Computed tomographic evaluation of mouth breathers among paediatric patients

Abstract

Objectives: Mouth breathing causes many serious problems in the paediatric population. It has been maintained that enlarged adenoids are principally responsible for mouth breathing. This study was designed to evaluate whether other mechanical obstacles might predispose the child to mouth breathing.

Methods: 67 children with ages ranging from 10 to 15 years were studied and grouped into mouth-breathers and nose-breathers. The children first underwent axial CT scans of the brain for which they were originally referred. In addition, they were subjected to a limited coronal CT examination of the paranasal sinuses. Congenital anatomical variations as well as inflammatory changes were assessed.

Results: 87% of mouth-breathing children had hypertrophied adenoids, 77% had maxillary sinusitis, 74% had pneumatized middle concha, 55% had a deviated nasal septum, 55% had hypertrophied inferior conchae, 45% had ethmoidal sinusitis and 23% showed frontal sinusitis. Such changes were significantly less prevalent in nose-breathers. 12.9% of mouth-breathing children did not have adenoids. Of these children, only 3.3% had one or more congenital or inflammatory change whereas the other 9.6% showed a completely normal CT scan signifying the incidence of habitual non-obstructive mouth breathing.

Conclusions: It is clear that adenoids have a dominant role in causing mouth breathing. Yet, we recommend that paediatricians should assess other mechanical obstacles if mouth breathing was not corrected after adenoidectomy. Further research should be performed to test the validity of correction of such factors in improving the quality of life of mouth-breathing children.

Figure 1

Study profile. Out of the 67 children who participated in this study, 31 were diagnosed as mouth-breathers and 36 as nose-breathers

Figure 2

Comparison of both groups as regards lip seal. Incompetent lips were present in 100% of the children in Group A compared with 13.9% of children in Group B. The difference was highly significant (P ≤ 0.01)

Figure 3

Comparison of both groups as regards maxillary incisor coverage. A higher percentage of cases in Group B showed total coverage of maxillary incisors. The differences were highly significant (P ≤ 0.01)

Figure 4

The distribution of the anatomical abnormalities among the two groups. Group A showed a significantly higher percentage of cases with pneumatized middle concha and septal deviation than Group B. There was no significant difference between the two groups regarding the other anatomical variations

Figure 5

The distribution of the inflammatory changes among the two groups. There was a highly significant difference between the two groups regarding maxillary sinusitis, hypertrophied inferior conchae and hypertrophied adenoids as well as a significant difference regarding ethmoid and frontal sinusitis

Figure 6

Coronal CT of a mouth-breathing child showing a pneumatized right middle concha (white arrow) as well as left Haller cells (black arrow) and bilateral hypertrophied inferior turbinates more evident on the right side. The maxillary and frontal sinuses are clear

Figure 7

Coronal CT of a mouth-breathing child showing a deviated and pneumatized nasal septum (arrow) in addition to thickened inferior turbinates

Figure 8

Coronal CT of a mouth-breathing child showing an agger nasi cell (beneath the arrow) with absence of frontal sinusitis. The left maxillary sinusitis is noted

Figure 9

Coronal CT of a nose-breather showing bilateral bulla ethmoidalis (arrows) with no evidence of maxillary or ethmoid sinusitis

Figure 10

Coronal CT of a mouth-breathing child showing bilateral maxillary and ethmoidal sinusitis more pronounced on the right side.