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Introduction: Leukotrienes play a significant role in the pathogenesis of adenoid hypertrophy (A.H.). Therefore, we aimed to analyse the role of montelukast, a leukotriene receptor antagonist, alone or in combination with mometasone, a potent local intranasal steroid, for the treatment of A.H. Methods: Participants were children with A.H. were treated with montelukast alone or montelukast and mometasone furoate. The main outcome measures were effect of montelukast on clinical symptoms of A.H. A literature review was conducted using online search engines, Cochrane Library, PubMed, Web of Science and Scopus, for randomized clinical trials assessing children with A.H. treated with montelukast alone or montelukast and mometasone furoate. Seven randomized clinical trials (RCTs) were included with 742 children. Results: Our study reveals that montelukast alone or in combination with intranasal mometasone furoate significantly improves clinical symptoms of adenoid hypertrophy such as snoring, sleeping disturbance, mouth breathing and A/N ratio. Montelukast was superior to placebo in decreasing snoring (SMD = −1.00, 95% CI [−1.52, −0.49]), sleep discomfort (SMD = −1.26, 95% CI [−1.60, −0.93]), A/N ratio (MD = −0.11, 95% CI [−0.14, −0.09]) and mouth breathing (SMD = −1.36, 95% CI [−1.70, −1.02]). No difference was detected between montelukast and mometasone versus mometasone alone in snoring (SMD = −0.21, 95%CI [−0.69, 0.27]); however, the combination group was superior to the mometasone alone in mouth breathing (SMD = −0.46, 95% CI [−0.73, −0.19]). Conclusions: The limitation of studies included a small sample size, with an overall low to medium quality. Thus, further larger, higher‐quality RCTs are recommended to provide more substantial evidence. [ABSTRACT FROM AUTHOR]

In the present work, the risk of infectious disease transmission is evaluated based on a statistical analysis of respiratory droplet trajectory distribution. An analytical model recently developed by the authors allows the prediction of the trajectory and evaporation rate of exhaled droplets. The model is used to collect data from a sampling set of more than twenty thousand droplets distributed over a range of diameters from 0.1 μm to 1 mm for different respiratory scenarios. The analytical tool implements the governing equations of droplet transport, evaporation, energy balance, and chemical composition. It also features a two-dimensional unsteady empirical model of respiratory cloud including momentum dissipation and buoyancy. A discrete random walk approach to simulate the droplet turbulent dispersion, and the randomization of the droplet release within the exhalation period and the mouth cross section area complete the model enabling statistical analyses to be rightly performed. With the due boundary conditions, different types of respiratory events can be modeled easily. With additional information on the exhaled droplet size distribution and viral content, spatial maps of virus concentration are derived and associated with the risk of infectious disease transmission being able to discriminate between various transmission routes such as fomite, airborne, or direct inhalation. Different scenarios are presented including mouth breathing, nose breathing, speaking, coughing, and sneezing. The fluid dynamic behavior of respiratory droplets is explored on a size basis, and the role of ventilation discussed. Risk evaluation provides useful information for a knowledgeable discussion on the prevention needs and means from case to case. [ABSTRACT FROM AUTHOR]

Custom-made titratable mandibular advancement device (MAD) treatment can nowadays be considered a promising first-line treatment in patients with mild to severe obstructive sleep apnea (OSA). Specific manufacturing designs and titration mechanisms of MAD are on the market, characterized by their titration approach, vertical opening, and materials selection. The wing-designed MAD (SomnoDent® Flex™, SomnoMed Ltd, Sydney, Australia) has a lateral screw mechanism to advance the lower jaw in incremental steps of 0.1 up to 6.0 mm. The newer uniquely designed custom-made MAD with passive mouth closing (SomnoDent® Avant™ SomnoMed Ltd, Sydney, Australia) has a frontal exchangeable advancement strap of fixed lengths as a specific titration mechanism, all supporting freedom of lateral movement. We aimed to assess the associations between the type of MAD prescribed and OSA treatment outcome. Data from 209 patients (165 male, mean age 53.9 (±10.9) years, median baseline BMI and AHI 27.02 [24.8; 29.7] kg/m2 and 22.8 [17.7; 31.6]/hour sleep, respectively) were collected. Of this cohort, 91 patients with the traditional, wing-based SomnoDent® Flex™ and 118 patients with SomnoDent® Avant™. All patients were diagnosed with a type 1 polysomnography demonstrating moderate to severe OSA (15 ≤ AHI ≤65 per hour sleep). The selected MAD was fitted in the so-called maximal comfortable protrusion. After 3 months of subjective titration until resolution of subjective symptoms and/or achieving physical limits, a checkup with validated home sleep monitoring was conducted. Treatment success was defined as "AHI reduction ≥50% with MAD compared to baseline AHI and AHI with MAD <10 events per hour". These real-world data set showed that 67% of patients achieved treatment success, with a statistically significant reduction in AHI from 22.8 [17.7; 31.6] to 7.45 [3.4; 15.0]/h sleep. The SomnoDent® Avant™ achieved 75% treatment success versus 56% for the traditional, wing-based SomnoDent® Flex™ (P < 0.05). Overall, AHI reduction was 70% for SomnoDent® Avant™ (P < 0.05) vs. 63% for SomnoDent® Flex™ (P < 0.05). This study shows that choice of MAD design can impact the treatment outcome and could become an important consideration in selecting the type of MAD for personalized treatment for OSA patients. While the results of the traditional wing-based MAD design were comparable to the therapeutic outcome with other titratable, custom-made MADs, the MAD with the passive mouth closing feature showed significantly greater reduction in total AHI potentially due to encouraged nasal breathing, reduced mouth breathing and lesser vertical opening thereby decreasing the probability of tongue base collapse. • Custom-made titratable mandibular advancement device (MAD) treatment can nowadays be considered a promising first-line treatment in patients with mild to severe obstructive sleep apnea (OSA). • Specific manufacturing designs and titration mechanisms of MAD are characterized by their titration approach, vertical opening, and materials selection. • This study offers evidence that choice of MAD design can impact the treatment outcome and is an important consideration for personalized treatment for patients with moderate to severe OSA. [ABSTRACT FROM AUTHOR]

In the Adriatic Sea, a female common bottlenose dolphin named "Boa" was observed on 19 occasions between 2009 and 2019, inhaling via her mouth for every observed respiration. We provide some explanations for the potential cause of this behaviour using existing evidence. Boa appeared to be in good physical shape and displayed behaviour similar to other individuals. She mothered three calves, raising at least one to independence successfully. Because she lived a normal life, we believe she could vocalise and echolocate. Boa may have been forced to breathe through her mouth to deal with internal injuries, occlusion, or disease. Of the potential causes, an occlusion of the upper respiratory tract seems more likely than a perforation or permanent dislocation of the larynx. An occlusion could result from disease, a congenital disorder, and/or wrongly ingested or inhaled food items or foreign materials. To breathe via the mouth, Boa must have been able to circumvent the separation of the respiratory tract from the oral cavity. By relaxing the respiratory muscles, particularly the palatopharyngeus, she could have used the negative pressure of the lungs to pull in air from the oropharynx into the upper respiratory tract. The true cause of Boa's condition will probably never be discovered. [ABSTRACT FROM AUTHOR]

Introduction: The nasal septum is crucial in the development of the craniofacial structures. Deviated nasal septum is one of the anatomical causes of mouth breathing which in turn lead to malocclusion. Aims and Objectives: To evaluate the dentofacial and cephalometric characteristics in individuals with nasal breathing obstruction brought on by nasal septal deviation, as well as the relationship between these defects and various malocclusions and the degree of facial asymmetry. Materials and Methods: A two-point evaluation was adopted for the selected patients, one at the ENT department using clinical examination and CT-PNS and the severity classified according to the Mladina classification and another at the dental department, using clinical examinations, PA cephalograms, lateral cephalograms, and facial photographs. Results and Discussion: The association between malocclusion and various grades of septal deviation was statistically significant with a P value of 0.006. Results showed that 13 patients are with Class I skeletal pattern, 20 patients with Class II, and 7 patients with Class III skeletal pattern. None of the grade 7 nasal septal deviation patients had class I malocclusion and none of the grade 2 nasal septal deviation patients had class III malocclusion. Class II division I malocclusion was the most common type noted in patients with nasal septal deviation. Grade 7 nasal septal deviation was associated with the maximum amount of ANS and mentioned deviation indicating significant facial asymmetry. Conclusion: Class-II Division-1 malocclusion was the most common type noted and Class III malocclusion was more common in higher grades of nasal septal deviation. Maxillary and mandibular asymmetry worsens significantly with an increase in the grade of nasal septal deviation and is one of the significant factors in causing facial asymmetry. [ABSTRACT FROM AUTHOR]

Recent studies have indicated that breathing shapes the underlying oscillatory brain activity critical for episodic memory, potentially impacting memory performance. However, the literature has presented conflicting results, with some studies suggesting that nasal inhalation enhances visual memory performance, while others have failed to observe any significant effects. Furthermore, the specific influence of breathing route (nasal vs. mouth) and the precise phase of the respiratory cycle during which stimuli are presented have remained elusive. To address this, we employed a visual recognition memory (VRM) and electroencephalography paradigm in which stimuli presentation was phase‐locked to either inhalation or exhalation onset, using a within‐subject design where participants performed the memory task while engaging in separate sessions of nose and mouth breathing. We show that neither breathing route nor breathing phase has a significant impact on VRM performance as measured by d‐prime, with the data supporting the null hypothesis. However, we did find an effect of breathing phase on response bias, with participants adopting a more conservative decision criterion during exhalation. Moreover, we found that breathing phase during memory encoding shaped the late parietal effect (LPE) amplitude, while the Frontal Negative Component (FN400) and LPE during recognition were less impacted. While our study demonstrates that breathing does not shape VRM performance, it shows that it influences brain activity, reinforcing the importance of further research to elucidate the extent of respiratory influence on perception, cognition, and behavior. We demonstrate that phase‐locked breathing through the nose and mouth does not shape episodic visual recognition memory performance but does impact underlying event‐related potentials and response bias criterion. These findings challenge the belief that breathing affects visual memory function and underscore the importance of methodological considerations. [ABSTRACT FROM AUTHOR]

Chronic rhinosinusitis (CRS) with severe asthma are associated with breathing pattern disorder (BPD). Mouth breathing is a sign of breathing pattern disorder, and nose breathing a fundamental part of breathing pattern retraining for BPD. The prevalence of BPD in relation to CRS subtypes and the relationship of nasal obstruction to BPD in CRS and associated severe asthma is unknown. The breathing pattern assessment tool (BPAT) can identify BPD. Our objective was to thus investigate the prevalence of BPD, nasal airflow obstruction and measures of airway disease severity in CRS with (CRSwNP) and without nasal polyps (CRSsNP) in severe asthma. We determined whether CRS status, peak nasal inspiratory flow (PNIF) or polyp disease increased BPD prevalence. Demographic factors, measures of airway function and breathlessness in relation to BPD status and CRS subtypes were also evaluated. 130 Patients were evaluated (n = 69 had BPD). The prevalence of BPD in CRS with severe asthma was 53.1%. There was no difference between BPD occurrence between CRSwNP and CRSsNP. The mean polyp grade and PNIF were not statistically different between the BPD and non-BPD group. The presence of nasal polyps did not increase breathlessness. BPD and CRS are commonly co-associated. CRS status and nasal obstruction per se does not increase BPD prevalence. [ABSTRACT FROM AUTHOR]

Summary This cross‐sectional study aimed to assess the prevalence of atypical deglutition (tongue thrust) in children diagnosed with moderate to severe obstructive sleep apnea syndrome (OSAS) and to explore its associations, particularly in relation to the type of dentition (mixed or permanent). The study was conducted over a 5 year period at a paediatric hospital in Paris, France. Children aged 6–18 years with moderate to severe OSAS (apnea–hypopnea index ≥5/h) underwent a comprehensive evaluation, including the recording of demographic data, symptoms of snoring and breathing issues, and otolaryngology examination. The swallowing pattern was assessed and orthodontic evaluations were performed. Cephalometric radiography and pharyngometry tests (pharyngeal collapsibility was computed) were conducted. The study found a high prevalence of atypical deglutition in children with mixed 74% [56–87] or permanent 38% [25–51] dentition. In children with mixed dentition and atypical deglutition, the pharyngeal compliance and lower facial dimensions were increased. In children with permanent dentition, atypical deglutition was associated with more severe OSAS and a lower hyoid bone position. Independent of the type of dentition, atypical deglutition was associated with an increase in the apnea–hypopnea index, an increase in the lower facial dimension, increased pharyngeal compliance, and a more caudal hyoid bone position. Atypical deglutition was strongly associated with increased pharyngeal collapsibility, more severe OSAS and altered facial measurements in children. The findings suggest that identifying atypical deglutition in children with OSAS could help to guide a personalised therapeutic approach, including myofunctional therapy. [ABSTRACT FROM AUTHOR]

Although humans breathe naturally through the nostrils, mouth breathing in children has recently gathered attention. In this study, we hypothesized that tongue function and its related maxillofacial morphology would affect breathing in adolescence. To verify this hypothesis, we examined the association between breathing patterns, including mouth and nasal breathing; oral functions, including tongue motor function; and craniofacial morphology during adolescence, which has not been investigated till date. C3-H, which indicates the anteroposterior position of the hyoid bone in relation to the third cervical vertebra, was significantly smaller in mouth-breathers than in nasal-breathers. Lip-closing force, tongue pressure, and masticatory efficiency were lower in the order of nasal-breathers, oronasal-breathers, and mouth-breathers, and the values for mouth-breathers were significantly lower than those for nasal-breathers. Tongue pressure alone was identified as a significant independent variable, with an odds ratio of 1.063 (95% confidence interval, 1.006–1.123; p < 0.05). Our results indicate a relationship between mouth breathing and the lip-closing force, tongue pressure, and masticatory efficiency, as well as the significance of tongue pressure on mouth breathing in adolescents. The findings highlight the importance of clarifying the pathophysiology of mouth breathing and its underlying causes. [ABSTRACT FROM AUTHOR]

Children with grade III or IV of adenotonsillar hypertrophy especially of a longer duration, may show cardiovascular changes due to mouth breathing. These changes can be detected on doppler echocardiocardiography which can be used as a screening tool. Fifty paediatric patients of grade 3 and 4 adenotonsillar hypertrophy underwent adenotonsillar resection after a pre-operative work up which included doppler echocardiography to measure pulmonary artery pressures. A post-operative doppler echocardiography was done after three months. 11 children (22%) showed deranged pulmonary artery pressure values with increased mean pulmonary artery pressure (MPAP) and pulmonary artery systolic pressure (PSAP) on preoperative doppler echocardiography, and 2 out of these 11 children had Pulmonary Artery Hypertension. A significant (p < 0.001) improvement was noted in pulmonary artery pressure values (MPAP and PSAP returned to normal) after adenotonsillectomy in 3-month postoperative echocardiography. Also, a statistically significant correlation was obtained between chronicity of symptoms and raised pulmonary artery pressures. Our study concluded that these children with chronic untreated upper airway obstructive symptoms get predisposed to potential cardiac complications. And these grave consequences can be easily prevented by a timely intervention. [ABSTRACT FROM AUTHOR]

Sleep is a major concern in Down syndrome children. Obstructive sleep apnea, delayed sleep onset, night-time and early awakenings have been reported contributing to the cognitive and behavioral outcomes. The aim is to evaluate sleep related difficulties in Down syndrome young children. A questionnaire of sleep related difficulties was translated and validated into Arabic language then was filled in by caregivers of 45 Down syndrome and 48 normal children. The questionnaire consisted of sections related to snoring, breathing difficulties, mouth breathing, upper respiratory tract infections, sleep position, restless sleep and frequent awakening, and daytime behavior. The results show highly significant differences between the total and subtotal questionnaire scores with higher scores in the control group. The questionnaire has a good reliability. Test–retest reliability of the questionnaire revealed a significant positive correlation in the total questionnaire and all the subitems except for the 7th subitem of the daytime behavior which showed no significant correlation. The questionnaire showed 100% sensitivity and 70.8% Specificity with at cut-off value of 8.5. The sleep related difficulties questionnaire has good psychometric properties and could detect significant sleep problems in Down syndrome children. [ABSTRACT FROM AUTHOR]

Aim: To determine the indications of adenotonsillectomy and to evaluate the quality-of-life post-adenotonsillectomy surgery. Materials and Methods: This is a descriptive cross-sectional study done in the department of ENT, Indira Gandhi Medical College and Research Institute (IGMCRI), Puducherry among patients who underwent adenotonsillectomy surgery from the year 2015 to 2022. The data regarding their clinical profile and indications for surgery were collected from the medical case records and these patients were contacted through telephone to know their quality of life using a standardized questionnaire. Results: A total of 98 patients were included in the study, 43 males and 55 females, between the age of 4 to 48 years. Adenotonsillitis (infection) was the indication for adenotonsillectomy in 69 out of 98 patients (70.4%), and Adenotonsillar hypertrophy (Obstruction) in 29 out of 98 patients (29.5%). Postoperatively, the symptoms like frequency of episodes of throat pain had decreased from 6.16 2.08 to 1.24 0.44 (p<0.001), snoring (72–1%), mouth breathing (70.4–3.1%), average number of doctor visits due to throat pain (3.91 1.44 to 1) and average number of days absent to school/ work (3.81 1.26 to nil) had decreased significantly. Conclusion: Adenotonsillitis (Infection) as an indication is more common than adenotonsillar hypertrophy (Obstruction) for performing adenotonsillectomy in our study. Majority of the patient's symptoms had markedly decreased post-surgery and hence a significant improvement in overall quality of life, both physical and general well-being. [ABSTRACT FROM AUTHOR]

Introduction: The Modified Mallampati (MM) grading and Friedman's Tongue Position (FTP) scores are two major scoring systems used to evaluate the oropharyngeal space. However, the current descriptions of performing these scores do not specify the route of breathing taken by the patient during the examination. The dynamic changes in the tongue and palate, in relation to the route of breathing, may contribute to the high interobserver variability in MM scoring. Aim: To explore the differences in MM scores and Friedman's scores obtained during mouth breathing and nose breathing in order to standardise the scoring system. Materials and Methods: A community-based cross-sectional study was conducted at the Departments of Anaesthesiology and Community Medicine at Believers Church Medical College Hospital in Central Kerala, India between April 2022 and October 2022, on 702 adults. MM scores and FTP scores were recorded separately for each person during mouth breathing and nose breathing. Socio-demographic variables such as age, gender, and Body Mass Index (BMI) were also collected. The data was analysed using the Z-test for proportions. Results: The mean age of the study participants was 3.58±16.42 years. The majority of the participants were females (69.2%), and more than half (59%) were above 50 years of age. Out of the 135 participants with an MM Score-1 during mouth breathing, 99 (73.3%) had higher scores during nose breathing. For the 196 individuals with an MM Score-2 during mouth breathing, 87 (44.3%) had higher scores during nose breathing. Similarly, out of the 220 people with an MM score of -3 during mouth breathing, 106 (48.2%) had a Score-4 during nose breathing. A similar pattern was observed for the FTP scores. Conclusion: The present study demonstrates significant variability in MM and FTP scores obtained during oral and nasal breathing, highlighting the need to standardise the route of breathing during examination. The study suggests that advising patients to breathe through the mouth may relax the tongue and improve the predictive value of MM grading. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to analyze the relationship between breastfeeding duration and adenoid size, snoring and acute otitis media (AOM). Methods: We analyzed the medical history of children admitted to the ENT outpatient clinic in 2022 and 2023, reported symptoms, ear, nose and throat (ENT) examination, and flexible nasopharyngoscopy examination of 145 children aged 3–5 years. Results: Breastfeeding duration of 3 and 6 months or more had a significant effect on the reduction of snoring (p = 0.021; p = 0.039). However, it had no effect on the adenoid size, mucus coverage and sleeping with an open mouth. Snoring was correlated with open mouth sleeping (p < 0.001), adenoid size with a 75% A/C ratio or more (p < 0.001), and adenoid mucus coverage in the Mucus of Adenoid Scale by Nasopharyngoscopy Assessment—MASNA scale (p = 0.009). Children who were breastfed for less than 3 months had more than a four-fold greater risk of snoring. There was a statistically significant correlation between AOM and gender (p = 0.033), breastfeeding duration in groups fed 1, 3 or 6 months or more (p = 0.018; p = 0.004; p = 0.004) and those fed with mother's breast milk 3 or 6 months or more (p = 0.009; p = 0.010). Moreover, a correlation was found between adenoid size and mucus coverage, tympanogram, and open-mouth sleeping (p < 0.001). Independent factors of snoring in 3- to 5-year-old children were breastfeeding duration of less than 3 months (p = 0.032), adenoid size with an A/C ratio of 75% or more (p = 0.023) and open mouth sleeping (p = 0.001). Conclusions: Children breastfed for 3 and 6 months or more exhibited reduced rates of snoring. There was no effect of breastfeeding duration on adenoid size in children aged 3 to 5 years, suggesting that the link between breastfeeding duration and snoring is primarily associated with craniofacial development and muscle tone stimulation. A breastfeeding duration of 1 month or more plays a key role in reducing the rate of AOM. The mother's milk plays a protective role against AOM. The presence of mucus might be responsible for snoring in preschool children. A medical history of breastfeeding should be taken into consideration when snoring children are suspected of adenoid hypertrophy. [ABSTRACT FROM AUTHOR]

Objective By analyzing the clinical data from 88 infants or young children with allergic rhinitis (AR), we explore the clinical characteristics of AR in those pediatric patients as well as the improvement in symptoms after drug treatment. Methods A retrospective analysis was conducted on 88 infants or young children initially diagnosed with AR who visited the pediatric respiratory clinic of the first affiliated hospital of Guangzhou medical university from February 1, 2020 to August 1, 2020. Telephone follow-ups were conducted from 6 to 12 months after the first visit. Based on the follow-up results, we summarized the clinical characteristics, complications, and efficacy of therapies of AR in infants and young children. Results Among 88 infants or young children aged 3 to 36 months with AR, 34 (38.6%) had mild AR and 54 (61.4%) had moderate to severe AR. Runny nose and nasal congestion were the most common clinical symptom (87.5%, 77/88), followed by sneezing (47.7%, 42/88) and nasal itching (37.5%, 33/88). Coughing (56.8%, 50/88) was the most common complications, followed by snoring (52.3%, 46/88), wheezing (27.3%, 24/88) and mouth breathing (12.5%, 11/88).The top three positive rates of serum specific IgE testing were 53.4% (47/88) in milk, 46.6% (41/88) in dust mites and 36.4% (32/88) in eggs. After 2 to 8 weeks of medication uses, the remission rate of rhinitis symptoms was significantly higher in mild AR than in moderate to severe AR [94.1% (32/34) vs. 75.9% (41/54), χ² = 4.883, P = 0.027]. 24.1% of patients with moderate to severe AR still had recurrent symptoms at follow-up visits, which was significantly higher than 5.9% in the mild AR group (χ² = 4.883, P = 0.027). Conclusion The main symptoms of AR in infants and young children are runny nose and nasal congestion, and the main complications include cough and snoring. The main allergens are dust mites, milk, and eggs. The symptom relief rate is better in mild AR than in moderate to severe AR after treatment. The symptoms in moderate to severe AR are prone to relapse. [ABSTRACT FROM AUTHOR]

Background: Individuals with spastic cerebral palsy are more predisposed to parafunctional oral activities and oral motor problems because of spasticity. Objectives: The aim of the study was to evaluate the relationship between the gross motor function classification system score (GMFCS), age, bruxism, parafunctional oral habits and oral motor problems in children with cerebral palsy. Methods: This cross‐sectional study included 63 children with spastic cerebral palsy, aged 3–18 years, with developmental disabilities. The relationship between parentally reported bruxism, parafunctional oral activity rates, oral motor problems, and GMFCS was analysed. Results: The prevalence of bruxism was 52.4%, and the rate decreased as age increased. There was a greater likelihood of bruxism in individuals with tongue thrust (OR [95% CI] = 8.15 [1.4–47.3]) and swallowing problems (OR [95% CI] = 5.78 [1.3–24.68]). Conclusion: In children with spastic cerebral palsy, bruxism and the rate of parafunctional oral habits were high, thus affecting oral motor activities. A relationship was found between oral motor problems and increased GMFCS levels, but no relationship was found between bruxism and GMFCS levels. Children with spastic cerebral palsy who display tongue thrust or swallowing problems have an increased likelihood of presenting with bruxism. The study found that the prevalence of bruxism was 52.4% among 63 children with spastic cerebral palsy, ranging in age from 3 to 18 years, and the incidence of bruxism decreased as age increased. Individuals with tongue thrust (OR [95% CI] = 8.15 [1.4–47.3]) and swallowing problems (OR [95% CI] = 5.78 [1.3–24.68]) had a significantly higher likelihood of experiencing bruxism. In children with spastic cerebral palsy, both bruxism and the frequency of parafunctional oral habits were notably high, thereby influencing oral motor activities. [ABSTRACT FROM AUTHOR]

Surgery on the growing pediatric nose poses many questions regarding the indications and proper timing. Historically, surgeries on the pediatric nose led to facial growth alterations so many urged caution and waiting until skeletal maturity at the age of 18. However, animal studies showed some promise that facial growth may not be affected. Investigations into effects of pediatric sinus surgery and septal surgery on facial growth showed no issues. The external nose is somewhat different in that minor variations potentially can grow to a cosmetic deformity. However, numerous studies on facial growth show, to date, that it is not affected, and that surgery is safe. The caveat that one uses is the techniques of cartilage sparing and preservation, which have been studied and shown to be safe. There are ways to measure the effectiveness of surgery in relieving nasal airway obstruction both objectively and, more recently, subjectively. It is essential to treat pediatric nasal airway obstruction to avoid other facial growth problems, such as mouth breathing, snoring, malocclusion, and obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Background: A simulated education, prior to surgery about postoperative nasal stuffiness and ease of breathing through the mouth may help patients tolerate discomfort after nasal surgery. This study aimed to investigate the effect of preoperative simulated education on immediate postoperative opioid requirements in patients undergoing elective nasal surgery. Methods: This randomized controlled trial of 110 patients undergoing nasal surgery randomly allocated patients into either a control (group C) or an education group (group E). One day before surgery, patients in group E were intensively trained to breathe through the mouth by using a nasal clip, with informative explanations about inevitable nasal obstruction and discomfort following surgery. Patients in group C were provided with routine preoperative information. Total intravenous anesthesia (TIVA) with propofol and remifentanil was used for anesthesia. No further opioid was used for analgesia intraoperatively. The primary outcome was index opioid (fentanyl) requirements at the post-anesthesia recovery unit (PACU). Secondary outcomes were emergence agitation, pain scores at the PACU, and postoperative recovery using the Quality of Recovery-15 (QoR15-K). Results: The rate of opioid use in the PACU was 51.0% in the group E and 39.6% in the group C (p = 0.242). Additional request for analgesics other than index opioid was not different between the groups. Emergence agitation, postoperative pain severity, and QoR15-K scores were comparable between the groups. Conclusion: Preoperative education with simulated mouth breathing in patients undergoing nasal surgery did not reduce opioid requirements. Trial registration: KCT0006264; 16/09/2021; Clinical Research Information Services (https://cris.nih.go.kr). [ABSTRACT FROM AUTHOR]

Introduction Changes in breathing patterns affect the harmonious development of the structures of the craniofacial system, leading to changes in posture, occlusion, and facial growth patterns. However, little is known about how these changes influence the muscle contraction patterns, either at rest or while functioning, and either in a normal or unbalanced condition. Objective To study the masseter and anterior temporal muscles fatigue during mastication in nasal- and mouth-breathing children, also considering their facial growth patterns. Methods: A total of 70 children aged 6 to 12 years old who met the study criteria were assessed. Speech-language-hearing, otorhinolaryngologic, and cephalometric assessments were performed to divide them into groups. In the electromyographic assessment, the children were asked to chew gum following a metronome until they felt fatigued. The median frequency of the muscles was analyzed at 15, 30, 45, and 60 seconds of mastication. The reported time of fatigue perception was recorded. The data were analyzed with analysis of variance (ANOVA) and the Kruskal-Wallis and the Mann-Whitney U tests. Results There were no median frequency decrease patterns nor differences in the myoelectric manifestations and reported time of fatigue between the groups. Conclusion The masticatory muscles did not reveal fatigue in the electromyographic analysis; however, the fatigue time was reported, despite the absence of physiological fatigue. The breathing mode, the facial growth pattern, and the association between them did not interfere with the behavior of the median frequency of the electromyographic signal and the fatigue time perception. [ABSTRACT FROM AUTHOR]

Simultaneous multilineage hematologic malignancies are uncommon and associated with poorer prognosis than single-lineage leukemia or lymphoma. Here, we describe a concomitant malignant neoplasm in a 4-year-old boy. The child presented with massive lymphoproliferative syndrome, nasal breathing difficulties, and snoring. Morphological, immunocytochemical, and flow cytometry diagnostics showed coexistence of acute myeloid leukemia (AML) and peripheral T-cell lymphoma (PTCL). Molecular examination revealed a rare t(9;9)(q34;q34)/SET::NUP214 translocation as well as common TCR clonal rearrangements in both the bone marrow and lymph nodes. The disease showed primary refractoriness to both lymphoid and myeloid high-dose chemotherapy as well as combined targeted therapy (trametinib + ruxolitinib). Hence, HSCT was performed, and the patient has since been in complete remission for over a year. This observation highlights the importance of molecular techniques for determining the united nature of complex SET::NUP214-positive malignant neoplasms arising from precursor cells with high lineage plasticity. [ABSTRACT FROM AUTHOR]

This literature review aimed to analyze mouth breathing in changes in craniofacial growth and describe the clinical characteristics that a mouth breather has. The diagnosis and treatment of mouth breathing are multidisciplinary, and the etiology of mouth breathing is generally associated with obstructive factors, functional habits and special needs involving neurological dysfunction. Mouth breathing is generally correlated with a more elongated face, narrow jaw, posterior crossbite and postural changes in the spine. Etiological factors must be recognized at diagnosis to ensure adequate growth and development of the stomatognathic system. [ABSTRACT FROM AUTHOR]

Background: Emergence delirium (ED) is generally occurred after anesthesia associated with increased risks of long-term adverse outcomes. Therefore, this study aimed to evaluate the efficacy of preconditioning with nasal splint and mouth-breathing training on prevention of ED after general anesthesia. Methods: This randomized controlled trial enrolled 200 adult patients undergoing ESS. Patients were randomized to receive either nasal splinting and mouth breathing training (n = 100) or standard care (n = 100) before surgery. The primary outcome was the occurrence of ED within 30 min of extubation, assessed using the Riker Sedation-Agitation Scale. Logistic regression identified risk factors for ED. Results: Totally 200 patients were randomized and 182 aged from 18 to 82 years with 59.9% of males were included in the final analysis (90 in C-group and 92 in P-group). ED occurred in 16.3% of the intervention group vs. 35.6% of controls (P = 0.004). Male sex, smoking and function endoscopic sinus surgery (FESS) were independent risk factors for ED. Conclusions: Preoperative nasal splinting and mouth breathing training significantly reduced the incidence of emergence delirium in patients undergoing endoscopic sinus surgery. Trial Registration: ChiCTR1900024925 (https://www.chictr.org.cn/index.aspx) registered on 3/8/2019. [ABSTRACT FROM AUTHOR]

Introduction: Many scales are designed to screen for obstructive sleep apnoea‐hypopnoea syndrome (OSAHS); however, there is a lack of an efficiently and easily diagnostic tool, especially for Chinese. Therefore, we conduct a cross‐sectional study in China to develop and validate an efficient and simple clinical diagnostic model to help screen patients at risk of OSAHS. Methods: This study based on 782 high‐risk patients (aged >18 years) admitted to the Sleep Medicine department of the Sixth Affiliated Hospital, Sun Yat‐sen University from 2015 to 2021. Totally 34 potential predictors were evaluated. We divided all patients into training and validation dataset to develop diagnostic model. The univariable and multivariable logistic regression model were used to build model and nomogram was finally built. Results: Among 602 high‐risk patients with median age of 46 (37, 56) years, 23.26% were women. After selecting using the univariate logistic model, 15 factors were identified. We further used the stepwise method to build the final model with five factors: age, BMI, total bilirubin levels, high Berlin score, and symptom of morning dry mouth or mouth breathing. The AUC was 0.780 (0.711, 0.848), with sensitivity of 0.848 (0.811, 0.885), specificity of 0.629 (0.509, 0.749), accuracy of 0.816 (0.779, 0.853). The discrimination ability had been verified in the validation dataset. Finally, we established a nomogram model base on the above final model. Conclusion: We developed and validated a predictive model with five easily acquire factors to diagnose OSAHS patient in high‐risk population with well discriminant ability. Accordingly, we finally build the nomogram model. [ABSTRACT FROM AUTHOR]

Breathing usually occurs without awareness unless there are problems such as asthma, emphysema, allergies, or viral infections. Infant and child development may affect how we breathe as adults. This article includes discussion of the benefits of nasal breathing, factors that contribute to mouth breathing, how babies' breastfeeding and chewing decreases the risk of mouth breathing, and recommendations that parents may implement to support healthy development of a wider palate. A link to a video presentation also is included: How the Tongue Informs Healthy (or Unhealthy) Neurocognitive Development, by Karindy Ong, MA, CCC-SLP, CFT. [ABSTRACT FROM AUTHOR]

We present a large-eddy simulation (LES) of saliva particle transport during normal human breathing through the nose and mouth. The flow of the air–saliva mixture is modeled using an Eulerian LES that is coupled with a Lagrangian particle tracking module to obtain trajectories of saliva particles in a room with stagnant air conditions. The coupled Eulerian–Lagrangian simulation yields novel insights into the intricate dynamics of Lagrangian coherent structures (LCS) and fundamental material lines that emerge from the saliva particles' trajectories during several breathing cycles. Further, we systematically compare the quantitative LCS diagnostics of mouth breathing with those of mouth and nose normal breathing. Analyzing the simulation results of human breathing from the mouth and nose, we show that, soon after the first breathing cycle, saliva particles form a series of roll-up vortex rings that propagate forward. The forward propagation of these vortex rings leads to the formation of an asymmetrical primary forefront vortex. The individual vortex rings continuously propagate forward, merging with the forefront vortex, and ascending along the limb of the leading vortex. [ABSTRACT FROM AUTHOR]

Abnormal functions, such as mouth breathing, swallowing, and unilateral chewing, and aberrant postures of the oral circumferential muscles, such as forwards tongue thrust, tongue biting, and low tongue at rest, can also contribute to the development of malocclusion. Even the most conservative of orthodontists would admit that aberrant tongue movement is a common contributor to misaligned teeth. This research was conducted with the intention of shedding light on the tongue's structure and development, as well as its functions and orthodontic consequences. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Choanal atresia with a supernumerary nostril located on the columella is extremely rare. Infants are obligate nasal breathers because the oral airway is invariably blocked during calm respiration. Infants breathe through the mouth only during crying, and they only have nasal breathing until 5 months of life. Congenital nasal anomalies have been reported to be fatal from birth, requiring tracheal intubation or tracheostomy in the early postnatal period. In these cases, it is crucial to maintain an adequate airway. Case Report: A 2948-g female infant was born at 40 weeks by normal vaginal delivery. Her Apgar scores were 9 and 9 at 1 and 5 min, respectively. She had retractive breathing, cyanosis, and a supernumerary nostril at birth. She had no other anomalies. Computed tomography showed bilateral membranous choanal atresia. She needed nasal continuous positive pressure or a high-flow nasal canula for oxygen desaturation during crying, apnea, and dyspnea. However, her respiratory symptoms did not improve completely. On day 25 of life, she was given a mouthpiece to support mouth breathing. Her respiratory symptoms improved gradually, and she was discharged on day 73 of life with a mouthpiece. Conclusions: A very rare case of choanal atresia with a supernumerary nostril located on the columella was described. A mouthpiece was effective for breathing, obviating the need for emergency surgical intervention in the early postnatal period. Emergency procedures were avoided, probably because this case involved incomplete bilateral membranous choanal atresia rather than complete bony atresia. [ABSTRACT FROM AUTHOR]

To obtain a correlation between endoscopic findings, radiological findings and clinical features in children with symptomatic Chronic Adenoid hypertrophy. A cross sectional study was conducted in 42 pediatric patients (3–14 years) who visited the Department of Otorhinolaryngology in a tertiary care centre from November 2019 to April 2021 (18 months). The patients were subjected to complete history taking; ENT examination, Rigid nasal endoscopic examination, a lateral X-ray nasopharynx were performed prior to surgery after obtaining consent from the parents of the patients. The endoscopic findings were assessed using ACE grading system and the X-ray nasopharynx was assessed using Adenoid- Nasopharyngeal ratio. A male predominance was noted with mouth breathing, snoring, nasal obstruction and recurrent rhinitis as common presentation. Grade 3 hypertrophy was the most common finding in X-ray Nasopharynx (Mean ANR-0.682). Children with Grade 3 adenoid hypertrophy with more than 50% choanal obstruction and Eustachian tube abutment in nasal endoscopy were noted to be the most symptomatic clinically. A positive correlation between reduced hearing (p value-0.004) and blocked ear sensation (p value- < 0.01) with eustachian tube abutment was noted. The children with more symptoms did not show higher-grade adenoid hypertrophy radiographically in our study. The adenoid- nasopharyngeal ratio on X-ray correlated with endoscopic grading of adenoid hypertrophy (p value-0.006) and degree of choanal obstruction (p value-0.003) but not with the abutment of the eustachian tube. The endoscopic grading correlated with clinical grading, but not the X-ray grading. Hence, endoscopic grading appears to be more accurate in assessing the adenoid size and endoscopic grading is nearer to clinical grading than X-ray grading. Though, the digital X-ray nasopharynx lateral view is a more convenient method, nasal endoscopy is the gold standard method to determine whether the adenoid hypertrophy is clinically significant or not. [ABSTRACT FROM AUTHOR]

Tonsillectomy is one of the most commonly performed surgical procedures worldwide. Postoperative pain remains a significant problem for patients undergoing tonsillectomy and is the most typical reason for readmission after the procedure. We conducted the present study to investigate the efficacy of a single dose of dexamethasone administered intravenously before tonsillectomy on postoperative pain in a group of patients undergoing cold dissection tonsillectomy, using a standardised anaesthetic and surgical procedure.It was a prospective study done in the Department of ENT in a tertiary care centre in eastern India, from 1 st September 2017 to 31 st August 2019 (2 years). Subjects included in the study were patients who attended the OPD of ENT of the tertiary care centre in eastern India, with a history of throat pain,difficulty in deglutition, mouth breathing, snoring. Tonsillectomy operation was recommended to the patients who fit the inclusion criteria. A hundred patients were selected for the study and divided randomly into two groups. Patients in group A (50 patients) were administered preoperative intravenous dexamethasone (0.15 mg/kg)after the induction of anaesthesia, and Group B patients (50 patients)were not administered dexamethasone along with other drugs.RESULTS: A hundred patients were enrolled after excluding the patients not fulfilling the selection criteria. The majority of patients were female, with the majority patients between 9–19 years. There was a noteworthy decreased mean pain score postoperatively of Group A on the first, third, and fifth day. (p-value = < 0.001).The results of this study suggest that a single preoperative injection of dexamethasone for patients undergoing tonsillectomy by cold dissection method significantly reduced postoperative pain. [ABSTRACT FROM AUTHOR]

Background Adenoid Hypertrophy (AH) results in symptoms ranging from mild nasal obstruction to the dangerous obstructive sleep apnoea. Normally for such patients Adenoidectomy with or without Tonsillectomy is carried out. However complications like haemorrhage and recurrence of adenoid tissue are common. Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The present study is aimed at evaluating the effect of oral Montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH. Materials and Methods Sixty children aged between 6 and 12 years with adenoid hypertrophy were randomly divided into two groups of thirty each. The study group was prescribed Tablet Montelukast 5 mg daily for 12 weeks while the control group received matching placebo. A questionnaire based upon the severity of the symptoms as well as the Adenoid Nasopharynx ratio (A/N), as measured via X-ray Adenoids and the Nasal endoscopic scores done before and after treatment (at 3 months) in the two groups were taken into consideration. Results The Mann Whitney Test which was used found no distinction in snoring, sleep discomfort and mouth breathing between the two groups before the start of treatment. But a significant difference was indeed observed between the two groups after treatment in case of snoring (P < 0.006), sleep discomfort(P < 0.001) and mouth breathing (P < 0.001). Conclusion Oral Montelukast therapy is seen to be effective not only in the reduction of the size of adenoids but also in improvement of the overall symptoms and can thus be considered as a viable alternative. [ABSTRACT FROM AUTHOR]

Background: Waldeyer’s ring is composed from adenoid, tonsils, and other lymphoid tissue. They can be hypertrophied causing many symptoms to the patient. Adenoidal tissue usually hypertrophied physiologically at middle childhood and starts to shrink at late childhood. However, in patients over the age of 10 they may enlarge leading to a number of obstructive symptoms. Objectives: The aim of this study is to identify the risk factors and the presenting symptoms associated with adenoid enlargement in patients above the age of 12 year. Methods: 130 patients above the age of 12 year old who underwent adenoidectomy in the date from the first of January 2016 to the first of January 2021 were studied. Patients were evaluated at Otorhinolaryngology and Head & Neck Surgery department at Jordan University Hospital in Amman – Jordan. Patient’s data was collected via medical records or telephone interviews. Results: Of the 130 patients, 81 are males and 49 are females. The mean age of the sample was 19.68. The most common presenting symptom was snoring (81.5%). The second most common presenting symptom was nasal obstruction (75.4%) and mouth breathing (71.5%). The most common associated risk factor was septal deviation (44.6%) followed by passive smoking (40.8 %), allergic rhinitis (38.5%), and pollution (38.5%). Conclusion: There are multiple suspected risk factors of adenoid hypertrophy in patients aged above 12 year old. In our study, septal deviation was found to be the most widely associated factor followed by passive smoking, allergic rhinitis and pollution. Patients commonly presented with symptoms of snoring and nasal obstruction. [ABSTRACT FROM AUTHOR]

Cassia twig, a Chinese herbal drug, is widely prescribed in Treatise on Cold Pathogenic Diseases, and it is found in more than 60 clauses and more than 40 prescriptions. It treats covers all of the diseases of the six meridians, namely, three yin and three yang. Shennong's Classic of Materia Medica described cassia twig as: (i) mainly used to relieve cough with dyspnea due to counterflow of qi, stagnation of qi, throat impediment, and breathing with the mouth due to severe impediment of the throat, to promote movement of joints, tonify the middle energizer, and replenish qi; and (ii) useful for ushering other traditional Chinese drugs to treat all the disease, and able to invigorate the spirit and mind, relax the body, and prevent aging. This article begins from the thought of "image," referred to in the text of Shennong's Classic of Materia Medica, by analyzing the natural attributes of cassia twigs, such as shape, position, color, taste, smell, texture, habits, and growth environment. This is combined with the Treatise on Cold Pathogenic Diseases and the experience of physicians in previous dynasties, and it summarizes and analyzes the "image" mechanism of its efficacy to broaden its application in modern clinical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Correct breathing is a fundamental condition for adequate vocal production. Respiratory dynamics are able to modify the growth of facial mass and lingual posture, i.e., of the skull, the mandibular one. For this reason, infant mouth breathing can cause hoarseness. Materials and methods: We evaluated the actual changes in the characteristics of the voice and articulation of language in a group of subjects affected by adenotonsillar hypertrophy (grade 3–4), with frequent episodes of pharyngo-tonsillitis who underwent adenotonsillectomy. Our study included 20 children—10 boys and 10 girls—aged 4 to 11 years who had adenotonsillar hypertrophy and pharyngotonsillitis episodes exceeding 5–6 per year in the previous 2 years. The control group (Group B) included 20 children—10 boys and 10 girls—aged 4 to 11 years (average age of 6.4 years) who had not undergone surgery and shared the same degree of adenotonsillar hypertrophy as those in Group A but who did not experience recurrent pharyngotonsillitis episodes. Discussion: The hypertrophy of adenoids and tonsils significantly impacted breathing, vocal function, and speech articulation. All this is responsible for a state of tension in the neck muscles, which at the level of the vocal tract causes hoarseness. The changes objectively observed in our study in the pre- and post-operative phase demonstrate how adenotonsillar hypertrophy is responsible for an increase in resistance to the passage of air at the glottic level. Conclusions: For this reason, adenotonsillectomy has an impact on recurrent infections and can also lead to an improvement in speech, breathing, and posture. [ABSTRACT FROM AUTHOR]

Multiforce nickel–titanium (NiTi) orthodontic archwires release progressively increasing forces in a front-to-back direction along their length. The properties of NiTi orthodontic archwires depend on the correlation and characteristics of their microstructural phases (austenite, martensite and the intermediate R-phase). From a clinical and manufacturing point of view, the determination of the austenite finish (Af) temperature is of the greatest importance, as in the austenitic phase, the alloy is most stable and exhibits the final workable form. The main purpose of using multiforce orthodontic archwires is to decrease the intensity of the applied forces to the teeth with a small root surface area, such as the lower central incisors, and also provide forces high enough to move the molars. With the optimally dosed forces of multiforce orthodontic archwires in the frontal, premolar and molar segments, the feeling of pain can be reduced. This will contribute to the greater cooperation of the patient, which is of utmost importance to achieve optimal results. The aim of this research was to determine the Af temperature at each segment of as-received and retrieved Bio-Active® and TriTanium® archwires with dimensions of 0.016 × 0.022 inches, investigated by the differential scanning calorimetry (DSC) method. A classical Kruskal–Wallis one-way ANOVA test and multi-variance comparison based on the ANOVA test statistic using the Bonferroni corrected Mann–Whitney test for multiple comparisons were used. The incisor, premolar and molar segments have different Af temperatures, and they decrease from the anterior to posterior so that the posterior segment has the lowest Af. Bio-Active® and TriTanium® with dimensions of 0.016 × 0.022 inches can be used as first leveling archwires by additional cooling and are not recommended for use on patients with mouth breathing. [ABSTRACT FROM AUTHOR]

Background: Mouth breathing (MB) can affect morphological changes in the craniofacial structures, electromyography is widely used for quantitative analysis of muscle function. Objective: The aim was to evaluate the electromyographic (EMG) activities of the anterior temporalis (TA), masseter muscle (MM), orbicularis oris superior (OOS) and mentalis muscle (MT) in children with different vertical skeletal patterns and breathing modes during rest and various functional mandibular movements. Methods: BioEMG III was used to measure the variations in EMG activities of TA, MM, OOS, and MT in 185 subjects aged 6–12 years during continuous clenching, rest, maximal intercuspation, lips closed lightly and swallowing. Results: The results of logistic regression analysis showed that the model with vertical skeletal patterns as the dependent variable was ineffective (p =.106), while the model with breathing modes as the dependent variable was effective (p =.000). When considering both vertical skeletal patterns and breathing modes, the following significant differences were found. (1) In the normal‐angle group, the EMG ratio in OOS with lips closed lightly of MB was significantly higher than NB (p =.005). (2) In the low‐angle group, EMG ratios in TA and MM during the swallowing of MB were significantly lower than NB (p =.020, p =.040, respectively). (3) In the high‐angle group, EMG ratios of MB were significantly higher in MT during continuous clenching, rest, lips closed lightly and swallowing (p =.038, p =.036, p =.005, p =.028, respectively), and OOS with lips closed lightly compared to NB (p =.005). Conclusion: Breathing modes and vertical skeletal patterns interacted to alter maxillofacial EMG activities, with breathing modes having a greater effect. Breathing modes and vertical skeletal patterns interacted to alter maxillofacial EMG activities, with breathing modes having a greater effect on the maxillofacial EMG. [ABSTRACT FROM AUTHOR]

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Sleep bruxism (SB) is a masticatory muscle activity during sleep, and its clinical manifestation in young children is still unclear. The aim of the present study was to evaluate the role of anamnestic information in predicting possible SB in children aged 4–12 years. In a cross-sectional retrospective exploratory study, the dental files of 521 children were examined with regard to the following anamnestic information: gender, age, medical conditions associated with ear, nose, and throat (ENT), respiratory disorders, use of methylphenidate (Ritalin), oral habits, and bruxing during sleep. A child was defined as presenting possible SB when a positive report was received from parents regarding such behavior (SB positive, No. = 84). There were no age- and/or gender-wise differences between SB-positive children and children whose parents did not report SB behavior (SB negative). SB-positive children suffered more from ENT and respiratory disorders than children without SB. Additionally, the use of pacifiers/finger sucking, as well as snoring, were more common among SB-positive children as compared to their SB-negative counterparts (Chi-square). The variables which were found to significantly increase the odds of possible SB in children were mouth breathing, ENT problems, and use of a pacifier or finger sucking (forward stepwise logistic regression). Clinicians should look for clinical signs of possible SB in children whose anamnesis reveals one or more of these anamnestic signals. [ABSTRACT FROM AUTHOR]

Summary: A 17‐year‐old cross‐bred pony gelding was presented for acute onset of respiratory distress and an inspiratory honking noise. He had been previously diagnosed with moderate mastocytic equine asthma and chronic tracheal collapse on endoscopy (grade 3/4). At admission, predominantly inspiratory dyspnoea with open mouth breathing, hypoxaemia and hypercapnia were present. Cervical and thoracic radiographs showed severe tracheal collapse from the mid‐cervical region to the thoracic inlet and a moderate generalised bronchial pattern. Due to the poor prognosis, euthanasia was elected. On post‐mortem examination, some granulomatous nodules compatible with tracheobronchopathia osteochondroplastica were present in the tracheal lumen, and the entire trachea was laterally flattened. This uncommon laterolateral collapse was more severe at the thoracic inlet and in the mid‐cervical area, where a peritracheal haematoma was detected. A blunt trauma that exacerbated the tracheal collapse was suspected. Tracheal histology revealed degenerative changes. Degeneration of tracheal cartilage and connective tissue can be a predisposing factor to chronic collapse and recurrent episodes of inspiratory and expiratory distress. It is unknown whether chronic tracheal collapse is an independent condition or a consequence of an underlying lung disease. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Adenoid cystic carcinoma (ACC) is a malignant tumor that involves the salivary glands and is rarely seen in the nasopharynx. It is characterized by pain, a high rate of recurrence, and poor survival rate and poor prognosis as it tends to invade the perineurium. Due to the ambiguity of patient presentations, most patients present at a late stage, at which point metastasis has already occurred. Case Report: The patient in this case report was an otherwise healthy 56-year-old male smoker who presented to the clinic in March 2022 complaining of nasal obstruction, mouth breathing, recurrent epistaxis, headache, and facial pain. He reported significant weight loss in the past 6 months. The nasal scope showed nasopharyngeal fullness and biopsy-confirmed ACC exhibiting tubular, solid, and focal cribriform growth patterns. Further work-up showed an advanced form of nasopharyngeal ACC with intracranial extension and lung metastasis. The patient received concurrent radiotherapy and chemotherapy. After 6 months, the patient reported an improvement in the pain, and repeated images showed regression of the tumor size. Conclusions: ACC is a malignant disease that is rarely seen in the nasopharynx. Currently, the most commonly agreed upon management for resectable ACCs in the literature is through surgical resection with adjuvant radiotherapy. However, most of the reported cases received radiation and chemotherapy due to the difficulty and risk of radical surgical excision of nasopharyngeal malignant tumors. Patients should be followed up to rule out any local recurrence or distant metastasis. [ABSTRACT FROM AUTHOR]

Schwannomas of sinonasal origin are rare tumours with an incidence as low as 4% and may present with a wide range of clinical features. Due to non-specific endoscopic and radiological findings, diagnosis becomes difficult. We present a case of an ethmoidal schwannoma with nasal and nasopharyngeal extension in an elderly female patient who had a slow course of the long-standing disease. Her main complaints were nasal obstruction, nasal discharge, mouth breathing, snoring and recurrent nasal bleed. Nasal endoscopy showed a pale, firm, polypoidal mass with dilated vessels on the surface which bled on probing. It was a non-enhancing sinonasal mass with scalloping of adjacent paranasal sinuses and erosion of posterior nasal septum on contrast-enhanced computed tomography. Endoscopic excision of the mass was done in toto and histopathology report confirmed it as schwannoma. Long standing sinonasal masses especially in the elderly age group with an indolent medical history should arise suspicion of benign neoplasm especially schwannomas due to their high rate of incidence amongst benign sinonasal neoplasms. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify the prevalence of parafunctional habits and common symptoms of temporomandibular disorders in young individuals reporting to the Watim Dental College Materials and methods: This cross-sectional study was carried out by a survey and clinical examination over a period of six months from September 2021 to February 2022. Data from 103 patients, who fulfilled the inclusion criteria, were collected using a structured questionnaire and clinical examination regarding their parafunctional habits and temporomandibular joint symptoms. Informed consent was filled out by all the participants. Data were analyzed using SPSS version 23. A descriptive analysis was calculated for both quantitative and qualitative variables. Results: The prevalence of oral parafunctional habits among the study sample was quantified on a binary scale (yes/no) where nail-biting was observed to be highly prevalent (38%), followed by mouth breathing (27%). The most frequently reported temporomandibular joint symptom was noise (clicking or crepitation) which was 66%. Difficulty in mouth opening was the least common (20%) of all the symptoms noted. Conclusion: It may be concluded from our study that amongst parafunctional habits nail biting is the most common habit amongst young individuals and amongst the temporomandibular joint disorder clicking and crepitation is the most common symptom persistent with the condition. [ABSTRACT FROM AUTHOR]

As evidenced by the worldwide pandemic, respiratory infectious diseases and their airborne transmission must be studied to safeguard public health. This study focuses on the emission and transport of speech-generated droplets, which can pose risk of infection depending on the loudness of the speech, its duration and the initial angle of exhalation. We have numerically investigated the transport of these droplets into the human respiratory tract by way of a natural breathing cycle in order to predict the infection probability of three strains of SARS-CoV-2 on a person who is listening at a one-meter distance. Numerical methods were used to set the boundary conditions of the speaking and breathing models and large eddy simulation (LES) was used for the unsteady simulation of approximately 10 breathing cycles. Four different mouth angles when speaking were contrasted to evaluate real conditions of human communication and the possibility of infection. Breathed virions were counted using two different approaches: the breathing zone of influence and direction deposition on the tissue. Our results show that infection probability drastically changes based on the mouth angle and the breathing zone of influence overpredicts the inhalation risk in all cases. We conclude that to portray real conditions, the probability of infection should be based on direct tissue deposition results to avoid overprediction and that several mouth angles must be considered in future analyses. Author summary: We have experienced the devastating nature of airborne transmitted diseases through the recent COVID-19 pandemic. To eradicate short and long-range cross-infection of viruses like SARS-CoV-2 and other such diseases, we need to unravel the fundamentals of droplet generation, transport and deposition due to human interactions. Here, we have computationally simulated viral droplet transport from one talking person to another and calculated the infection probability by predicting the exact number of virions attached to the respiratory tract tissue of the possible host. Our results emphasize the need of using real-like settings and conditions for virtual infection risk prediction to avoid under or overestimation. The ability to accurately predict infection probability of SARS-CoV-2 and other airborne transmitted diseases through computer simulations benefits society by enabling us to create new guidelines and preventive measures for present and future needs. [ABSTRACT FROM AUTHOR]

Background: Bovine babesiosis caused by an intraerythrocytic apicomplexan protozoon responsible for the most prevalent and costly tick borne diseases (TBD’s) of cattle throughout the globe. Cerebral babesiosis of bovine is fatal and mainly caused by Babesia bovis. To the knowledge of author, there is no confirm molecular report of Babeisa bigemina caused cerebral babesiosis in cattle. Therefore, authors want to report Babesia bigemina caused cerebral babesiosis on record. Methods: In the year 2015, a Holstein-Friesian cow aged 3 years and weighing approximately 300 kg, was attended at Jabalpur, (M.P.) with the clinical signs of high rise in temperature (104F), recumbency, severe dysponea, peculiar sound during open mouth breathing, pale color of eye conjunctiva and mucous membrane of vagina, convulsions, sever anaemia, paddling of legs at frequent interval. After preparation of peripheral thin blood smear from animal at the site of collection and fixation with methanol, blood sample brought to Department of Veterinary Parasitology, College of Veterinary Science and A.H, Jabalpur and stained by standard protocol for Giemsa staining. Genomic DNA was isolated from the collected blood sample using QIAamp® DNA blood mini kit following the manufacturer’s recommendations and PCR was performed. Conclusion: The thin blood smear examination revealed the presence of Babesia parasite. The species of Babesia was confirmed by molecular amplification of genomic DNA as B. bigemina. This might be the first confirmed report of cerebral babesiosis caused by B. bigemina from Central India. [ABSTRACT FROM AUTHOR]

The extrathoracic oral airway is not only a major mechanical barrier for pharmaceutical aerosols to reach the lung but also a major source of variability in lung deposition. Using computational fluid dynamics, deposition of 1–30 µm particles was predicted in 11 CT-based models of the oral airways of adults. Simulations were performed for mouth breathing during both inspiration and expiration at two steady-state flow rates representative of resting/nebulizer use (18 L/min) and of dry powder inhaler (DPI) use (45 L/min). Consistent with previous in vitro studies, there was a large intersubject variability in oral deposition. For an optimal size distribution of 1–5 µm for pharmaceutical aerosols, our data suggest that >75% of the inhaled aerosol is delivered to the intrathoracic lungs in most subjects when using a nebulizer but only in about half the subjects when using a DPI. There was no significant difference in oral deposition efficiency between inspiration and expiration, unlike subregional deposition, which shows significantly different patterns between the two breathing phases. These results highlight the need for incorporating a morphological variation of the upper airway in predictive models of aerosol deposition for accurate predictions of particle dosimetry in the intrathoracic region of the lung. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lip incompetence resulting from mouth breathing is a common clinical manifestation, while there are no definite indicators of amplitude and intensity of muscle functional training in clinical practice, which leads to unsatisfactory training results. OBJECTIVE: The aim was to quantify the relationship between electromyography (EMG) and force in orbicularis oris muscle, so that the indicators of muscle functional training can be evaluated using EMG signals, so as to improve the training effects. METHODS: The EMG and the force signals of orbicularis oris muscle from 0% to 100% MVC within 5 s in twelve healthy subjects (six males and six females; age, 25 ± 2 years; mass, 60 ± 15 kg) were recorded simultaneously for three trials. Four EMG features consisting of RMS, WAMP, SampEn and FuzzyEn were analyzed. The regression analyses were performed using first-order and third-order polynomial model. RESULTS: There were high correlations between the four EMG features and muscle force with the two models. The third-order model yielded a higher coefficient of determination (R 2) than the linear model (p < 0.001) and the result of FuzzyEn (R 2 : 0.884 ± 0.059) was the highest in the four features. CONCLUSION: The third-order model with FuzzyEn of EMG signals may be used to guide the muscle functional training. [ABSTRACT FROM AUTHOR]

The breathing pattern of Mouth Breathing (MB) implies the adaptation of body posture to facilitate the passage of airflow through the oral cavity, which can be prevented or reversed through physical exercise. However, there is no consensus on which is the best model of exercise program to minimise these postural adaptations. The purpose of the review was to investigate the effect of different physical exercise programs on the posture of mouth-breathing children and adolescents. The research was performed in Scopus, PubMed, Lilacs, Bireme, and Scielo databases in November 2022. The following descriptors were included: "mouth breather and exercise", "mouth breathing and exercise", "nasal obstruction and exercise", "mouth breather and exercises", "mouth breathing and exercises", and "nasal obstruction and exercises". Clinical trials related to the effect of physical exercise on the posture of MB children and adolescents were considered. Among 2796 identified studies, six were included. The mean score of the methodological quality scale of the selected studies was 5.5 points on a scale of 0 to 10. All studies showed an improvement in body posture after the exercise program. The exercise programs comprised muscle strengthening and stretching exercises, neuromuscular proprioceptive facilitation, and postural and diaphragmatic reeducation. The duration of the programs and the weekly frequency varied in the studies. Although it is difficult to compare studies and establish guidelines for formulating an exercise protocol, it was observed that upper limb strengthening and stretching exercises could effectively improve the body posture of MB children and adolescents. [ABSTRACT FROM AUTHOR]

Although nasal obstruction (NO) during growth causes maxillofacial growth suppression, it remains unclear whether eliminating the NO affects maxillary and mandibular growth differentially. We aimed to clarify whether eliminating NO can help regain normal maxillofacial growth and to determine the optimal intervention timing. Forty-two 4-week-old male Wistar rats were randomly divided into six groups. Their left nostril was sutured to simulate NO over different durations in the experimental groups; the sutures were later removed to resume nasal breathing. Maxillofacial morphology was assessed using microcomputed tomography. Immunohistochemical changes in hypoxia-inducible factor (HIF)-1α, osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-B ligand (RANKL) of the condylar cartilage were evaluated to reveal the underlying mechanisms of these changes. Maxillary length was significantly lower in rats with NO for ≥5 weeks. In groups with NO for ≥7 weeks, the posterior mandibular length, ramus height, thickness of the hypertrophic cell layer in the condylar cartilage, HIF-1α levels, and RANKL levels were significantly lower and OPG levels and RANKL/OPG were significantly higher than those in the control group. Our findings suggest that eliminating NO is effective in regaining maxillofacial growth. Moreover, the optimal timing of intervention differed between the maxilla and mandible. [ABSTRACT FROM AUTHOR]

Coblation intracapsular tonsillectomy (ICT) is becoming popular due to its decreased postoperative complications. However, a concern exists about the need for revision surgery. We conducted a retrospective observational cohort study, with a null hypothesis that Coblation ICT is not associated with recurrence of the preoperative symptoms, obstructive tonsillar regrowth, or the need for revision tonsillar surgery. We reviewed 345 patients (median age of 4.5 years; IQR 3.2–6.3), operated by the senior author between Feb 2017 and Sep 2020, for a median follow-up of 395.0 days (IQR 221.5–654.5). Most patients had snoring (94.2%), mouth breathing (92.8%), restless sleep (62.6%), and sleep disorder breathing (52.8%); 12.5% had recurrent tonsillitis. The mean initial total symptoms score (TSS) was 5.2 (SD 1.4, range 1–8); 87.5% had three or more symptoms; 86.7% underwent ICT; TSS decreased postoperatively to a mean of 0.2, SD 0.8, range 0–7. The mean hospital stay was 0.96 day (SD 0.36, range 0–3). Secondary bleeding occurred in 0.7% of ICT patients. No patient required admission or intervention. There was no documented tonsillar regrowth resulting in upper airway obstruction. No one needed tonsillar revision surgery. Intracapsular tonsillectomy was shown to be an effective procedure with long-lasting results. [ABSTRACT FROM AUTHOR]

To compare intraoperative and postoperative parameters of the two techniques of adenoidectomy, endoscope and microdebrider powered adenoidectomy and conventional adenoidectomy. Study Design Prospective study. Setting: Academic tertiary referral centre. In our study, cases of adenoid hypertrophy were randomly selected from the outpatient department of department of ORL & HNS. Out of these patients, 30 underwent Endoscopic adenoidectomy (EA) (Group A) and 30 underwent Conventional adenoidectomy (CA) (Group B). All of the patients were assessed pre-operatively, intra-operatively and post-operatively to compare the various parameters. The most common complaint in both the groups was mouth breathing with snoring. Intra-operative bleeding was 29.15 ml in group EA and 15.2 ml in group CA. Operative time for CA was shorter at 21.8 min as compared to 32.1 min for group EA. Residual adenoids and injury to adjacent structures were more common in group CA. Hospital stay was 3.2 days for EA patients and 3.43 days for CA patients. Resolution of symptoms was near comparable in both groups. Operative time and intra-operative bleeding are both significantly reduced with the CA as opposed to EA. However, injury to adjacent structures and residual adenoids occur significantly less in group EA. After weighing the risks and benefits, we can conclude that EA is comparatively better than CA. [ABSTRACT FROM AUTHOR]