title: Muscular, functional and orthodontic changes in pre school children with enlarged adenoids and tonsils.
abstract: BACKGROUND
  Hypertrophy of the adenoids and palatine tonsils is the second most frequent cause of upper respiratory obstruction and, consequently, mouth breathing in children. Prolonged mouth breathing leads to muscular and postural alterations which, in turn, cause dentoskeletal changes.
  
  
  OBJECTIVE
  The aim of this study was to determine muscular, functional and dentoskeletal alterations in children aged 3-6 years.
  
  
  METHODS
  Seventy-three children, including 44 with tonsil hypertrophy and 29 controls, were submitted to otorhinolaryngologic, speech pathologic and orthodontic assessment.
  
  
  RESULTS
  Otorhinolaryngologic evaluation revealed a higher incidence of nasal obstruction, snoring, mouth breathing, apneas, nocturnal hypersalivation, itchy nose, repeated tonsillitis and bruxism in children with tonsils hypertrophy. Speech pathologic assessment showed a higher incidence of open lip and lower tongue position, and of hypotonia of the upper and lower lips, tongue and buccinator muscle in these children, accompanied by important impairment in mastication and deglutition. Orthodontic evaluation demonstrated a higher incidence of lower mandible position in relation to the cranial base, a reduction in lower posterior facial height, transverse atresia of the palate, and a dolicofacial pattern.
  
  
  CONCLUSIONS
  Postural and functional alterations anticipate dentoskeletal changes, except for the facial pattern. Postural alterations and the skeletal pattern seem to play an important role in infant dentofacial growth.
authors.affiliation: Otorhinolaringology Department of Clinical Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. facpvalera@uol.com.br
authors.forename: Fabiana C P
authors.initials: FC
authors.lastname: Valera
authors.forename: Luciana V V
authors.initials: LV
authors.lastname: Travitzki
authors.forename: Sara E M
authors.initials: SE
authors.lastname: Mattar
authors.forename: Mírian A N
authors.initials: MA
authors.lastname: Matsumoto
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Elias
authors.forename: Wilma T
authors.initials: WT
authors.lastname: Anselmo-Lima
mesh_terms: D000234:Adenoids / Q000473:pathology*; D000704:Analysis of Variance; D016022:Case-Control Studies; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008334:Mandible / Q000473:pathology; D009058:Mouth Breathing / Q000209:etiology; D015508:Nasal Obstruction / Q000209:etiology; D014066:Palatine Tonsil / Q000473:pathology*; D012132:Respiratory Muscles / Q000473:pathology* / Q000503:physiopathology*; D012141:Respiratory Tract Infections / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D013064:Speech Disorders / Q000175:diagnosis / Q000209:etiology; D014076:Tooth Diseases / Q000175:diagnosis / Q000209:etiology