From the Department of Pediatrics, University of Washington School of Medicine, the Division of Allergy, Childrens Orthopedic Hospital and Medical Center; and the Department of Orthodontics, University of Washington School of Dentistry, Seattle, Washington.
Historical Background:
The subject of this review is the relationship between nasal airway obstruction and facail development. Put anotherh way, the review will explore past and present research into the question of whether an aberrant mode of respiration, ie, using the mouth to brethe in perference to the nose, causes deviation in facial anatomy. A number of important anatomic relationships which have been in the focus of study are decribed in Figure1.
The earliest statements on this subject are informed opinions, not criticl evaluations. Robert (1843)1 noted the relationship between a high, narrow alate and obstructed nasal breathing. Meyer (1873)1 concluded that narrow, high-arch palatal develoment occured in individuals with small nasal chambers because the nose failed to develop normally due to obstructive disease.
A dominant theme in the early twentieth century was the immutability of heredity, The role of genetic predisposition in creating an unchangeable facial type took preeminence over an notion that functional relationships migh alter form. Grosheints 1 made extensive measurements of skulls and ocncluded that developmet of a small, hgih-arched palate depended in most instances on a "congenital racial characteristic of skull formation and not upon postnatal and axquired conditions such as nasla obstruction." Somewhat leater, GynneEvans and Ballard,2 professors of orthodontics and respiratory diseases, respectively, evalutated the relationship between morphology and breathing conditinos over a 15-year period. They concluded that orofacial morphology remained constant during growth regardless of mode of respiration, and that there was no special morphologic type associated with mouth breathing.
Counter to this hereditary determinatoin school, others in the twentieth century reiterated the nineteenth century senitments of Robert and Meyer. Duke3 (1926) postulated that nasal allergy produced a specific facial type because of defective aeration of the ethmoid cells and maxillary antra. Bowen4 (1934) stated that protruding maxillary teeth and retrusive lower jaws were....
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