The Journal
*Dr. Amandeep Kaur
Role of Airway in Malocclusion and Facial Deformity
The debate in orthodontics concerning the role of respiration in the etiology of malocclusion and facial
deformity dates back over 100 years. Current trends in clinical practice are focused on attempting to
modify growth in an endeavor to prevent the development of orthodontic problem or at least to
minimize the effect of environmental factors that may alter growth unfavourably. A logical extension of
this interest in early treatment and growth modification is the revival of the controversy over the role of
respiration.
Introduction
Normal airway is one of the important factors for
the normal growth of the craniofacial
structures.1Nasorespiratory function and its
relation to craniofacial growth is of great interest
not only for orthodontist but for pediatricians,
otorhinolaryngologists, speech pathologists
and other members of health care community.
The growth and function of the nasal cavities,
the nasopharynx, and the oropharynx are
closely associated with the normal growth of the
skull.
The size of the nasopharyngeal airway space is
of importance in its relationship to the
morphology of the face, the mandible included,
because with reduction of the nasopharyngeal
airway space, nasal breathing becomes difficult
or impossible, and mouth breathing becomes
necessary. It is with chronic mouth breathing
that the normal balance of oral and paraoral
structures is upset and changes of both
1
structures can be expected .
Because of the close relationship between the
pharynx and the dentofacial structures, a
mutual interaction is expected to occur between
the pharyngeal structures and the dentofacial
pattern, and therefore justifies orthodontic
interest. In many studies carried out on this
subject, it has been demonstrated that there are
statistically significant relationships between
the pharyngeal structures and both dentofacial
and craniofacial structures at varying degrees2-
5.
Among the predisposing factors for obstruction
of the pharyngeal airways such as allergies,
environmental irritants and infections, which
are amenable to adequate treatment, there is
also the natural anatomical predisposition of
narrower airway passages6.
The pharynx is a tube-shaped structure formed
by muscles and membranes. It is located
behind the nasal and oral cavities and the
larynx, and extends from the cranial base to the
level of the sixth cervical vertebra and the lower
border of the cricoid cartilage. Its length is
approximately 12 to 14 cm, and it is divided into
three parts: nasopharynx, oropharynx, and
laryngopharynx 2 .
The nasopharyngeal airway size can be defined
as the shortest distance from the most anterior
aspect of the adenoids to the most posterior
aspect of the soft palate, in a relaxed position.
This airway space can thus be small or non-
existent if the adenoids are hypertrophied and
large if the adenoids have regressed1.
The nasopharynx, forming the upper part of the
respiratory system, is situated behind the nasal
cavity and above the soft palate. Anteriorly, it is
connected with the nasal cavity. Posteriorly, it
continues downward as the oropharynx. In a
midsagittal image, the nasopharynx extends
from the nasal turbinates to the hard palate. The
nasopharynx begins superiorly at the
attachment of the superior constrictor muscle to
the pharyngeal tubercle on the basilar part of
the occipital bone and ends at the level of the
soft palate. It should be recorded that this is the
*MDS Orthodontics & Dentofacial Orthopaedics
34
Vol. 14 No. 2
May-August 2018