The use of distraction osteogenesis to improve the airway volume of individuals affected by craniofacial anomalies is common practice today. The methods of assessing the outcomes of such surgical procedures have changed over the last several years.

Objective : The objective of the present pilot study was to determine if the CBCT imaging modality may serve as a simple and reliable method for craniofacial practitioners to evaluate airway volume changes following distraction osteogenesis.

Materials and Methods : Twelve patients who had previously undergone distraction osteogenesis for the primary purpose of improving their airways were enrolled in the current study. Pre (T0) and post-surgical (T1) CBCT’s volumes were analyzed to measure the nasopharyngeal (NP) and oropharyngeal (OP) volume changes. InVivoDental 4.0 (Anatomage Inc., San Jose, CA) (IVD) program was used to visualize and render the oropharyngeal (OP) and nasal passage (NP) volumes, separately. Means and standard deviations were calculated.

Results : Of the 7 males and 5 females in the study, 4 patients underwent mandibular distraction (MandDO) and 8 underwent maxillary distraction (MaxDO). Four in the MaxDO group were treated with internal distractors and 4 were treated with external distractors. Individuals who underwent internal MaxDO greatly improved their NP volumes (1605 ± 1736 to 3273 ± 3130 mm3) as did patients who underwent external MaxDO (5763 ± 5077 to 9243 ± 9442 mm3). In comparison, the MandDO group’s NP volume showed modest gains (3519 ± 1944 to 3894 ± 2516 mm3). With regard to the OP volumes, the MandDO group gained substantially (4906 ± 2347 to 11385.8 ± 6393.5 mm3) while the MaxDO groups showed humble increases; internal MaxDO group (1779 ± 273.8 to 2639.5 ± 898.4 mm3) and the external MaxDO group (8959 ± 5311 to 9734.13 ± 7124.7 mm3).

Conclusions : In the present preliminary study of assessing airway volume changes using CBCT on patients who have undergone different DO techniques, MandDO greatly increases OP volumes and MaxDO tends to increase NP volumes. The CBCT imaging modality holds great promise for craniofacial practitioners in its application to assess airways of individuals affected by craniofacial anomalies.

Measurements of nasal resistance do not give an exhaustive functional assessment of nasal breathing function. Nevertheless, an increase in its thermal endocranial exchanges during its operation, which are regulated specifically by respiratory nasal mucosa, can be utilized to construct an operative physiological definition of nasal breathing at a state of optimal rest. These precise assessments, in elucidating the etiology of oral-nasal malformations, can give a clear picture of the morphological characteristics that orthodontists should strive to optimize as the face develops over the course of their treatment of malocclusions.

The objective of this article is to demonstrate the effectiveness of good cooperation between orthodontists and Ear, Nose, and Throat specialists because of the importance of freeing the upper airways from obstruction in order to achieve a good orthodontic result as well as the other side of the coin, the beneficial effect orthodontic treatment can have in stimulating a functional liberation of those airways when no mechanical blockage is present. The article will emphasize how important it is for orthodontists to understand and to be alert to the signs and symptoms that would indicate the need for an ENT evaluation.

Every day orthodontists observe the consequences habitual mouth breathing has in their patients’ oral cavities and the limitations this dysfunction places on their orthopedic and orthodontic treatments. Orthodontists can enlist the assistance of their ENT colleagues for the elimination of hypertrophied adenoidal and tonsillar tissue, but when asked to perform surgical correction of malformed nasal septa and turbinates for young children most otolaryngologists usually advise strongly against such procedures. Even surgery for labio-maxillo-palatal clefts is still entangled in the same web of dogmatic disapproval. For these unilateral or bilateral cleft patients, 75 % of whom breathe primarily through their mouths, the potential for growth is considered to be limited and unpredictable. This belief, we feel, is related to the tendency of workers in our field to pay insufficient attention to nasal breathing. But in our practice, for the past thirty years we have been re-establishing it for patients at about the age of 6 and now we are doing it for children between the ages of 4 and 5. For the last 13 years we have helped affected children to breathe nasally at the age of 6 months by means of an ambitious but rigorous surgical procedure on all patients with total clefts. The current results on the nasal and maxillary growth of these children are good enough to encourage us to continue along the same lines, with the expectation of very soon being able to confirm our results as they reach the end of their growth periods.

The surgical treatment of maxillo-mandibular malformations accompanying cases of hyperdivergence should aim at achieving good function for the patient by increasing space available for the tongue to move in and for proper respiration to take place and by reducing the tensions affecting muscles and ligaments either by dis-inserting them or by moving skeletal structures in the direction that muscles attached to them contract. An analysis of the literature shows that by respecting these principles surgeons can obtain good results in the majority of cases even in instances of extreme deficiency of the body of the mandible or where lengthening of the ascending rami is required. For these patients a cooperative effort of the surgeon and the orthodontist becomes even more than ever indispensable. In addition it will be necessary for the treatment team to follow these patients for an extended post-operative period.