I recently overheard a discussion between two of the most highly qualified Orthotropic clinicians in the world. I was dismayed to hear them both agree that surgery was often necessary. I myself trained as a surgeon and accept that many of my orthodontic colleagues and surgeons would currently recommend mandibula advancement surgery for an overjet of more than 5mm, but not me.

A lot depends on age and I would hope that all orthotropists would be able to avoid surgery for children under eight. After that vertical growth can make things difficult, however this is entirely due to one thing, open mouth posture which matters even more than age. Can surgery ever be recommended just because a child continues to breath through their mouth? Or should the blame rest with the parents or perhaps the clinician?

As I explain in my Mastantlos Hypothesis most children live in houses and houses are full of allergens which give rise to allergies in many (most) young kids. This is why so many of them have blocked noses and develop the habit of mouth breathing. Mistakenly many clinicians believe this is due to enlarged tonsils or adenoids but removing these defensive organs fails to break the habit in most youngsters. In the large majority of cases mouth breathing is just a habit and can be broken by any determined parent or carer. I recommend tapping then firmly on the head with a long stick whenever the lips are apart. This will soon enrage them and only then will they remember to keep them closed. 

Interestingly breathing through the nose actually shrinks the mucosa and helps to open the nose. A parent can put tape across the lips and spray the nose with a decongestant before bedtime and they will find the child will sleep with their lips closed a little bit longer each night. If this fails in an older child with a narrow upper jaw, try eight to ten millimetres of expansion. Mouth breathing is just a habit and no child should have surgery just because their parents are too lazy. Sadly millions of young children are never trained to keep their lips closed and I hope the widespread popularity of mewing on the web will help to change attitudes. 

The two Orthotropists I was listening to were assuming that it was just not possible to train some children to keep their lips together. I would never accept that as I have seen too many orthotropic patients change completely long after natural growth has stopped.