Nasal Airway and the Long Face Syndrome

Nasal Airway and the Long Face Syndrome

This has been taken from excerpts from

Meridith, G. (2013). Your child’s airway and dentofacial development. Kunal Walia.


Nasal Airway and the Long Face Syndrome | Beyond DentalLike so many things in life, timing is everything. Parents, family physicians, paediatricians, family dentists, paediatric dentists, ear nose and throat surgeons, friends, family and, especially orthodontists find themselves, from time to time, in unique situations where they can change a child’s quality of life, literally for the rest of that child’s life. Mouth breathing, snoring, excessive daytime sleepiness, obstructive sleep apnoea, aesthetically unpleasing facial features and dental arches, need for future major jaw surgery, recurring nasal and sinus infections, sinus pressure headaches, dry raw pharynx, post nasal drip and lifelong nasal obstruction are some of the quality of life issues that the child or teenager with the developing long face syndrome will have to deal with for the rest of his adult life, if the developing long face syndrome is not intercepted. The child, who has a developing long face syndrome, can have that pathological process intercepted through the use of some unusually simple procedures. Tonsillectomy and adenoidectomy, partial resection of the inferior turbinates, rapid maxillary expansion, upper lateral cartilage lateral (alar) rotation and use of the Petite Face Mask are some of the embarrassingly simple procedures that can, when done in a timely manner, literally intercept the developing long face syndrome. And at the same time greatly improve that child’s quality of life. And, in some cases, ensure that child’s very survival, within weeks after completion of these wonderful procedures.

Unfortunately current internet websites, as well as the government run, offer little in depth information re: diagnosing the developing long face syndrome, and virtually nothing re: intercepting the developing long face syndrome.

Find knowledgeable practitioners who can implement the same. And your child will thank you for the rest of his life.

Nasal Airway and the Long Face Syndrome | Beyond Dental
Patients exhibiting the usual habitués of chronic mouth breathing (adenoid facies).

Normal Nasal Respiration

The nose filters, warms, and humidifies the air in preparation for entry into the bronchi and lungs. The functioning nasal airway may also create a certain degree of nasal resistance to facilitate the movements of the diaphragm and intercostal muscles in creating negative intrathoracic pressure that, in turn, promotes airflow into the alveoli. 30 (final branching of the respiratory tree… the primary gas exchange units of the lungs). Appropriate nasal resistance is 2 to 3.5 cm H2O/ L/ sec and produces high tracheobronchial airflow, which improves the oxygenation of the most peripheral pulmonary alveoli. Mouth breathing results in a lower velocity of incoming air and also eliminates nasal resistance. Suboptimal pulmonary compliance (the ability of the lungs to stretch in a change in volume relative to an applied change in pressure) is the result. Blood gas studies have revealed that advanced mouth-breathers have 20 percent higher partial pressures of carbon dioxide and 20 percent lower partial pressures of oxygen in the blood, associated with their lower pulmonary compliance and reduced velocity.

Nasal Airway and the Long Face Syndrome | Beyond Dental
Venous Pooling under the eyes.


Treatment of Nasal Obstruction

Nasal Airway and the Long Face Syndrome | Beyond Dental

Adenoidectomy with or without tonsillectomy is indicated if enlarged adenoids (and tonsils) are the cause of upper airway compromise. The lateral x-ray of the head provides an excellent view of any adenoid tissue in the epipharynx.

Septal surgery is rarely indicated in the child, but should be considered in the presence of a marked nasal septal deflection with impaction.

Rapid maxillary expansion (RME), an orthodontic procedure, 38 is effective in improving the airway by widening the nasal vault.

Nasal Airway and the Long Face Syndrome | Beyond Dental

The orthodontic literature concerning the upper-airway compromise, as it relates to aberrant dentofacial development, is sizeable. It is reasoned that upper airway compromise, produces chronic mouth breathing, especially in the dolichocephalic (narrow-faced) child as well as in the neuromuscularly deficient child. Chronic mouth breathing calls forth the recruitment of perioral and suprahyoid muscles. The increased tonicity and rhythmicity of these muscle groups often produces a negative effect on dentofacial form and function. Often, the long-face syndrome develops as a result. The long-face syndrome is characterized by increased anterior vertical facial height in the lower third of the dentofacial skeleton excess dentoalveolar height, gummy smile , posterior buccal cross bite, high-arched palate, steep mandibular plane, tension nose (with collapse of the valve area and lower lateral cartilages), nasal obstruction, and Class-II (mandibular retrognathic) occlusal relationship.