Skip to main content

The Human Facial Skeleton: Influence on the Airway and Aesthetics? An Analysis of Cause/Effect Paradigms

  • 291 Accesses

Abstract

The extent of protrusion of the facial bones has diminished over the course of hominid evolution and may be continuing to do so. This process may, through structural changes of the maxilla and mandible, be resulting in what we see as an aesthetic deformity of the receded chin. Beyond this simple aesthetic problem, the petite jaws may predispose individuals to mouth-breathing and extrusion externally of the nasal septum, resulting in nasal deformity and deviation. The structural problem may also relate to sleep disordered breathing.

Keywords

  • Hominid facial evolution
  • Mandible growth
  • Retro-gnathia
  • Mouth-breathing
  • Nasal septum
  • Sexual selection

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-44674-1_4
  • Chapter length: 23 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   84.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-44674-1
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   109.99
Price excludes VAT (USA)
Fig. 4.1
Fig. 4.2
Fig. 4.3
Fig. 4.4
Fig. 4.5
Fig. 4.6
Fig. 4.7
Fig. 4.8
Fig. 4.9

References

  1. Davidson TM. The Great Leap Forward: the anatomic basis for the acquisition of speech and obstructive sleep apnea. Sleep Med. 2003;4(3):185–94.

    PubMed  CrossRef  Google Scholar 

  2. Stupak HD. The human external nose and its evolutionary role in the prevention of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2010;142(6):779–82.

    PubMed  CrossRef  Google Scholar 

  3. Mladina R, Skitarelić NB, Skitarelić NP. Letter to: the human external nose and its evolutionary role in the prevention of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2010;143:712.. author reply 712–3

    PubMed  CrossRef  Google Scholar 

  4. Elluru RG. Adenoid facies and nasal airway obstruction: cause and effect? Arch Otolaryngol Head Neck Surg. 2005;131(10):919–20.

    PubMed  CrossRef  Google Scholar 

  5. Dierks E. No convincing premise for efficacy of prophylactic Adenotonsillar ablation. Arch Otolaryngol Head Neck Surg. 2005;131(10):918.

    PubMed  CrossRef  Google Scholar 

  6. Huang YS, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol. 2013;3:184.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  7. Dowsett EB. Discussion on mouth breathing and nasal obstruction. Proceedings of the Royal Society of Medicine. Section of Odontology, April, 1932. p. 1343–55.

    Google Scholar 

  8. Stupak HD, Park SY. Gravitational forces, negative pressure and facial structure in the genesis of airway dysfunction during sleep: a review of the paradigm. Sleep Med. 2018;51:125–32.

    PubMed  CrossRef  Google Scholar 

  9. Williams and Mahoney – “The effect of enlarged adenoids on a developing malocclusion”. 2010, Revista latinomericana de otrodoncia y odontopediatria.

    Google Scholar 

  10. Vargervik K, Miller AJ, Chierici G, Harvold E, Tomer BS. Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod. 1984;85(2):115–24.

    CAS  PubMed  CrossRef  Google Scholar 

  11. Tomer BS, Harvold EP. Primate experiments on mandibular growth direction. Am J Orthod. 1982;82(2):114–9.

    CAS  PubMed  CrossRef  Google Scholar 

  12. Harvold EP, Tomer BS, Vargervik K, Chierici G. Primate experiments on oral respiration. Am J Orthod. 1981;79(4):359–72.

    CAS  PubMed  CrossRef  Google Scholar 

  13. Linder-Aronson S. The impact of adenotonsillectomy on the dentofacial development of obstructed children. Eur J Orthod. 2018;40(4):451.

    PubMed  CrossRef  Google Scholar 

  14. Linder-Aronson S. The relation between nasorespiratory function and dentofacial morphology. Am J Orthod. 1983;83(5):443–4.

    CAS  PubMed  CrossRef  Google Scholar 

  15. Zettergren-Wijk L, Forsberg CM, Linder-Aronson S. Changes in dentofacial morphology after adeno-/tonsillectomy in young children with obstructive sleep apnoea–a 5-year follow-up study. Eur J Orthod. 2006;28(4):319–26.

    PubMed  CrossRef  Google Scholar 

  16. Koca CF, Erdem T, Bayındır T. The effect of adenoid hypertrophy on maxillofacial development: an objective photographic analysis. J Otolaryngol Head Neck Surg. 2016;45(1):48.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  17. Farid MM, Metwalli N. Computed tomographic evaluation of mouth breathers among paediatric patients. Dentomaxillofac Radiol. 2010;39(1):1e10.

    CrossRef  Google Scholar 

  18. Basheer B, Hegde S, Bhat SS, et al. Influence of mouth breathing on the dentofacial growth of children: a cephalometric study. J Int Oral Health. 2014;6(6):50e5.

    Google Scholar 

  19. Masaaki S, Taiji F, Akira S, et al. Relationship between oral flow patterns, nasal obstruction, and respiratory events during sleep. J Clin Sleep Med. 2015;11(8):855e60.

    Google Scholar 

  20. Ali AA, Richmond S, Popa H, et al. The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study. BMJ Open. 2015;5(9):e009027.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  21. Stellzig-Eisenhauer A, Meyer-Marcotty P. Interaction between otorhinolaryngology and orthodontics: correlation between the nasopharyngeal airway and the craniofacial complex. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:04.

    Google Scholar 

  22. Fernando M, Feres N, Muniz TS, et al. Craniofacial skeletal pattern: is it really correlated with the degree of adenoid obstruction? Dental Press J Orthod. 2015;20(4):68e75.

    Google Scholar 

  23. Oh K, Kim M, Youn J, et al. Three-dimensional evaluation of the relationship between nasopharyngeal airway shape and adenoid size in children. Korean J Orthod. 2013;43(4):160e7.

    CrossRef  Google Scholar 

  24. Juliano ML, Machado MA, Bizari L, et al. Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children. J Clin Sleep Med. 2009;5(6):554e61.

    CrossRef  Google Scholar 

  25. Grewal N, Alkesh V, Godhane L. Lateral cephalometry: a simple and economical clinical guide for assessment of nasopharyngeal free airway space in mouth breathers. Contemp Clin Dent. 2010;1(2):66e9.

    Google Scholar 

  26. Adedeji TO, Amusa BY, Aremu AA. Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy. Afr J Paediatr Surg. 2016;13(1):14e9.

    Google Scholar 

  27. Ritzel RA, Berwig LC, Toniolo da Silva MA, et al. Correlation between nasopharyngoscopy and cephalometry in the diagnosis of hyperplasia of the pharyngeal tonsils. Int Arch Otorhinolaryngol. 2012;16(2):209e16.

    Google Scholar 

  28. Grippaudo C, Paolantonio EP, Antonini G, et al. Association between oral habits, mouth breathing and malocclusion. Acta Otorhinolaryngol Ital. 2016;36(5):386e94.

    Google Scholar 

  29. Ucar FI, Ekizer A, Uysal T. Comparison of craniofacial morphology, head posture and hyoid bone position with different breathing patterns. Saudi Dent J. 2012;24(3e4):135e41.

    Google Scholar 

  30. de Sousa Michels D, da Mota Silveira Rodrigues A, Nakanishi M, et al. Nasal involvement in obstructive sleep apnea syndrome. Int J Otolaryngol. 2014;2014:717419.

    Google Scholar 

  31. Gupta N, Gupta SD, Varshney S, et al. Orthodontic treatment after adenoidectomy patients: effect on jaw relations in sagittal plane. Indian J Otolaryngol Head Neck Surg. 2009;61(2):153e6.

    CrossRef  Google Scholar 

  32. Peltomäki T. The effect of mode of breathing on craniofacial growth–revisited. Eur J Orthod. 2007;29(5):426–9.

    PubMed  CrossRef  Google Scholar 

  33. Baik G, Brietzke SE. Cost benefit and utility decision analysis of turbinoplasty with adenotonsillectomy for pediatric sleep-disordered breathing. Otolaryngol Head Neck Surg. 2019;161(2):343–7.

    PubMed  CrossRef  Google Scholar 

  34. Tang A, Benke JR, Cohen AP, Ishman SL. Influence of tonsillar size on OSA improvement in children undergoing adenotonsillectomy. Otolaryngol Head Neck Surg. 2015;153(2):281–5.

    PubMed  CrossRef  Google Scholar 

  35. Nolan J, Brietzke SE. Systematic review of pediatric tonsil size and polysomnogram-measured obstructive sleep apnea severity. Otolaryngol Head Neck Surg. 2011;144(6):844–50.

    PubMed  CrossRef  Google Scholar 

  36. Zautner AE, Krause M, Stropahl G, et al. Intracellular persisting Staphylococcus aureus is the major pathogen in recurrent tonsillitis. PLoS One. 2010;5(3):e9452.

    PubMed  PubMed Central  CrossRef  CAS  Google Scholar 

  37. Szalmás A, Papp Z, Csomor P, Kónya J, Sziklai I, Szekanecz Z, Karosi T. Microbiological profile of adenoid hypertrophy correlates to clinical diagnosis in children. Biomed Res Int. 2013;2013:629607.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  38. Szalmas A, Papp Z, Csomor P, et al. Bacteriology of symptomatic adenoids in children. N Am J Med Sci. 2013;5(2):113e8.

    Google Scholar 

  39. Ruben RJ. The adenoid: its history and a cautionary tale. Laryngoscope. 2017;127(Suppl. 2):S13e28.. Review

    Google Scholar 

  40. Scheffler P, Wolter NE, Narang I, Amin R, Holler T, Ishman SL, Propst EJ. Surgery for obstructive sleep apnea in obese children: literature review and meta-analysis. Otolaryngol Head Neck Surg. 2019;160(6):985–92.

    PubMed  CrossRef  Google Scholar 

  41. Byars SG, Stearns SC, Boomsma JJ. Association of long-term risk of respiratory, allergic, and infectious diseases with removal of adenoids and tonsils in childhood. JAMA Otolaryngol Head Neck Surg. 2018;144(7):594–603.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  42. Lawlor CM, Riley CA, Carter JM, Rodriguez KH. Association between age and weight as risk factors for complication after tonsillectomy in healthy children. JAMA Otolaryngol Head Neck Surg. 2018;144(5):399–405.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  43. Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AG. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children. Cochrane Database Syst Rev. 2015;10:CD011165.

    Google Scholar 

  44. Guilleminault C, Akhtar F. Pediatric sleep-disordered breathing: new evidence on its development. Sleep Med Rev. 2015;24:46–56.

    PubMed  CrossRef  Google Scholar 

  45. Lee SY, Guilleminault C, Chiu HY, Sullivan SS. Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep Breath. 2015;19(4):1257–64.

    PubMed  CrossRef  Google Scholar 

  46. Catlin G. Shut your mouth and save your life. London, England: Paternoster House; 1891. p. 25e35.

    Google Scholar 

  47. Price W. Nutrition and physical degeneration: a comparison of primitive and modern diets and their effects. J Am Med Assoc. 1940;114(26):2589.

    Google Scholar 

  48. Zicari AM, Marzia D, Occasi F. Cephalometric pattern and nasal patency in children with primary snoring: the evidence of a direct correlation. PLoS One. 2014;9(10):e111675.

    PubMed  PubMed Central  CrossRef  CAS  Google Scholar 

  49. Almendros I, Carreras A, Ramírez J, Montserrat JM, Navajas D, Farré R. Upper airway collapse and reopening induce inflammation in a sleep apnoea model. Eur Respir J. 2008;32(2):399–404.

    CAS  PubMed  CrossRef  Google Scholar 

  50. Vinyard CJ, Taylor AB, Teaford MF, Glander KE, Ravosa MJ, Rossie JB, Ryan TM, Williams SH. Are we looking for loads in all the right places? New research directions for studying the masticatory apparatus of New World monkeys. Anat Rec (Hoboken). 2011;294(12):2140–57.

    CrossRef  Google Scholar 

  51. Chirchir H, Kivell TL, Ruff CB, Hublin JJ, Carlson KJ, Zipfel B, Richmond BG. Recent origin of low trabecular bone density in modern humans. Proc Natl Acad Sci U S A. 2015;112(2):366–71.

    CAS  PubMed  CrossRef  Google Scholar 

  52. Prum RO. The Lande–Kirkpatrick mechanism is the null model of evolution by intersexual selection: implications for meaning, honesty, and design in intersexual signals. Evolution. 2010;64(11):3085–100.

    PubMed  CrossRef  Google Scholar 

  53. Swaddle JP, Reierson GW. Testosterone increases perceived dominance but not attractiveness in human males. The Royal Society Proceedings, May 2002 Wrangham, R. The goodness paradox. Pantheon 2019.

    Google Scholar 

  54. Johal A, Conaghan C. Maxillary morphology in obstructive sleep apnea: a cephalometric and model study. Angle Orthod. 2004;74(5):648–56.

    PubMed  Google Scholar 

  55. Kim JH, Guilleminault C. The nasomaxillary complex, the mandible, and sleep-disordered breathing. Sleep Breath. 2011;15(2):185–93.

    PubMed  CrossRef  Google Scholar 

  56. Anderson S, Alsufyani N, Isaac A, Gazzaz M, El-Hakim H. Correlation between gonial angle and dynamic tongue collapse in children with snoring/sleep disordered breathing – an exploratory pilot study. J Otolaryngol Head Neck Surg. 2018;47(1):41. https://doi.org/10.1186/s40463-018-0285-8.. Malhotra, J Indian Soc Pedod Dent, 2012

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  57. Lefevre CE, Lewis GJ, Perrett DI, Penke L. Telling facial metrics: facial width is associated with testosterone levels in men. Evol Hum Behav. 2013;34(4):273–9.

    CrossRef  Google Scholar 

  58. Tunis TS, Pokhojaev A, Sarig R, O’Higgins P, May H. Human mandibular shape is associated with masticatory muscle force. Sci Rep. 2018;8:Article number: 6042.

    CrossRef  CAS  Google Scholar 

  59. Crupi P, Portelli M, Matarese G, Nucera R, Militi A, Mazza M, Cordasco G. Correlations between cephalic posture and facial type in patients suffering from breathing obstructive syndrome. Eur J Paediatr Dent. 2007;8(2):77–82.

    CAS  PubMed  Google Scholar 

  60. Hartman CH. Nasal septal deviation and craniofacial asymmetries. MS (Master of Science) thesis, University of Iowa, 2015. http://ir.uiowa.edu/etd/1620.

  61. Stupak HD, Weinstock M. Bony/Cartilaginous Mismatch: a radiologic investigation into the etiology of tension nose deformity. Plast Reconstr Surg. 2018;141:312–21.

    PubMed  Google Scholar 

  62. Kezirian EJ. Does my tongue look fat? Sleep. 2014;37(10):1583–4.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  63. Ito E, Tsuiki S, Maeda K, Okajima I, Inoue Y. Oropharyngeal crowding closely relates to aggravation of OSA. Chest. 2016;150(2):346–52.

    PubMed  CrossRef  Google Scholar 

  64. Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H, Torigian DA, Pack AI, Schwab RJ. Tongue fat and its relationship to obstructive sleep apnea. Sleep. 2014;37(10):1639–48.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  65. Naughton JP, Lee AY, Ramos E, Wootton D, Stupak HD. Effect of nasal valve shape on downstream volume, airflow, and pressure drop: importance of the nasal valve revisited. Ann Otol Rhinol Laryngol. 2018;127(11):745–53.

    PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Stupak, H.D. (2020). The Human Facial Skeleton: Influence on the Airway and Aesthetics? An Analysis of Cause/Effect Paradigms. In: Rethinking Rhinoplasty and Facial Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-44674-1_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-44674-1_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-44673-4

  • Online ISBN: 978-3-030-44674-1

  • eBook Packages: MedicineMedicine (R0)