Persistent Mouth Breathing Following Adenoidectomies

IRVING SOBOTKY
1913 Boston Medical and Surgical Journal  
Why are there so many failures after adei noidectomies and what can be done to facilitate nasal breathing? How often patients return anywhere from one to six months after operation with little or none of the nasal respiration that was so emphatically promised! Parents are told to compel the young patient to breathe through the nose-that it is simply the-"habit" of mouth breathing, formed from birth to the present time, that prevents nasal breathing and if the child is constantly told to keepi
more » ... tly told to keepi the mouth closed and force air through the nostrils-a cure will be effected. This may be true in some cases but in many the difficulty lies in abnormal conditions within the nasal cavities. It is obvious, then, that simply removing the adenoid, however completely, will not cure mouth breathing when there is nasal obstruction of any cause. J. V. White1 speaks of variations of the sphenoid bones, of the location of the fossa of Rosenmuller and of Thornwald's disease, as factors determining the post-operative mouth breathing. Maure gives similar reasons. Another factor according to Brühl of Berlin, is delay in removing the adenoid until the bony framework is formed with a high palatal arch. In thesehigh arch cases, mouth breathing will persist after operation and the patient must be referred to a dentist for the spreading of the arch and the regulating of the teeth. These conditions» are also the cause of deviated septum, as there is not sufficient room for the septum to grow straight. This type of case can usually be recognized by the elongated shape of the face and skull. An examination of the nose, which should be a matter of routine in every case of adenoid, will often reveal hypertrophied lower turbinâtes or deviated septum. The presence of enlarged lower turbinâtes, deviation and spur of the septum are said to favor the development of adenoid, but, according to St. Clair Thomson of London, it is much more likely that these intra-nasal conditions are secondary. Diemont2 expresses the same opinion and has observed the co-relation of hypertrophy of the lower turbinate with adenoid. By enlarged turbinâtes a true hypertrophy is meant and not the vaso-motor type or the enlargement caused by constitutional diathesis. These three types can be differentiated by a thorough examination. The vaso-motor lower turbinâtes are pillowlike, smooth, red or pinkish in color and may seem to be in contact with the septum or with the middle turbinâtes. A probe sinks as if into an air cushion. The application of adrenalin and cocaine causes shrinking, but when the ef-The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on July 8, 2016. For personal use only. No other uses without permission. From the NEJM Archive.
doi:10.1056/nejm191302131680703 fatcat:fdnvwnxcw5b5jl3nfn6bwtduj4