Volume 27 Number 1 pp. 44-53 2001 Tutorial Orofacial myofunctional disorders related to malocclusion Ana L. Garretto (Buenos Aires University, [email protected]) Follow this and additional works at: https://ijom.iaom.com/journal The journal in which this article appears is hosted on Digital Commons, an Elsevier platform. Suggested Citation Garretto, A. L. (2001). Orofacial myofunctional disorders related to malocclusion. International Journal of Orofacial Myology, 27(1), 44-53. DOI: https://doi.org/10.52010/ijom.2001.27.1.5 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. The views expressed in this article are those of the authors and do not necessarily reflect the policies or positions of the International Association of Orofacial Myology (IAOM). Identification of specific oducts,pr programs, or equipment does not constitute or imply endorsement by the authors or the IAOM. International Journal of Orofacial Myology Volume XXVII 44 OROFACIAL MYOFUNCTIONAL DISORDERS RELATED TO MALOCCLUSION Ana Lía Garretto ABSTRACT The purpose of this article is to enhance awareness about different pathologies that can be minimized or alleviated simultaneously. The author writes about the assessment, the etiologies, the differential diagnosis and the most important interdisciplinary team. Keywords: INTRODUCTION through the mouth even though the nasal problems no longer exist (Nowak & Warren, The stomatognatic system is a 2000; Zickefoose & Zickefoose, 2000). morphofunctional unity anatomically Some investigators have reported that the integrated and physiologically coordinated; prevalence of mouth breathing decreases its constitution is of a heterogeneous with age (Gross, Kellum, & Franz, 1994; conjunct of tissues and organs (Biolcati, Pierce, 1980; Warren, Hairfield, Seaton, Garretto, & Nicosia, 1995). The results of 1988). However, adults may still suffer from treatment obviously depends on a enlarged adenoids (Biolcati competent, detailed differential diagnosis www.sinfomed.org.ar). and must encompass knowledge of allied specialty areas and related treatments The low/forward tongue resting posture of a (Cistulli, Palmisano, & Poole, 1998; mouth breather is obligatory (Adamidis & Davidson, Haryett, & Sandiales, 1967; Spyropoulos, 1983; Ramirez de los Santos, Feijoo, 1963; Garretto, 1995). 1991). The effect of this low and forward tongue resting posture in addition to the ETIOLOGICAL FACTORS impact of open mouth posture has two major effects on the growth of the orofacial Mouth Breathing complex (Ramirez de los Santos, 1991). The respiratory function has major influence in the development of the Orofacial complex First, lower tongue position reduces the role and emerges at birth. Mouth breathing has of the tongue in fostering growth in the width been associated with a distinct pattern of of the maxillary arch. Studies have effects on facial growth (Bresolin, Shapiro, demonstrated that maxillary arch-width is & Shapiro, 1984; Garreto, 1996; Nowak & reduced in children with chronic nasal Warren, 2000). It is known that all children obstruction (Strnad, 1978). Several other breathe through the mouth from time-to-time studies reported that chronic airway because of nasal congestion, transient obstruction promoted by nasal allergies and obstruction or during periods of physical asthma is also associated with posterior activity or exercise. However, some crossbites - indicative of narrower maxillary children, without organic obstruction or arch (Garretto, 1992, Nowak & congestion related to current hypertrophy Casamassino, 1995; Nowak & Warren, tonsils and/or adenoids(Figure 1), to rhinitis, 2000; Venetikidou,1993). or to allergies (Ramirez de los Santos, 1991; Sweeney, 1997) continue to breathe International Journal of Orofacial Myology Volume XXVII 45 FIGURE 1 Adenoids hypertrophy in adults Lateral Cranio Radiography is a useful Second, open-mouth resting posture tool to evaluate adenoid size. Sometimes, associated with mouth breathing often leads tonsils shape and size, and the implications to over-eruption or to the supra eruption of of shape and size inrelation to upper airway the secondary molars. The mandible obstruction can be observed (Cayley, rotates downward in its resting position Tindall, Sampson, Butcher, 2000; Maw, A. (Principato, 1991; Strnad, 1978). This et al., 1991)). Looking at the cephalometric downward rotation may contribute to longer head film taken by the orthodontist can lower face height and somewhat retrusive assist the orofacial myologist (Allegrotti, mandibles as growth and development 1992; Ricketts, et al. 1988).) (see Figure 2). continues. The cephalometric assessment gives more reliable images for the diagnostician by Some investigators have studied the made avoiding cranio-rotation, and provides the a study to investigate the relationship characteristics of double image of vertical between nocturnal enuresis and upper and horizontal branches of the mandible, airway obstruction in pediatric population and the changes that this may produce in (Cistulli, Palmisano & Poole, 1998). They the evaluation of the rinopharynx (Garretto, concluded that upper airway obstruction is A.: Factores de Riesgo en los desordenes probably one of the contributing etiology Miofuncionales Orales. Educación Médica factors in nocturnal enuresis. There was Interactiva. improvement in controlling the enuresis http//www.sinfomed.org.ar/revelct.htm; after the nasal obstruction was treated. Garretto, 1992; Gross, Kellum, Franz et al.; There are several hypotheses to explain the 1994) relationship between upper airway obstruction and nocturnal enuresis. Madern International Journal of Orofacial Myology Volume XXVII 46 FIGURE 2 FIGURE 3 FIGURE 4 International Journal of Orofacial Myology Volume XXVII 47 Mouth breathing or open-mouth resting habits usually are present without posturing promotes abnormal swallowing psychological abnormality. However, some patterns that can lead to malocclusion and prolonged thumb or pacifier sucking beyond sensorial disabilities. The literature the preschool years may reflect some expresses a multifaceted myriad of psychological disturbance (Nowak, & etiologies (Garretto,1993; Hanson, 1988; Warren, 2000). The severity of the non- Hanson & Barrett, 1988; Marchesan, 2000; nutritive induced deformity is influenced by Segovia, 1988; Zambrana Toledo Gonzalez, the frequency, the duration and the intensity & Dalva López, 1999): (see figure 3) of the habit (Zdik, Stern, Litner, 1977). Lip sucking is a habit that sometimes depends 1. Bottle feeding on the the lips and mouth, or may be related 2. Upper airway obstruction to stress or psychological problems. 3. Mouth breathing 4. Excessive non-nutritive sucking Figure 5 represents the frequency and habits of the: tongue, digits, thumb, distribution of orofacial myofunctional cheeks, objects, clothes, upper disorders which were found in 129 children and/or lower lip of both sexes, age 5 years to 9 years (mean 5. Structural disharmonies (skeletal 7.3 years) with functional malocclusions malocclusions) who were evaluated at the Department of 6. Deglutition disorders because of Pediatric Dentistry, University of Buenos enlarged tonsils Aires (Garretto, et al.; 1996; Garretto, 7. Restriction of the lingual or labial 1999). frenum 8. Long period of open spaces during mixed dentition 9. Tongue size discrepancies (macroglossia or microglossia) 10. Oral sensory deficiencies 11. Genetic structural characteristics such as a narrow and/or high palatal arch 12. Prolonged soft diet 13. Environmental pressures 14. Psychological problems Oral habits FIGURE 5 Some oral habits in infants have been linked to medical conditions including associations ? (1982) suggested that nocturnal between acute otitis media and early enuresis is a result of decreased cessation of breastfeeding. Little association neuromuscular tonus in the course of has been found between oral habits and sleep that is more significant in patients general health beyond infancy; however, with O.S.A.S. (sleep obstruction apnea such persistent habits can have profound syndrome) effects on orofacial structures (Hultcrantz, 1991; . Massler, 1982; Nowak, & Warren, Obstructive Sleep Apnea Syndrome: 2000). (see figure 4) (OSAS) In an Ear Nose and Throat evaluation Non-nutritive habits sucking behaviors that parents should be questioned regarding are adaptative and are rewarded, child’s sleeping habits. Some of the key subsequently become learned habits. Such International Journal of Orofacial Myology Volume XXVII 48 questions include, “Does the patient snore TREATMENT IMPLICATIONS frequently? Is there noticeable thorax During 1995, 250 patients reflecting both contraction during sleep? Does the patient sexes, mean age 8.5 years of age who exhibit other signs of sleep apnea?” During received dental pediatric assistance at the the examination when the child is awake, Department of Pediatric Dentistry, Buenos signs of Obstructive Sleep Apnea Syndrome Aires University in Argentina were evaluated. (O.S.A.S.) may not be observable (Biolcati The purpose of this study was to explore the &Garretto,1997; Biolcati:www.sinfomed.org. relationship between vertical occlusal ar). Hypertrophy of tonsils and adenoids is anomalies: open bite related to abnormal thought to be the number one etiology in swallowing patterns (tongue thrust) and non- this pathology ( Owen, 1995; Paradise, nutritive sucking habits. Bernard, Colborn & Janosky, 1998; Venetikidou, 1993). Very small changes