STOMATOGNATHIC STRUCTURES
Cranio-Facial Respiratory Complex includes Palate, Upper and Lower Jaws, Tongue, Nose, Pharynx, Larynx.
Any changes in these Anatomic structures (Stomatognathic structures) decreases the PAS -posterior airway space or Retroglossal and retro palatal space causing Snoring and OSA (Obstructive sleep Apnea)
pic curtesy Dr Rustum
Oral habits Such as Thumb Sucking, Tongue Thrusting, Mouth Breathing, Bruxism,
Nail Biting, Lip Biting play a major role in shaping the Stomatognathic structures.
Likewise
ANATOMICAL STRUCTURAL CHANGES ( Tongue Tie, Adenoids, Tonsils. )
ANATOMICAL POSITIONAL CHANGES (Retrognathia, Micrognathia.)
ASSOCIATED NEUROMUSCULAR TONICITY CHANGES
also play an important role in shaping the Airway and Craniofacial appearances as well.
TONGUE RESTICTIONS
The Tongue plays a very major role in the development of Craniofacial Structures, Airway and TMD
Tongue Tie (Ankyloglossia)
Its a condition present at birth that restricts the tongue's range of motion, restricting the movement of the tongue and may even causes restrictions in its activities like speech (phonetic disorders) and in suckling of milk. (Breast feeding)
Typically, the lingual frenulum separates tongue from floor of the mouth before birth, (The tongue and the floor of the mouth fuse together when an embryo is growing in the womb). allowing the tongue a free range of motion.
With tongue-tie, the lingual frenulum remains attached to the bottom of the tongue. Although the exact reason is unknown, it has been associated with certain genetic factors.
Anterior tongue ties are easy to locate and see because they are near a baby's gumline when they raise their tongue.
A Posterior tongue tie is located deeper in the mouth, further underneath the tongue.
A posterior tongue tie can cause the same problems as an anterior tongue tie, even though it isn't as easily visible, however A tight posterior tongue-tie could cause worse feeding problems than a loose anterior tongue-tie. it also causes lot of restriction to its growth pattern, (tongue grows Laterally) and overall growth of the palate and facial skeleton interfering in the shape of the dental arches and their consequent occlusion.
RME : Rapid maxillary Expansion. Its an Orthodontic Procedure indicated for Children who demonstrate a transverse deficiency in the width of their Maxilla usually manifested by a Cross Bite
Early detection of a tongue tie is important to minimalize the negative effects on growth. Tongue restriction heavily influences jaw growth and development and class II malocclusions. The lower jaw is not able to develop because the restriction of the tongue stops growth of the mandible. Palatal development and shape is also significantly influenced by the placement of the baby's tongue at rest and during breastfeeding
As the tongue grows the palate and arch also grows 👆 with the upward thrust of the tongue,... only if the tongue is free to move, otherwise it will lead to narrow high arched palate (Gutter Palate) due to unopposed 👇inward Cheek pressure
This deep narrow Palate leads to Long face syndrome a condition that causes a long and narrow face.
In the early childhood stages it can be corrected by Myofunctional Appliances but if the Growth Phase is arrested Orthognathic surgery is the treatment indicated in most cases to correct this malformation 👇
Tongue position plays a role in altered dentition. Tongue when placed low instead being up in the Palate especially in Mouth Breathing falls on the lower molar teeth preventing its proper eruption on par with the anterior teeth leading to Bi Cuspid Dentition 👇
The Posterior dental Portion of the Jaw brings changes in the Cranial Vault and Facial complex which is also attributed to habitual feeding on Soft, cooked food and thus using their Jaws less causing decrease in size and robusticity of the masticatory Complex.
pic courtesy to Dr Rustum
Natural Breastfeeding plays an important role in the maturation of the perioral musculature and, therefore, in the development of correct breathing, swallowing and, subsequently, occlusion. ( source-Brookes A, Bowley DM. Tongue tie the evidence for frenotomy. Early Hum Dev.)
If the Tongue is free to move with every suckling the Tongue puts 500grms of pressure on the Palate which thus expands the Palate too. If the Tongue is tied baby uses the lower lip to suckle which alters the Facial Anatomical structures.👇
So, its best advised to get the tongue tie relived as early as possible to prevent above mentioned structural changes
In Anatomical Positional changes lets discuss Retrognathism vs Micrognathias
Retrognathia is a condition characterized by an abnormal position in relation to the maxilla in which the lower jaw is set further back than the upper jaw, making it look small with a severe overbite while Micrognathia is a truly a small Mandible characterized mandibular hypoplasia and is frequently associated to different genetic syndromes. causing a small receding chin
Retrognathism is measured by Facial angle👆 while, The jaw index, the mandibular/maxillary width, (mandibular ratio measured in the axial view) are particularly useful to assess the severity of the micrognathia. Both abnormalities can be detected by ultrasound.
These Facial deformities can be detected as early as in fetal stage when baby is is utero by Fetal Echography with calculation of Inferior Facial Angle which is about 65* to 69*
pic courtesy to Dr Rustum
How to go about it ?
Tongue-tie can improve on its own by the age of two or three years. Severe cases of tongue-tie can be treated by cutting the tissue under the tongue (the frenum).
A Frenotomy, in which the frenulum is snipped with surgical scissors, may be used to treat tongue-ties in infants to prevent future concerns with mouth development.
Palate expanders are devices that exert pressure on Palate to widen the palate
Myofunctional Appliances are given in phase wise to train the muscles from falling inward and to reverse the alveolar arch collapse and appreciate proper shape during Growth Phase.
Orthognathic Surgeries are mostly needed to correct Skeletal Malformations once the Growth Phase is arrested in adult stage.
To Get your child's Occlusal and Tongue status evaluated, Facial growth pattern evaluated & Corrected, and to reverse child's mouth breathing habit, Please book your slot at our website dentistLotusclinics.com
Issued in Public Interest
Well explained doctor