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Title: The influence of breathing disorders on face shape : a three-dimensional study
Author: Alali, Ala
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2013
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Breathing disorders can potentially influence craniofacial development through interactions between the respiratory flow and genetic and environmental factors. It has been suggested that certain medical conditions such as persistent rhinitis and renal insufficiency may have an influence on face shape. The effects of these conditions are likely to be subtle; otherwise they would appear as an obvious visible facial feature. The use of three-dimensional imaging provides the opportunity to acquire accurate and high resolution facial data to explore the influence of medical condition on facial morphology. Therefore, the aim of the present study is to investigate the influence of breathing disorders (asthma, atopy, allergic rhinitis and sleep disordered breathing) on face shape in children. The study sample, comprising of 4784 British Caucasian children of which 2922 (61.1%) were diagnosed with a breathing disorder, was selected from the Avon Longitudinal Study of Parents and Children (ALSPAC), which had been conducted to investigate the genetic and environmental determinants of development, health and disease. Three-dimensional surface laser scans were conducted on the children when they were 15 years old. A total of 21 reproducible facial landmarks (x, y, z co-ordinates) were identified. Average facial shells were constructed for each of the different disease groups and compared to facial shells of healthy asymptomatic children. Face-shape variables (angular and linear measurements) were analysed with respect to the different breathing disorders by employing a variety of statistical methods, including t-tests, chi-square tests, principal component analysis, binary logistic regression and analysis of variance (ANOVA). The results reveal that individual breathing disorders have varying influences on facial features, including increased anterior lower face height, a more retrognathic mandible and reduced nose width and prominence. The study also shows that the early removal of adenoids and tonsils can have a significant effect on obstructive breathing, resulting in the restoration of the facial morphology to its normal shape. This was particularly evident in children with normal BMIs. Surprisingly, no significant differences in face shape were detected in children with multiple diseases (combinations of asthma, allergic rhinitis, atopy and sleep-disordered breathing) when compared to healthy children. This may indicate the multifactorial, complex character of this spectrum of diseases. The findings provide evidence of small but potentially real associations between breathing disorders and face shape. This was largely attributable to the use of high-resolution and reproducible three-dimensional facial imaging alongside a large study sample. They also provide the scientific community with a detailed and effective methodology for static facial modelling that could have clinical relevance for early diagnosis of breathing disorders. Furthermore, this research has demonstrated that the ALSPAC patient archive offers a valuable resource to clinicians and the scientific community for investigating associations between various breathing disorders and face shape.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RF Otorhinolaryngology