儿童口呼吸的多学科诊疗路径：儿科变态反应科、耳鼻咽喉科与口腔正畸视角

文献信息

中文摘要

背景： 儿童口呼吸（MB）是一种功能性改变，其特征是以口呼吸或混合呼吸替代鼻呼吸。持续性口呼吸，尤其是发生于睡眠期间者（夜间口呼吸），可能与睡眠片段化、神经行为障碍及颅面发育改变相关。尽管已确立的睡眠呼吸障碍（SDB），特别是阻塞性睡眠呼吸暂停综合征（OSAS），已被广泛认识并由国际指南加以处理，但表现为持续性或夜间口呼吸、却不符合OSAS既定诊断标准的儿童，可能仍处于常规诊断路径之外。因此，口呼吸的多因素性质要求对鼻腔、过敏、上气道、颅面、牙科及口颌面因素进行协同评估。方法：本叙述性综述主要基于对PubMed/MEDLINE数据库自建库至2026年6月的出版物进行结构化检索，并辅以对相关文章和临床指南参考文献列表的手工筛查。文献依据其与综述目的的相关性、方法学稳健性、临床适用性以及对儿科、变态反应学、耳鼻咽喉科和牙科/正畸视角的贡献进行筛选。优先纳入系统综述、荟萃分析、随机对照试验、临床实践指南、共识文件及高质量观察性研究。最终稿件共纳入79篇参考文献。结果：所综述的证据表明，口呼吸可能与过敏性和鼻腔疾病、上气道阻塞、颅面及牙齿异常以及口颌面功能改变相关，并可能在部分儿童中与SDB共存。证据从儿科、变态反应学、耳鼻咽喉科和正畸视角进行综合，以制定一条多学科诊疗路径，该路径基于口呼吸的临床识别、有针对性的专科评估、在适当时对SDB进行客观评估，以及个体化管理与随访。结论：口呼吸可能是早期识别潜在可治疗疾病及相关SDB的重要临床切入点。所提出的多学科诊疗路径整合了儿科、变态反应学、耳鼻咽喉科和牙科/正畸专业知识，以支持对口呼吸儿童的协同评估、个体化管理和纵向随访。

英文摘要

Background: Mouth breathing (MB) in children is a functional alteration characterized by the substitution of nasal breathing with oral or mixed breathing. Persistent MB, particularly when occurring during sleep (nocturnal MB), may be associated with sleep fragmentation, neurobehavioral disturbances, and alterations in craniofacial development. Although established sleep-disordered breathing (SDB), particularly obstructive sleep apnea syndrome (OSAS), is well-recognized and addressed by international guidelines, children presenting with persistent or nocturnal MB without established diagnostic criteria for OSAS may remain outside conventional diagnostic pathways. The multifactorial nature of MB therefore requires the coordinated evaluation of nasal, allergic, upper airway, craniofacial, dental, and orofacial factors. Methods: This narrative review was based primarily on a structured search of the PubMed/MEDLINE database covering publications from database inception to June 2026, supplemented by manual screening of the reference lists of relevant articles and clinical guidelines. The literature was selected according to relevance to the review objectives, methodological robustness, clinical applicability, and contribution to pediatric, allergological, otorhinolaryngological, and dental/orthodontic perspectives. Priority was given to systematic reviews, meta-analyses, randomized controlled trials, clinical practice guidelines, consensus documents, and high-quality observational studies. A total of 79 references were included in the final manuscript. Results: The reviewed evidence indicates that MB may be associated with allergic and nasal conditions, upper airway obstruction, craniofacial and dental abnormalities, and orofacial functional alterations, and may coexist with SDB in selected children. The evidence was synthesized across pediatric, allergological, otorhinolaryngological, and orthodontic perspectives to develop a multidisciplinary care pathway based on the clinical identification of MB, targeted specialist assessment, objective evaluation of SDB when indicated, and individualized management and follow-up. Conclusions: MB may represent an important clinical entry point for the early recognition of potentially treatable conditions and associated SDB. The proposed multidisciplinary care pathway integrates pediatric, allergological, otorhinolaryngological, and dental/orthodontic expertise to support coordinated assessment, individualized management, and longitudinal follow-up of children with MB.