Etiology of narrow maxilla creating orthodontic and prosthetic treatment difficulties.

Abstract

Narrow maxilla occurring due to various congenital or acquired causes creates major orthodontic problems and complicates prosthetic dental rehabilitation. The etiologic factors are mostly related to upper airway pathologies that restrict breathing and cause negative pressure at the base of the nose and nasopharynx. The upper and lower airway is a whole unit. Regional anomalies or acquired problems affect the entire system. This can lead to developmental issues and permanent disorders in childhood, which will last their real life. This study was planned to investigate the incidence of nasopharyngeal obstruction originating from allergic rhinitis, turbinate hypertrophy, septum deviation, and adenoid vegetation in children scheduled for orthodontic treatment due to maxillary stenosis. Our study group consists of one hundred children aged 12-16 years who applied to the orthodontist due to dental malalignment and were found to have a narrowing of the maxilla. After the orthodontic evaluation, the patients were referred for an ENT examination to evaluate the etiological factors originating from the upper respiratory tract. In the study group, nasal congestion and allergic rhinitis were first investigated. All symptoms were evaluated and scored. Then, an ENT physical examination was performed in all cases, and nasal cavities, nasopharynx, and oropharynx were assessed with a fiberoptic endoscope. Regarding etiological factors, allergic rhinitis, turbinate hypertrophy, nasal septum deviation, and adenoid vegetation that would prevent breathing were carefully investigated. Firstly, deep palate, narrowed maxillary arch, V-shaped arch, adenoid face type, bilateral posterior crossbite, insufficient lip presence, maxillary incisor protrusion (upper forward thrust), skeletal class 2 division 1 malocclusion, and increased lower face height detected in patients primarily diagnoses were grouped according to their pathologies. Allergic rhinitis was found in 43 cases, turbinate hypertrophy in 30 instances, nasal septum deviation in 18 cases, and adenoid vegetation that prevented respiration in 61 patients. It is known that increased nasal airway resistance due to allergic rhinitis, septal deviation, turbinate hypertrophy, or adenoid vegetation in the upper respiratory tract may lead to permanent orthodontic disorders in children and adolescents. A multidisciplinary approach, early diagnosis, and treatment should be the first step to prevent this situation. Secondly, it should be planned to correct the anatomical disorders that have occurred with appliances and, if necessary, surgical approaches. Taking precautions before permanent problems arise in childhood is also crucial in prosthetic dentistry.