The purpose was to determine age-specific values of the minimum cross-sectional area of the nasal airway in children without cleft lip or palate and to assess whether gender differences occur with growth in order to develop guidelines for assessment in children with clefts.
Participants:
All schoolchildren aged 8 to 17 years who met the research criteria were studied during rest breathing using the pressure-flow technique. The children came from a rural area of 3800 inhabitants. Consecutive age cohorts were used for comparisons.
Results:
Nasal cross-sectional area increased in females from 0.38 cm2 in 8-year-olds to 0.58 cm2 in 17-year-olds. There was a decrease in size at ages 10 to 11 and 14 to 15 years. In males, the area increased from 0.40 to 0.68 cm2 and decreased slightly from 9 to 10 and 14 to 15 years. The annual changes were statistically significant in females between 8 and 9 and 11 to 13 years of age, and in males from 11 to 12, 13 to 14, and 15 to 17 years of age. Across gender, the only significant difference occurred at age 16.
Conclusions:
Our results indicate that the increase in nasal airway size is not consistent during growth. Nasal airway size showed almost equal values for both genders in young children but was systematically larger in boys from 14 years of age on. The results refer that by 17 years of age nasal airway may not have reached adult size in males.
CrouseUK. Naso-Respiratory Function in Children and Adults[dissertation]. Lexington, KY: University of Kentucky; 2001.
3.
CrouseULaine-AlavaMT. The effects of age, BMI and gender on nasal airflow rate and pressures. Laryngoscope. 1999;109(9):1503–1508.
4.
CrouseULaine-AlavaMTWarrenDWWoodCL. A longitudinal study of nasal airway size from age 9 to age 13. Angle Orthod. 1999;69:413–418.
5.
de FreitasMRAlcazarNMPVJansonGde FreitasKMSHenriquesJF. Upper and lower pharyngeal airways in subjects with class I and class II malocclusion and different growth patterns. Am J Orthod Dentofac Orthoped. 2006;130(6):742–745.
6.
FieldsHWWarrenDWBlackKPhillipsC. Relationship between vertical dentofacial morphology and respiration in adolescents. Am J Orthod Dentofac Orthop. 1991;99(2):147–154.
7.
FukushiroAPTrindadeIEK. Nasal airway dimensions of adults with cleft lip and palate: differences among cleft types. Cleft Palate Craniofac J. 2005;42(4):396–403.
8.
GeorgalasC. The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol. 2011;268(9):1365–1373.
9.
HaavistoLESipiläJI. Acoustic rhinometry in children: some practical aspects and influence of age and body surface area on results. Am J Rhinol. 2008;22(4):416–419.
10.
HaavistoLEVahlbergTJSipiläJI. Reference values for acoustic rhinometry in children at baseline and after decongestion. Rhinology. 2011;49(2):243–247.
11.
HairfieldMWWarrenDWSeatonDL. Prevalence of mouth breathing in cleft lip and palate. Cleft Palate J. 1988;25(2):135–138.
12.
HallDJTurveyTAWarrenDW. Alterations in nasal airway resistance from superior repositioning of the maxilla. Am J Orthod. 1984;85(
2
):109–114.
13.
HallaniMWheatleyJAmisT. Enforced mouth breathing decreases lung function in mild asthmatics. Respirology. 2008;13(4):553–558.
14.
HarariDRedlichMMiriSHamudTGrossM. The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope. 2010;120(10):2098–2093.
15.
HarvoldEPTomerBSVargervikKChiericiG. Primate experiments on oral respiration. Am J Orthod. 1981;79(4):359–372.
16.
HoWKWeiWIYuenAPChanKLHuiY. Measurement of nasal geometry by acoustic rhinometry in normal-breathing Asian children. J Otolaryngol. 1999;28(4):232–237.
17.
IkävalkoTTuomilehtoHPahkalaRTompuriTLaitinenTMyllykangasRVierolaALindiVNärhiMLakkaTA. Craniofacial morphology but not excess body fat is associated with risk of having sleep-disordered breathing—the PANIC study (a questionnaire-based inquiry in 6-8 year-olds). Eur J Pediatr. 2012;171(12):1747–1752.
18.
IndriksoneIJakobsoneG. The influence of craniofacial morphology on upper airway dimensions. Angle Orthod. 2015;85(5):874–880.
KilpeläinenP. Palatal Morphology and Oral-Nasal Function in Cleft-Palate Patients[dissertation]. Kuopio, Finland: University of Kuopio; 1997
21.
KuemperGTVigPSVigKWL. Nasorespiratory characteristics and craniofacial morphology. Eur J Orthod. 1995;17:491–495.
22.
KunkelMWahlmannUWagerW. Acoustic airway profiles in unilateral cleft palate patients. Cleft Palate Craniofac J. 1999;36:433–441.
23.
LaineMTHuggareJRuoppiP. A modification of the pressure-flow technique for measuring breathing of cold air and its effect on nasal cross-sectional area. Am J Orthod Dentofacial Orthop. 1994;105(3):265–269.
24.
LaineMTWarrenDW. Effects of age, gender, and body size on nasal cross-sectional area in children. Eur J Orthod. 1991;13(4):311–316.
25.
LaineMTWarrenDW. Perceptual and respiratory responses to added nasal airway resistance loads in older adults. Laryngoscope. 1995;105(4):425–428.
26.
LaineMTWarrenDW. Effects of age, gender, and body size on nasal cross-sectional area in children. Eur J Orthod. 1991;13:311–316.
27.
Laine-AlavaMTMinkkinenUK. Variation of nasal respiratory pattern with age during growth and development. Laryngoscope. 1997;107(3):386–390.
28.
Laine-AlavaMTMinkkinenUK. Should history of nasal symptoms be considered when estimating nasal patency?Angle Orthod. 1999;69:126–132.
29.
Laine-AlavaMTMurtolahtiSCrouseUKWarrenDW. Upper airway resistance during growth: a longitudinal study of children from 8 to 17 years of age. Angle Orthod. 2016;86(4):53–58.
30.
LeeSHChoiJHShinCLeeHMKwonSYLeeSH. How does open-mouth breathing influence upper airway anatomy?Laryngoscope. 2007;117(6):1102–1106.
31.
Linder-AronsonS. Respiratory function in relation to facial morphology and the dentition. Angle Orthod. 1979;6(2):59–71.
32.
LuYLiSJinHSongLLiYZhongNZhangX. High nasal resistance may be a result rather than a cause of obstructive sleep apnea. Eur Arch Otorhinolaryngol. 2014;271(11):2999–3003.
33.
McNamaraJA. Influence of respiratory pattern on craniofacial growth. Angle Orthod. 1981;51(4):269–300.
34.
MiyamotoYTakeuchiKMajimaY. Measurement of nasal patency by acoustic rhinometry in Japanese school children. Auris Nasus Larynx. 2009;36(4):406–410.
35.
MossML. The functional matrix theory revisited. Am J Orthod Dentofacial Orthop.1997;112:8–11,221–226,338–342,410–417.
36.
Muraja-MurroA. Obstruction Event Severity in Diagnostics of Sleep Apnea[dissertation]. Kuopio, Finland: University of Kuopio; 2014.
37.
NakazakiCNodaAYasudaYNakataSKoikeYYasumaFMuroharaTNakashimaT. Continuous positive airway pressure intolerance associated with elevated nasal resistance is possible mechanism of complex sleep apnea syndrome. Sleep Breath. 2012;16(3):747–752.
38.
NiinimaaVColePMintzSShephardRJ. The switching point from nasal to oronasal breathing. Respir Physiol. 1980;42(1):61–71.
39.
PeltomäkiT. Stability, adaptation and growth following distraction osteogenesis in the craniofacial region. Orthod Craniofac Res. 2009;12(3):187–194.
40.
PeltomäkiTVendittelliBLGraysonBHCuttingCBBrechtLE. Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics. Cleft Palate Craniofac J. 2001;38(6):582–586.
41.
ProffitWRFieldsHW. Occlusal forces in normal and long-face children. J Dent Res. 1983;62(5):571–574.
42.
ReiserEAndlin-SobockAManiMHolmströmM. Initial size of cleft does not correlate with size and function of nasal airway in adults with unilateral cleft lip and palate. J Plast Surg Hand Surg. 2011;45(3):129–135.
43.
RezendeARPintoRAMiuraMSant’AnnaGGrechiBCollaresM. Evaluation of nasal patency by acoustic rhinometry after repair of complete unilateral cleft lip and palate. J Plast Surg Hand Surg. 2015;49(4):204–208.
SaaresrantaT. Current care guidelines. Sleep apnea (obstructive sleep apnea in adults). The Finnish Medical Society Duodecim. 2015;Article ID: ccs00083.
46.
SolowBSiersbaek-NielsenSGreveE. Airway adequacy, head posture, and craniofacial morphology. Am J Orthod. 1984;86(3):214–223.
47.
SolowBKreiborgS. Soft-tissue stretching: a possible control factor in craniofacial morphogenesis. Scand J Dent Res. 1977;85(6):505–507.
48.
SoukiBQPimentaGBSoukiMQFrancoLPBeckerHMGPintoJA. Prevalence of malocclusion among mouth breathing children: do expectations meet reality?Int J Pediatr Otorhinolaryngol. 2009;73(5):767–773.
49.
SousaJBRAnselmo-LimaWTValeraFCPGallegoAJMatsumotoMAN. Cephalometric assessment of the mandibular growth pattern in mouth breathing children. Int J Pediatr Otorhinolaryngol. 2005;69:311–317.
50.
StraszékSPSchlünssenVSigsgaardTPedersenO. Reference values for acoustic rhinometry in decongested school children and adults: the most sensitive measurement for change in nasal patency. Rhinology. 2007;45:36–39.
51.
TrindadeIEKCastilloRLSampaio-TeixeiraACMTrindade-SuedanIKSilva-FilhoOG. Effects of orthopedic raid maxillary expansion on internal nasal dimensions in children with cleft lip and palate assessed by acoustic rhinometry. J Craniofac Surg. 2010;21:306–311.
52.
ValeraFCPTravizkiLVVMattarSEMMatsumotoMANEliasAMAnselmo-LimaWT. Muscular, functional and orthodontic changes in preschool children with enlarged adenoids and tonsils. Int J Pediatr Otorhinolaryngol. 2003;67(7):761–770.
53.
VargervikKMillerAJChiericiGHarvoldETomerBS. Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod. 1984;85(2):115–124.
54.
VigKW. Nasal obstruction and facial growth: the strength of evidence for clinical assumptions. Am J Orthod Dentofacial Orthop. 1998;113(6):603–611.
55.
VigPSZajacDJ. Age and gender effects on nasal respiratory function in normal subjects. Cleft Palate Craniofac J. 1993;30(3):279–284.
56.
WarrenDW. A quantitative technique for assessing nasal airway impairment. Am J Orthod Dentofacial Orthop. 1984;86:306–314.
57.
WarrenDW. Compensatory speech behaviors in cleft palate; a regulation/control phenomenon. Cleft Palate J. 1986;23(4):251–260.
58.
WarrenDW. Effect of airway obstruction upon facial growth. In: KoopmanFC, ed. Otolaryngologic Clinics of North America; Sleep Apnea. Philadelphia, PA: WB Saunders; 1990:699–712.
59.
WarrenDW. Breathing behaviors and posture. In: McNamaraJA, ed. The Enigma of the Vertical Dimension. Ann Arbor, MI: University of Michigan, Center of Human Growth and Development; 2000:36:103–120.
60.
WarrenDWDrakeAFDavisJU. Nasal airway in breathing and speech. Cleft Palate Craniofac J. 1992;29(6):511–519.
61.
WarrenDWDuanyLFFischerND. Nasal airway resistance in normal and cleft palate subjects. Cleft Palate J. 1969;6:134–140.
62.
WarrenDWHairfieldWMDalstonET. Effect of age on nasal cross-sectional area and respiratory mode in children. Laryngoscope. 1990;100(1):89–93.
63.
WarrenDWTrierWCBevinAG. Effect of restorative procedures on the nasopharyngeal airway in cleft palate. Cleft Palate J. 1974;11:367–373.
64.
WeiderDJBakerGLSalvatorielloFW. Dental malocclusion and upper airway obstruction, an otolaryngologist’s perspective. Int J Pediatr Otorhinolaryngol. 2003;67(4):323–331.
65.
WitsellDDrakeAWarrenD. Preliminary data on the effect of pharyngeal flaps on the upper airway in children with velopharyngeal inadequacy. Laryngoscope. 1994;104(1):12–15.
66.
WoodsideDGLinder-AronsonSLundströmAMcWilliamJ. Mandibular and maxillary growth after changed mode of breathing. Am J Orthod Dentofacial Orthop. 1991;100(1):1–18.
67.
YoungTFinnLPaltaM. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Arch Internal Med. 2001;161(12):1514–1519.
