The "equilibrium theory" posits that the tongue and perioral muscles, including the orbicularis oris (OO) muscle, function synergistically to maintain balanced tooth positioning. Surface electromyography (sEMG) is a valuable, nonivasive method for assessing muscle activity. However, previous electromyographic (EMG) studies comparing lip muscle activity in children with and without lip competence (LC) have yielded inconsistent results. Therefore, further research is needed to clarify OO muscle activity patterns in this population. The aim of the study was to evaluate the EMG activity of the superior (SOO) and inferior orbicularis oris (IOO) muscles in children with and without LC. The sample comprised 30 children with lip incompetence (LI) (mean age 9.46 ± 1.76 years) and 30 children with LC (mean age 8.85 ± 1.52 years). Electromyographic recordings of the SOO and IOO muscles were obtained using a DAB Bluetooth Instrument (Zebris Medical GmbH, Isny im Allgäu, Germany) at clinical rest, during saliva swallowing, lip protrusion ("kissing" position), lip compression, and while articulating the syllables /pa/, /ba/, and /ma/. Statistical analyses were performed using Stata v. 11.0 (StataCorp, College Station, USA). The level of significance was set at p < 0.05. Electromyographic activity of the SOO and IOO muscles during saliva swallowing (p < 0.001, adjusted p (padj) = 0.002) and lip compression (p = 0.001, padj = 0.013 for SOO; p < 0.001, padj = 0.005 for IOO) was significantly greater in children with LI compared to those with LC. Similar EMG activity at rest and during speech production was observed in children with and without LC. Children with LI demonstrate increased SOO and IOO muscle activity during saliva swallowing and lip compression, suggesting greater muscular effort is required to achieve lip seal. This increased activity may disturb the muscular force balance essential for proper maxillofacial growth and could contribute to the development of malocclusion.

Composite mandibulo-labial defects require restoration of mandibular continuity and oral competence. Stage 1 fibula free flap reconstruction restores bone and provides lining and cover, but oral competence depends on reestablishing orbicularis oris continuity. After stage 1, patients may continue to experience drooling, poor lip seal, and an obliterated gingivolabial sulcus due to scar tethering and muscle discontinuity. We describe a stage 2 salvage procedure, which includes release of vestibular scar bands, limited mobilization of the healed fibula free flap skin paddle for sulcus lining, and direct reapproximation of orbicularis oris stumps (figure-of-eight 3-0 poly-p-dioxanone). In a pediatric ballistic injury, lip seal improved; after rehabilitation, no visible drooling was observed during conversation, although active excursion remained limited.

Mouth breathing (MB) and incompetent lip seal (ILS) are common oral dysfunctions with potential repercussions for dentofacial development, systemic health, and psychological well-being. Although related, MB and ILS represent distinct conditions: ILS denotes difficulty maintaining lip closure at rest, whereas MB concerns the route of respiration. Despite growing recognition of their physical impacts, few studies have examined how MB and ILS are related to psychological stress in young adults. A cross-sectional study was conducted among 567 Japanese university students aged 18–27 years using a self-administered questionnaire. The survey included 53 items on oral conditions, lifestyle habits, and nasal symptoms, and 29 items from Section B of the Brief Job Stress Questionnaire to assess psychological stress. Exploratory factor analysis (EFA) was used to identify latent constructs. Extreme Gradient Boosting (XGBoost) was applied to classify high-stress individuals and highlight important predictors, while direct and indirect associations among ILS, MB, nasal disease, and stress were examined using structural equation modeling (SEM). EFA extracted five latent factors: nasal disease, ILS and MB, oral hygiene and bad breath, condition of the teeth and gums, and lip dryness. XGBoost achieved moderate predictive performance (accuracy = 0.69, F1 = 0.74), with top predictors corresponding to ILS- and MB-related items (“Do you sleep with your mouth open?” and “Is your mouth often open during the day?”). SEM indicated that nasal disease had a direct association with stress, whereas ILS and MB indirectly influenced stress through oral symptoms such as lip dryness and bad breath. Lip dryness also showed a direct path to stress, suggesting its dual role as both a symptom and a potential stressor. ILS and MB are associated with higher stress levels in young adults primarily through indirect pathways involving oral discomfort. Lip dryness may mediate this relationship. Their partial independence from nasal disease supports the view that ILS and MB are distinct but interrelated conditions. These findings highlight the need for early screening and integrated management of oral and nasal function to promote psychological well-being.

Introduction: Down syndrome is an abnormality caused by an extra chromosome 21. Oral soft tissue conditions are one of the most frequently reported clinical features in Down syndrome because their prevalence is relatively high. The purpose of this study was to determine the various oral soft tissue conditions in children with Down syndrome from various literatures. Methods and Material: The literature review was conducted using the Scoping Review method following the frameworks published by Arksey and O'Malley (2005) and developed by Levac, et al. (2010) and Peters, et al. (2015). Screening and selection of studies was carried out using PRISMA-ScR. Articles were searched using keywords, boolean operators, limit functions, and inclusion criteria on the Pubmed, EBSCOHost, ScienceDirect, and Google Scholar search engines. Results: There were 12 articles that met the criteria and were analyzed. The most commonly reported oral soft tissue conditions in Down syndrome are fissured tongue, macroglossia, and cheilitis. Fissured tongue varies from 28% - 78%, macroglossia varies from 36.8% - 94%, total &amp; angular cheilitis varies from 6.3% - 51%. Incompetent lip, geographic tongue, everted lower lip, chapped lower lip, protruded tongue, gingivitis, and several other soft tissue conditions have also been reported in only a few articles. Conclusion: The most common frequently oral soft tissue conditions reported in the Down syndrome population are fissured tongue varies from 28% - 78%, macroglossia varies from 36.8% - 94%, and total &amp; angular cheilitis varies from 6.3% - 51%. Keywords: Cheilitis, Down syndrome, Fissured tongue, Macroglossia, Oral soft tissue conditions

Aim:To compare the impact of early orthodontic treatment to an untreated control group in order to assess how it affects pediatric patients’ craniofacial development and dental relationships.Methodology:Twelve children between the ages of 8 and 10 years participated in the intervention group and an untreated control group in this 36-month follow-up study. Both the baseline and final evaluations included thorough cephalometric, dental, and soft tissue evaluations.Result:Sagittal jaw relationships, maxillary transverse width, overjet and overbite reduction, facial convexity, and lip competence all significantly improved in the intervention group. There were not many changes in the control group. Significant intergroup differences were confirmed by statistical analysis (P < 0.05).Conclusion:By improving occlusal harmony, improving facial aesthetics, and positively influencing craniofacial growth, early orthodontic treatment during the mixed dentition stage may lessen the need for more involved future interventions.

Down syndrome is a genetic condition caused by trisomy 21, often accompanied by orofacial hypotonia and anomalies in stomatognathic development. A hypotonic tongue may alter oral cavity morphology, particularly palatal depth, anterior dental relationships, and lip competence, thereby affecting mastication, swallowing, and speech. To evaluate the association between tongue strength and endurance with oral cavity morphology in children with Down syndrome during the permanent dentition period. A cross-sectional analytic study was conducted among children with Down syndrome at RCDS POTADS, Jakarta. Thirty-three children aged 15-18 years participated in this study. Tongue strength and endurance were measured using a TongueMeter™, while oral cavity morphology was measured linearly for palatal depth, overjet, overbite, and lip competence. Pearson correlation and multiple linear regression analysis were performed to determine the relationship between tongue strength and endurance with oral cavity morphology. Tongue strength showed a significant negative correlation with palatal depth (r = -0.359; P = 0.040). Linear regression confirmed that tongue strength significantly influenced palatal depth (β = -0.364; B = -0.679; R2 = 0.133; P = 0.037). Tongue endurance showed no significant association with palatal depth, overjet, overbite, or lip competence. Tongue strength may play a determining role in shaping palatal depth in children with Down syndrome during the permanent dentition period, whereas tongue endurance showed no significant effect. The ideal positioning and function of the tongue contribute to the harmonious development of oral morphological components, facilitating the establishment of a proper occlusal relationship. In children with Down syndrome who exhibit hypotonia, this study demonstrated that lower tongue strength is associated with a deeper palatal morphology.

Behavioral and oral health interaction: Evaluating ADHD symptoms, dentofacial anomalies and trauma among mouth breathing children aged 6-12 years

Introduction: Moebius syndrome is a rare congenital condition characterized by bilateral cranial nerve VI and VII palsy, leading to impaired facial expression, compromised oral function, and malocclusion.Orthodontic management in affected adults is particularly challenging due to severe limited neuromuscular control and associated craniofacial discrepancies.Case Description: This report describes the orthodontic treatment of a 18-year-old adult patient with Moebius syndrome.The primary treatment objectives were to establish a functional occlusion, achieve lip competence , and enhance esthetics.Temporary Anchorage Devices (TADs) were utilized as a key element of the biomechanical plan to achieve controlled tooth movement and overcome the limitations of conventional anchorage in this complex case.Specific TAD placement and force application protocols were implemented to achieve treatment goals .Results: Treatment was successfully completed over a duration of 34 months.Through careful biomechanical planning and the use of skeletal anchorage, the treatment goals were met, protrusion reduction with bilateral class I occlusion , and normal overjet and overbite.The patient achieved complete static lip competence.The patient reported a significant improvement in esthetics and oral function . Conclusion:This case demonstrates that TAD-assisted orthodontics is an effective and predictable treatment modality for achieving stable functional and esthetic outcomes in the complex craniofacial environment of adult patients with Moebius syndrome.

Objective: To evaluate differences in craniofacial skeletal pattern among subjects with competent and incompetent lip seal (ILS). Methodology: Sample of 261 subjects (177 females and 84 males) was constituted by random selection from patients who visited Orthodontic OPD. Lip seal was assessed by clinical examination on the basis of visual inspection of muscular tension in the mental region at mandibular rest position and subjects were divided into competent lip seal and incompetent lip seal group. Skeletal measurements were performed on lateral cephalograms to assess differences in vertical and sagittal skeletal pattern among subjects in both groups. Results: Competent lip seal was found in 64.4 % of the subjects and 35.6% of subjects had incompetent lips. ILS group had greater values of SNA and ANB whereas SNB value was reduced. The inclination of maxilla (SNPP) was larger in competent lip group and inclination of mandible (SNMP) was larger in incompetent lip group. Statistically significant differences were found between the two groups in the interbasal relationship (PPMP), Y-axis angle and anterior lower facial height ratio, with increased values of these measurements in incompetent lip group. Posterior facial height ratio was comparatively reduced in subjects with ILS. Conclusion: Patients with ILS have higher tendency to develop class II skeletal pattern with mandibular retrognathia, increased inclination of mandibular plane and tendency for clockwise rotation of mandible. Lip incompetence also leads to vertical growth pattern resulting in increased anterior lower face height and decreased posterior facial height

Orofacial Myofunctional Disorders (OMDs) affect oral functions and influence craniofacial development, contributing to skeletal and dental malocclusions. The collaboration between orthodontists and speech-language pathologists (SLPs) is crucial for early diagnosis and comprehensive treatment. This study aims to evaluate the diagnostic competence of orthodontic residents in identifying OMDs, and to determine whether the application of a standardised interdisciplinary orofacial assessment protocol enhances diagnostic accuracy and interprofessional consistency. Twenty-nine postgraduate orthodontic residents (PORs) at the University of Pavia were asked to conduct the first visit of one patient each to assign a Diagnostic Score (DS) from 1 to 10, where 1 indicated no need for intervention and 10 indicated an absolute necessity for orofacial myofunctional therapy (T0). Subsequently, an adapted version of the Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (aIOEPCA) was used to improve the diagnostic ability of PORs. aIOEPCA comprised 15 clinical items, including assessment of sagittal, vertical, and transverse malocclusion patterns, lip competence, tongue mobility, breathing, swallowing, and speech articulation-each scored to quantify the severity of dysfunction. A second evaluation of the DS was conducted after the use of the protocol (T1), to assess improvements in PORs diagnostic ability. An expert SLP independently evaluated the same patients using the interdisciplinary protocol and DS were compared. Statistically significant differences (p < 0.05) were observed between the PORs and the SLP evaluations across several functional parameters. Regarding DS, a significant difference was found between PORs T0 and SLP (p < 0.05), while after the use of the protocol the score improved, and PORs T1 vs SLP resulted not significant (p > 0.05). The use of the aIOEPCA improved diagnostic consistency, highlighting its potential as a standardised interdisciplinary diagnostic tool. The findings highlight a deficiency in the ability of orthodontic residents to identify functional impairments requiring orofacial myofunctional therapy. Implementing interdisciplinary assessment tools could help to mitigate this deficit and foster more cohesive diagnostic pathways. Structured interprofessional education should be considered an imperative part of orthodontic education.

The case study details the correction of Angle’s Class II Division 1 Malocclusion with anterior deep bite using frictionless loop mechanics. A 15-year-old female reported with a convex profile, acute nasolabial angle, incompetent lips, proclined and crowded upper anterior, deep bite, enhanced overjet, end-on canine relationship, and class II molar relationship. A skeletal class II pattern and Bolton’s disparity of 7 mm in the maxillary arch and 5 mm in the mandibular archwere discovered. A Kalra Simultaneous Intrusion and Retraction (K-SIR) arch was introduced in the upper arch to enable the simultaneous intrusion and retraction of the upper anterior teeth, while in the lower arch, en masse retraction and lower molar mesialization were continued with a type I active tie-back after the extraction of the upper first and lower second premolars. The Angle’s class I relationship of both the canines and molars was successfully established. The results after treatment were pleasing and remained stable. The K-SIR loop offers various advantages, including reduced friction between the bracket and archwire during the space closure, retraction, and concurrent tooth intrusion in cases of deep biting.

Abstract Purpose β-thalassemia major, a severe genetic disorder affecting globin synthesis, often presents with marked orofacial deformities. This study evaluated the orofacial, medical, haematological, and radiographic characteristics of patients with β-thalassemia major. Methods This monocentric cross-sectional study evaluated 150 transfusion-dependent β-thalassemia major patients (aged 6–40 years) and 150 age- and sex-matched controls. Clinical assessment focused on craniofacial features; haematological parameters included haemoglobin, RBC/WBC, platelet count, MCH, MCV, and serum ferritin. Radiographic evaluation assessed skeletal base, frontal bone thickness, mandibular cortex, maxillary sinus, inferior alveolar canal, lamina dura, marrow, and diploic space. Correlations between craniofacial deformity (CFD) and haematological/radiological variables were analyzed using SPSS v22, with p &lt; 0.05 considered significant. Results CFD was present in 83% of thalassemia patients, while 17% showed no deformity. Patients exhibited severe anaemia (mean Hb, 6.57 ± 1.53 g/dL), low RBC count, and significantly elevated serum ferritin (4120.31 ± 2036.34 ng/mL). Radiographically, 92.7% had a Class II skeletal base; other common findings included thickened frontal bone (93.3%), maxillary sinus hypoplasia (49.3%), and widened diploic space (81.3%). Most correlations between CFD and haematological/radiological parameters were weak and non-significant, except for significant associations with hair-on-end appearance, granular bone pattern, icterus, and lip incompetency. Conclusions Beta-thalassemia patients exhibited distinct craniofacial and radiological changes strongly associated with chronic anaemia and marrow hyperplasia. Early identification of these features through clinical and radiographic evaluation is essential for timely intervention and improved patient outcomes.

The study aimed to describe the interdisciplinary non-surgical management of a severe skeletal Class II division 1 malocclusion with bimaxillary protrusion and asymmetric gummy smile using three-dimensional (3D) digital planning, skeletal anchorage, and unilateral botulinum toxin injection. A 38-year-old female presented with lip incompetence, a 4 mm unilateral gummy smile on the right side, and protrusive upper and lower incisors. Cephalometric analysis showed A point, nasion, B point (ANB) 4.1°, U1-SN 125°, and incisor mandibular plane angle (IMPA) 105°. The treatment plan included the extraction of teeth 24, 35, and 45; full fixed appliance therapy; two maxillary inter-radicular miniscrews and two mandibular buccal shelf miniscrews for en masse anterior retraction and vertical control; and unilateral botulinum toxin injection at the Yonsei point after debonding to reduce hyperactivity of the right upper lip elevator complex. Total treatment time was 24 months. Post-treatment records demonstrated improved facial profile, symmetrical smile, and Class I canine and molar relationships. Cephalometric changes included a reduction of ANB from 4.1° to 2.8°, U1-SN from 125° to 108.9°, and IMPA from 105° to 95.2°. Gingival display on the right side was reduced from 4 mm to within normal limits, with balanced smile esthetics. The combination of digital 3D planning, skeletal anchorage mechanics, and targeted unilateral botulinum toxin injection can effectively address both the dental-skeletal and soft-tissue components of an asymmetric gummy smile in a severe skeletal Class II case. This approach offers a predictable, minimally invasive alternative to orthognathic surgery for selected adult patients.

Introduction: Traumatic dental injuries (TDIs) involving permanent anterior teeth are a prevalent type of dental injury in school-going children and can have a considerable impact on their physical health, psychological well-being, and social functioning. In the state of Goa, a study on TDI prevalence and its associated risk factors among children aged eight to 12 years has not been conducted.Aim: This study aimed to determine the prevalence of TDIs and its association with various risk factors in eight- to 12-year-old children in the state of Goa.Materials and methods: A cross‑sectional study was conducted on 2,732 school‑going children aged eight to 12 years. A detailed history and examination of 202 children who were identified with dental trauma was performed. Anterior dental trauma was assessed, and the data obtained were statistically analyzed.Results: A prevalence of 202 out of 2,732 (7.39%) children was observed in the sample studied. TDIs in rural areas comprised 132 (65.34%) children. Single-tooth enamel fractures were most commonly seen. Left maxillary central incisors were mostly involved. About 80 (39.60%) subjects were unaware of their TDI incident. About 91 (45%) subjects had overjet <3 mm, three (1.5%) children showed anterior open bite, 168 (83.2%) children had Angle’s class I molar relation, and 194 (96%) children presented with competent lips. Among the subjects with trauma, only 25 (12.4 %) children sought treatment, while the remainder, 151 (74.8%) children, were unaware that they should seek treatment. Moreover, most of the children were unaware of the immediate management and first aid for TDI episodes.Conclusion: This study provides valuable insights into the prevalence of TDIs among children in Goa, emphasizing the higher occurrence in rural areas, maxillary central incisors, and enamel fractures. Moreover, the study has found that only 25 (12.4%) children sought treatment for dental trauma, indicating the need for increased awareness and elaboration of prevention strategies for TDIs at the population level.

Mucoceles that occur on the ventral surface of the tongue are called Blandin-Nuhn cysts, and congenital cases are very rare.We report a case of an infant with an eating disorder associated with lip incompetence due to congenital Blandin-Nuhn cyst.The patient was a 16-day-old male infant.The patient was referred to our department because a cystic lesion had been present on his tongue at birth.On initial examination, a cystic lesion was found on the ventral surface at the apex of the tongue and presenting with lip incompetence.However, neither breathing nor feeding disorders were observed.At 3 months of age, puncture aspiration revealed saliva, and the cyst was reduced in size, allowing lip closure.However, the cyst gradually increased, and the infant developed an eating disorder associated with lip incompetence.Therefore, cyst removal was performed under general anesthesia when the infant was 11 months old.The histopathological diagnosis was retention-type Blandin-Nuhn cyst.This disease should be surgically treated if feeding or breathing disorders are observed.Therefore, it was necessary to carefully monitor the patient for symptoms and then decide when to perform surgery.

Patients undergoing mandibular reconstruction often experience long-term functional and aesthetic challenges, impacting their quality of life (QOL). The objective of this study was to identify factors that most powerfully impact the long-term QOL and functional outcome of patients following mandibular reconstruction with free fibula flaps. This investigation was undertaken to enhance the treatment of this patient population. QOL was assessed between March 2022 and May 2023 in 47 consecutive patients undergoing mandibular reconstruction with fibula free flaps (FFFs) using the University of Washington QOL Questionnaire. Evaluation of functional outcome was based on mouth opening, jaw deviation, tissue atrophy, tongue mobility, lip competence, and speech intelligibility. The study found that loss of chewing was the strongest impairment of QOL (score: 63.83). The most important negative predictors for QOL were female gender (p = 0.047), radiotherapy (QOL subcategory p-values: p = 0.007 to p = 0.034), anterior segment resection (QOL subcategory p-values: p = 0.038 to p = 0.045), advanced defect size (QOL subcategory p-values: p = 0.008 to p = 0.035), and free-hand fibula reconstruction (QOL subcategory p-values: p = 0.003 to p = 0.041). Long-term outcomes revealed that reduced tissue atrophy (QOL subcategory p-values: p < 0.001 to p = 0.025) and preserved tongue mobility (QOL subcategory p-values: p = 0.002 to p = 0.043) were associated with better QOL scores. Functional limitations such as reduced mouth opening (QOL subcategory p-values: p = 0.008 to p = 0.049) and impaired speech intelligibility (QOL subcategory p-values: p < 0.001 to p = 0.015) were significantly correlated with lower QOL in several domains. Mandibular reconstruction with FFFs provides a favorable long-term QOL and functional outcomes, though certain clinical factors, including radiotherapy, anterior segment resection, and defect size, significantly reduce patient-reported QOL.

Robinow syndrome (RS) is a rare genetic disease that may involve cardiovascular, skeletal and urogenital systems and manifest through short limb dwarfism, defects in vertebral segmentation, hypoplastic genitalia and cranial and facial abnormalities. In this article, we hereby present a patient of a 10-year-old Brazilian boy with RS who presented with a remarkable number of classical general and dental features. Physical examination revealed disproportionate short stature with shortening limbs, syndromic face with normal hair appearance, low-set ears, macrocephaly, prominent forehead, hypertelorism and ocular prominence, nose anomalies, triangular mouth with long/short philtrum, incompetent lip seal, midface hypoplasia, retrognathia, deficient malar prominence, among others. Clinical examination revealed gingival hyperplasia, malocclusion, crowding dental, diastemas, microdontia, enamel hypoplasia, prolonged retention, dental caries, delay of dental eruption v-shaped palate, bifid tongue and ankyloglossia history. Radiographically, dental agenesis, hypertaurodontism and thick roof pulp chambers and delayed tooth eruption were observed. Preventive, restorative and rehabilitative dental procedures are being carried out. Robinow syndrome presents clinical and radiographic findings that may be present from birth and require pediatric dentistry follow-up. Furthermore, the pediatric dentist plays an essential role in developing effective planning and treatment in terms of health promotion, aesthetic rehabilitation and functional interventions in the stomatognathic system.

This study aimed to investigate the correlation between orthodontic malocclusion and parafunctional habits, including atypical swallowing, mouth breathing and drooling, in children with cerebral palsy (CP). Fifty-one children with CP (ages 6-14) from the Spastic Children Foundation were assessed. Drooling, lip incompetence and malocclusion were evaluated using the Balasco and Ballard methods, Angle Classification and WHO standards. Soft tissue relations, facial type, profile and face ratios were examined via extraoral assessment and photo analysis. Fisher's exact test was used for statistical analysis. Among the children, 47% had lip incompetence, 57% exhibited mouth breathing, 63% had atypical swallowing and 66% showed increased overjet. Malocclusion findings included 45% with Class II molar relationships and 66% with parafunctional habits. A significant relationship was found between parafunctional habits and orthodontic malocclusion (p < 0.05). A high prevalence of parafunctional habits was observed in children with CP, significantly correlating with orthodontic issues. Early preventive and interceptive orthodontic treatment before the growth phase is essential to improve swallowing, chewing, respiratory function and nutritional intake, ultimately enhancing overall quality of life. Parafunctional habits are highly prevalent in children with cerebral palsy. These habits are significantly associated with the development of malocclusion and craniofacial morphology. Complex tongue thrust, mouth breathing and severe drooling are strongly linked to skeletal and dental anomalies. Early multidisciplinary follow-up and preventive orthodontic approaches can reduce long-term complications. Swallowing patterns, respiratory types and oral motor functions should be evaluated together in clinical assessment and treatment planning.

ABSTRACTAim and backgroundTo evaluate and compare growth and development, breathing habit, and occlusion in children with and without hypertrophic adenoids and tonsils.Materials and methodsThis cross-sectional study was conducted on a total of 78 participants, aged 4–12 years, with 52 children with adenoid/tonsillar hypertrophy (group I) and 26 healthy children (group II). For each participant, a detailed history of respiratory obstruction or infection was recorded, followed by an orthodontic evaluation. A lateral cephalogram was taken for airway space and cephalometric analysis. Descriptive and inferential statistical tests were computed using SPSS software version 21.ResultsChildren with hypertrophic adenoids and tonsils showed a higher incidence of repeated tonsillitis (73.07%) and otitis media (17.3%). On assessing breathing patterns, 88.4% had the mouth breathing habit and 11.5% had the oronasal breathing habit. However, the difference was not statistically significant (p > 0.05). On intergroup comparison, there was a statistically significant difference observed in cephalometric and orthodontic parameters. A higher frequency of lip incompetency, constricted maxillary arch, class II molar relationship, and the posterior crossbite was observed in children with adenotonsillar hypertrophy. Children in group I reported increased overjet (4.9 ± 2.0), increased mandibular plane angle (28.8 ± 3.1), and decreased posterior facial height (61.8 ± 6.1) with a dolichofacial profile (p < 0.05).ConclusionAdenoid or tonsillar hypertrophy in children results in altered skeletal growth patterns, showing a higher tendency of increase in anterior facial height, dolichofacial profile, change in breathing patterns, and malocclusion in children.Clinical significanceHypertrophic adenoids and tonsils are the most common cause of respiratory obstruction in children. Such cases, if diagnosed at an early stage, can be dealt with in a holistic approach to not only intervene but also prevent growth-related problems in children.How to cite this articleJaiswal V, Deshpande AN, Shah Y, et al. Correlation of Hypertrophic Adenoids and Tonsils with Craniofacial Growth, Occlusion, and Breathing Habit in 4–12-year-old Children. Int J Clin Pediatr Dent 2025;18(7):792–798.

Background and Aim: Lip incompetence is defined as a habitual gap of more than 3-4 mm between the lips at rest, which can contribute to oral health issues and malocclusions.This study aimed to propose a deep learning-based model for automatic detection of lip separation on orthodontic photographs.Materials and Methods: This retrospective observational study employed a balanced dataset of 800 clinical images, comprising 400 cases of lip incompetence and 400 cases of lip competence.An autocropping technique based on averaged manual cropping coordinates was used to isolate the lip region.The cropped images were resized to 7070 pixels and normalized before feeding into a novel attentionbased residual connection convolutional neural network (ARN-CNN).The model incorporated both residual connections and attention modules to enhance feature learning and training stability.Data augmentation (e.g., rotation and scaling) was applied to improve generalizability.Training was conducted using 5-fold cross-validation, with an external test set to evaluate performance and reduce overfitting.Metrics such as accuracy, precision, recall, F1 score, receiver-operating characteristic curve-area under the curve (ROC-AUC), and a confusion matrix were used for performance evaluation.Results: The ARN-CNN achieved 95% accuracy on the test set.For the competent class, precision was 0.97, recall was 0.94, and F1 score was 0.96.These values were 0.94, 0.96, and 0.95, respectively, for the incompetent class with an AUC of 0.98. Conclusion:The ARN-CNN model effectively identified lip incompetence, highlighting the potential of deep learning to support orthodontic diagnosis through image-based analysis.