Bras Otorrinolaringol. 2004;70(4):500–503. 10.1590/S0034-72992004000400010
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Jul 1, 2023
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Carvalho, P. de T. A., Cappellette Junior, M., Wandalsen, G. F., & Solé, D. (2023). Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis. Allergologia Et Immunopathologia, 51(4), 55-62. https://doi.org/10.15586/aei.v51i4.853
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How to Cite
Carvalho, P. de T. A., Cappellette Junior, M., Wandalsen, G. F., & Solé, D. (2023). Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis. Allergologia Et Immunopathologia, 51(4), 55-62. https://doi.org/10.15586/aei.v51i4.853