The OrthoSmile™ Newsletter

What's New on the Block?

Monday, September 13, 2010


On occasion, in thoughtful query, a few in the profession have expressed that the basis for the Homeoblock™ Appliance protocol is anecdotal, without scientific basis. I will address such judgment herein.

Donald Enlow in the “Essentials of Facial Growth, second edition”, points out that “bone remodeling and displacement are the two critical elements of growth and development.” He indicates that “the brain with its associated sensory organs and basicranium, the facial and pharyngeal airway, and the oral complex are all interrelated.” He states that “the airway function is the keystone for the face and that growth processes work toward an ongoing state of composite function and structural equilibrium.”

We postulate that with age, the loss of facial support; i.e. bone volume, fat and collagen, is reflected in the pharyngeal airway as loss of volume and tone.

Pharyngeal airway of a healthy 15 year old girl.

Collapsed airway of an adult patient.

It is documented via evidence based science, that Homeoblock™ Appliance treatment results in a better developed face.

Research has demonstrated “facial changes of 8-11% size-increase extending across the maxillofacial region” and findings consistent with a “more symmetrical and better developed appearance compared with pre-treatment condition.” (Singh, G.D. et al., Facial changes following treatment with a removable orthodontic appliance in adults. Funct Orthod, 21:18-23, 2004).

Following along, a better developed airway would be in accordance with Enlow’s principles of growth and development and the interrelationship between the face and the airway. See below:

The shape and contour of the posterior wall of the pharyngeal airway at the level of C2 behind the tongue, is significant in maintaining the airway opening when the airway is compromised by the tongue.

With the type of compromised airway contour shown above, the airway is sealed off when the tongue collapses against the pharyngeal wall.

The shape and contour of the pharyngeal wall shown in the photo above, allows the airway to remain patent, with the tongue collapsed against the wall.
The above photo shows a patient’s airway before Homeoblock™ treatment.

Airway contour above is after Homeoblock™ Appliance treatment, and is more conducive to maintaining airway patency after tongue collapse.
This patient has a compromised airway. Note the shape of the posterior pharyngeal wall. The patient has been under Homeoblock™ Appliance treatment for 3 months. Note that the Hyoid is below the 3rd cervical vertebrae.
The patient’s facial improvement, particularly under the chin, indicates the possibility of an improvement in the airway. She will have a follow-up scan in 3 months. Stay tuned.