What does this research mean for the field?

Prefabricated myofunctional appliance therapy significantly enlarges nasopharyngeal and oropharyngeal airway dimensions and improves nasal symptoms in children with skeletal Class II division 1 malocclusion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the impact of prefabricated myofunctional appliances on airway dimensions in children with Class II division 1 malocclusion.

June 6, 2026Open Access

Airway Morphometric Changes Following Prefabricated Myofunctional Appliance in Class II Division 1 Patients: A Clinical Evaluation

Key Points

This study aims to evaluate the impact of prefabricated myofunctional appliances on airway dimensions in children with Class II division 1 malocclusion.
Retrospective analysis of 34 children treated with PMAs and 29 matched untreated controls for comparison.
Airway areas of the nasopharynx, oropharynx, and hypopharynx measured using cephalometric radiographs and McNamara Airway Analysis.
Follow-up after one year, with exclusion of patients with prior orthodontic treatment or poor compliance.
The PMA group showed significant increases in nasopharyngeal (p = 0.044) and oropharyngeal (p = 0.039) airway areas compared to controls.
No significant change was observed in the hypopharyngeal area (p = 0.121).
The TNSS indicated significant improvements post-PMA therapy (p < 0.001).

Abstract

Prefabricated myofunctional appliances (PMAs) are designed to improve airway function by advancing the mandible, enhancing tongue posture, and reducing airway resistance, thereby facilitating nasal breathing in children with sleep-disordered breathing (SDB). This retrospective study evaluated the effects of PMAs on airway dimensions in children with skeletal Class II division 1 malocclusion. Patients were selected from a departmental database (2017–2019). The treatment group included children with Class II division 1 malocclusion, an incisor overjet of ≥6 mm, cervical vertebral maturation (CVM) stage III or earlier, and documented myofunctional dysfunction (e.g., adenoid hypertrophy, allergic rhinitis, or mouth breathing), with complete pretreatment and one-year follow-up lateral cephalometric radiographs. Patients with prior orthodontic intervention or poor compliance were excluded. A matched observation group consisted of untreated patients undergoing growth monitoring. Airway dimensions of the nasopharynx, oropharynx, and hypopharynx were measured using cephalometric radiographs, along with McNamara Airway Analysis. The total nasal symptom score (TNSS) was used as a self-report measure. A total of 34 patients (mean age 9.4 years) were included in the PMA group and 29 patients (mean age 9.6 years) in the observation group. Compared with controls, the PMA group demonstrated significant increases in nasopharyngeal (p = 0.044) and oropharyngeal (p = 0.039) airway areas, while changes in the hypopharyngeal area were not significant (p = 0.121). McNamara Airway Analysis also showed a significant improvement in upper pharyngeal airway dimensions (p = 0.018). TNSS revealed significant changes following PMA therapy (p < 0.001). These findings indicate that PMA therapy is associated with enlargement of the nasopharyngeal and oropharyngeal airway in children with skeletal Class II division 1 malocclusion, suggesting functional airway adaptation beyond simple mandibular advancement.

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