Nasopharyngeal lymphoid tissue, breathing pattern, and articulation disorders in children with unilateral posterior crossbite: controlled clinical trial

Background: Unilateral posterior crossbite (ULCB) in early mixed dentition is associated with hereditary factors, sucking habits, and impaired nasal breathing. This study aimed to assess ear, nose, and throat (ENT) structures, orofacial functions, and articulation disorders in children with ULCB, compared to healthy controls, and to evaluate the changes after rapid maxillary expansion (RME). Methods: Thirty-one children with ULCB (mean age 7.62 ± 1.3 years) and 31 age- and gender-matched control subjects without malocclusion (mean age 7.63 ± 0.67 years) were examined by an orthodontist, an ENT specialist, and speech therapist. Children with ULCB were treated with a Haas-type maxillary expander. ENT and orofacial assessments were repeated four years after treatment. Data were analysed using chi-square, Mann-Whitney, and Wilcoxon tests. Results: At baseline, children with ULCB were significantly more likely to have impaired nasal breathing (p < 0.001), enlarged adenoids (p = 0.005), low tongue posture (p = 0.001), lip incompetence (p = 0.026), and articulation disorders (p < 0.001) compared with controls. Post-treatment evaluations revealed significant improvements in nasal breathing (p = 0.001), tongue posture (p < 0.001), adenoid size and nasopharyngeal patency (p < 0.001), mentalis muscle activity (p = 0.025), lip competence (p = 0.014), and swallowing pattern (p = 0.031). Conclusions: A unilateral posterior crossbite was associated with articulation disorders, impaired nasal breathing, tongue posture at the floor of the mouth, and enlarged adenoids in the early mixed dentition. The widening of the maxilla had a significant effect, as it improved nasopharyngeal patency as well as the breathing pattern and tongue posture. Clinical Trial Registration: ISRCTN15126033 (Retrospectively registered).

Unilateral posterior crossbite; Adenoids; Palatine tonsils; Tongue habits; Orofacial function; Mouth breathing; Articulation disorders

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