DISEASES OF THE NASOPHARYNX 131 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 results. 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.