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DISEASES OF THE NASOPHARYNX
2. In older children nasal obstruction leads to mouth breathing, a habit
which is very difficult to break. Mouth breathing is abnormal, and no normal
baby will breathe through the mouth. Once the habit of mouth breathing due
to obstruction is established, however, the child has little desire to use the
nose for respiration. Therefore the sooner the condition is corrected the
better chance there is for the re-establishment of the nasal mechanism.
3. The voice loses tone, and becomes nasal and lifeless. It must be shown
that the fault is entirely due to adenoids. Movement of the palate may be
demonstrated by lateral palatography, and if it is impaired speech therapy
should be given before and after a modified removal of adenoids to give good
4. There is nasal discharge, partly due to mechanical obstruction at the
posterior nares, and partly to a secondary chronic rhinitis.
The term 'adenoid facies*, which used to be applied to the child with an
open mouth, a vacant expression and an underslung lower jaw (Plate VII> 1) is
in many instances a misnomer. It has been shown that many of these children,
whose mouths remain open, are breathing normally through the nose and the
defect is one of dental malocclusion, with consequent inadequate musculature
of the mouth. This should be treated by remedial exercises and orthodontic
measures. Children who have enlarged adenoids do not develop these skeletal
and muscular changes and, after removal of adenoids, no re-education is
fig. 51. Lateral radiograph of child with protruding upper incisors suggesting mouth breathing. The
dental gap may be seen, while the nasal airway is completely free and is being used.