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Prashanth S, Nandlal B. Cervical and craniofacial morphology in asthmatic children: A cephalometric study. J Oral Biol Craniofac Res 2024; 14:378-383. [PMID: 38832292 PMCID: PMC11144732 DOI: 10.1016/j.jobcr.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/15/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Image 1.
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Affiliation(s)
- Prashanth S
- Department of Pedodontics and Preventive Dentistry, J S S Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, 570 015, Karnataka, India
| | - B. Nandlal
- Department of Pedodontics and Preventive Dentistry, J S S Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, 570 015, Karnataka, India
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Kucukkaraca E. Is There a Relationship Between Unilateral/Bilateral Impacted Maxillary Canines and Nasal Septum Deviation? Cureus 2023; 15:e47931. [PMID: 38034237 PMCID: PMC10684973 DOI: 10.7759/cureus.47931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction A deviated nasal septum may be associated with some dentofacial deformities. The aim of the study was to determine whether there is a relationship between some craniomaxillary features of unilateral and bilateral maxillary impacted canines and nasal septum deviation. Methods This is a retrospective study consisting of cone beam computed tomography (CBCT) images of 51 patients. All patients were divided into three subgroups: unilateral maxillary impacted canines (UMIC) (n=19) bilateral maxillary impacted canines (BMIC) (n=15), and control group (MC) (n=17). The septal deviation angle and some angular and dimensional measurements were performed. Differences in linear and angular measurements between the groups were analyzed using One-way ANOVA and the Kruskal-Wallis test. Pearson's correlation analysis was performed to determine the relationship between the septal deviation angle, septal deviation direction, nasal floor angle, and other parameters, and multivariate linear regression analysis was performed to determine the effect of variables in the septal deviation angle. Results Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle and the nasal floor angle values were found to be significantly higher in the UMIC and BMIC groups (p<0.001) than in the MC group. Maxillary width was found to be significantly lower in the BMIC group compared to the UMIC (p<0.01) and MC group (p<0.001). Septal deviation angle was positively correlated with septal deviation direction and nasal floor angle (p<0.001). Palatal width and nasal floor angle were found to be negatively correlated (p<0.05), and palatal depth and septal deviation direction were found to be positively correlated (p<0.01). Groups and septal deviation angle, septal deviation direction, and nasal floor angle were found to be negatively correlated (p<0.001). The multivariate linear regression analysis revealed an association between septal deviation angle, group (p<0.01), and nasal floor angle (p<0.05). Conclusion Bilateral or unilateral position of the impacted canines was found to be effective on septal deviation. The septal deviation angle values were found to be higher when the maxillary impacted canine was unilateral. Unilateral or bilateral positions of the impacted canine and the nasal floor angle were found to be factors affecting the formation of septal deviation.
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Affiliation(s)
- Ebru Kucukkaraca
- Department of Orthodontics, Faculty of Dentistry, Ankara Yildirim Beyazit University, Ankara, TUR
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Levrini L, Persano R, Piantanida S, Carganico A, Deppieri A, Naboni G, Mastrapasqua RF, Saran S. The Effects of the Myobrace ® System on Peripheral Blood Oxygen Saturation (SpO 2) in Patients with Mixed Dentition with Oral Dysfunction. Dent J (Basel) 2023; 11:191. [PMID: 37623287 PMCID: PMC10453079 DOI: 10.3390/dj11080191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Myobrace® is an orthodontic device that has the purpose of correcting oral dysfunctions, thus predisposing the physiological growth of the jaws, aligning teeth, and optimizing face development. This device is usually associated with Myobrace® Activities to reach this target. Considering the lack of studies in the literature about peripheral blood oxygen saturation (SpO2) and the use of preformed oral devices, the aim of this study is to quantify the change in blood oxygen saturation (SpO2) in patients treated with the Myobrace® System in mixed dentition. MATERIALS AND METHODS In this study, 23 children (11 females and 12 males) were involved, who were affected by different oral dysfunctions and were treated with a Myobrace®. Blood oxygen saturation measurements were taken at baseline and after every four months for a year. The SpO2 measurements were taken in the rest position and with a closed mouth for a total of 12 min-6 min with and 6 min without the Myobrace® oral device. All data points were anonymized and recorded on an Excel spreadsheet. A statistical analysis was carried out. RESULTS Therapy with a Myobrace® in patients with mixed dentition resulted in a statistically significant increase in oxygen saturation. In particular, in patients with a closed mouth, a statistically significant increase in oxygen saturation was observed, bringing it from 97.66% to 99.00%, while in the rest position, the increase was from 98.03% to 99.07%. CONCLUSIONS The use of Myobrace® devices in patients with mixed dentition could lead to a significant improvement in blood oxygen saturation.
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Affiliation(s)
- Luca Levrini
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (R.P.); (S.P.); (A.C.); (A.D.); (G.N.); (S.S.)
| | - Roberta Persano
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (R.P.); (S.P.); (A.C.); (A.D.); (G.N.); (S.S.)
| | - Sofia Piantanida
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (R.P.); (S.P.); (A.C.); (A.D.); (G.N.); (S.S.)
| | - Andrea Carganico
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (R.P.); (S.P.); (A.C.); (A.D.); (G.N.); (S.S.)
| | - Alessandro Deppieri
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (R.P.); (S.P.); (A.C.); (A.D.); (G.N.); (S.S.)
| | - Giulia Naboni
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (R.P.); (S.P.); (A.C.); (A.D.); (G.N.); (S.S.)
| | | | - Stefano Saran
- Department of Human Sciences, Innovation and Territory, School of Dentistry, Postgraduate of Orthodontics, University of Insubria, 21100 Varese, Italy; (R.P.); (S.P.); (A.C.); (A.D.); (G.N.); (S.S.)
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Yu JL, Tangutur A, Thuler E, Evans M, Dedhia RC. The role of craniofacial maldevelopment in the modern OSA epidemic: a scoping review. J Clin Sleep Med 2022; 18:1187-1202. [PMID: 34984972 DOI: 10.5664/jcsm.9866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES There is increasing recognition that environmental factors affect human craniofacial development and our risk for disease. A scoping review of the literature was performed looking at environmental influences on craniofacial development to better understand this relationship and investigate what further study is needed to determine how this relationship may impact obstructive sleep apnea. METHODS A comprehensive literature search was performed using the Ovid Medline database from inception to May, 2020 with relevance to craniofacial development in 5 clinically-oriented variables: diet, secular change, breastfeeding/non-nutritive sucking habits (NNSH), nasal obstruction/mouth breathing, and masticatory muscle function. The Oxford Centre for Evidence-Based Medicine Levels of Evidence (LoE) was used to assess studies based on study design. RESULTS 18,196 articles were initially identified, of which 260 studies were fully reviewed and 97 articles excluded. The remaining 163 articles were categorized as follows: Secular change (n = 16), Diet (n = 33), Breastfeeding/NNSH (n = 28), Nasal obstruction/Mouth breathing (n = 57), and Masticatory muscle function (n = 35). 93% of included studies reported a significant association between craniofacial morphology and environmental factors. The majority of studies were characterized as low LoE studies with 90% of studies being LoE 4 or 5. CONCLUSIONS The studies in this review suggest that environmental factors are associated with changes in craniofacial development. However, most studies were heterogeneous and low-level studies, making strong conclusions about these relationships difficult. Future rigorous studies are needed to further our understanding of environmental influences on craniofacial development and OSA risk.
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Affiliation(s)
- Jason L Yu
- Division of Sleep Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA.,Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
| | - Akshay Tangutur
- Division of Sleep Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA
| | - Eric Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA
| | - Marianna Evans
- Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
| | - Raj C Dedhia
- Division of Sleep Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA.,Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
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Voudouris JC, Voudouris JD, Nicolay O, Glaser B, Nicozisis J, Theodoridis G, Carrillo R, Moshiri M, Masoud M. TEMPORARY REMOVAL: Clear Aligners, Dentofacial Orthopedics, Physics and Supercorrection Biomechanics. A Meeting of the Minds. Semin Orthod 2021. [DOI: 10.1053/j.sodo.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Awuapara S, Liñan C, Solis G, Meneses A, Lagravère M. Evaluation of the nasal septum and depth of palatal arch in different facial vertical patterns: A Cone-Beam Computed Tomography Study. Int Orthod 2021; 19:228-234. [PMID: 33836972 DOI: 10.1016/j.ortho.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the nasal septum and the depth of posterior palatal arch in the different facial vertical patterns using cone-beam computed tomography (CBCT). MATERIALS AND METHODS A total of 143 CBCTs were analysed (53 normodivergents, 26 hypodivergents, and 64 hyperdivergents) using the software Real Scan 2.2. On the coronal view, the following measurements were taken, palatal interalveolar length (PIL), palatal arch depth (PAD), maxillopalatal arch angle (MPAA), septal vertical length (SVL), deviated septal length (DSL), and deviated septal curve angle (DSCA). Using the program Stata v16.0, we obtained the mean, standard deviation and median values. The identification of significant differences between facial biotypes was performed using the one-way ANOVA test and H of Kruskal-Wallis test, considering a significance level of 0.05. RESULTS The hypodivergent group got the highest PIL and MPAA (49.6mm and 118.1° respectively), with statistically significant differences (P<0.05) between this group and the hyperdivergent group. Statistically significant differences were found by gender for the SNMeGo, PFH, AFH, and the relationship between the facial heights, where the males had the highest values. Additionally, PIL and SVL also had the highest values for males (48.8mm and 63.6mm respectively). CONCLUSIONS Patients presenting with greater hyperdivergence have shorter interalveolar distances and smaller maxillopalatal arch angles.
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Affiliation(s)
- Shereen Awuapara
- Universidad Peruana Cayetano Heredia, Faculty of Stomatology, Lima, Peru
| | - Carlos Liñan
- Universidad Peruana Cayetano Heredia, Faculty of Stomatology, Lima, Peru
| | - Gilmer Solis
- Universidad Peruana Cayetano Heredia, Faculty of Science and Philosophy, Department of Statistics, Demography, Humanities and Social Sciences, Lima, Peru
| | - Abraham Meneses
- Universidad Peruana Cayetano Heredia, Faculty of Stomatology, Lima, Peru
| | - Manuel Lagravère
- School of Dentistry University of Alberta, Faculty of Medicine and Dentistry, Orthodontic Graduate Program, ECHA 5-524, 11405 - 87th avenue, T6G 1C9 Edmonton, Alberta, Canada.
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Quick septoplasty in children: Long-term effects on nasal breathing and dentofacial morphology. A prospective cephalometric study. Auris Nasus Larynx 2021; 48:914-921. [PMID: 33685756 DOI: 10.1016/j.anl.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/09/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Many authors have investigated the most appropriate surgical approach to the deviated septum in childhood, considering the obligate mouth-breathing habit a possible cause of malocclusion and disharmonious development of the facial skeleton in growing kids. Nevertheless, controversies still remain about the long-term functional/esthetic results of such procedures, mainly due to the duration of the follow-up and possible confounding factors. METHODS 111 Caucasian children (age range: 6-13 years) were submitted to a personal "Quick" septoplasty surgical technique between 2005 and 2010. Preoperative otorhinolaryngological examination using flexible nasal endoscopy, anterior active rhinomanometry (AAR), Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and dentofacial evaluation (including cephalometry) were performed. Postoperative AAR, NOSE questionnaire and cephalometric assessment were carried out in all patients at the age of 18 years. Informed consent was obtained from children's parents as appropriate. RESULTS No surgical complication was recorded. Among our patients, a significant (p <0.001) improvement of nasal breathing resistances at AAR and NOSE questionnaire scores was found after surgery. A significant improvement in cephalometric/dental parameters (gonial angle values, anterior facial height, prevalence of class I occlusion, maxillary intermolar width, and cross-bite frequency) was noticed after the follow-up with respect to preoperative conditions. CONCLUSION The "Quick" septoplasty technique described is a practical and conservative procedure with a low complication rate that offers long-term favourable results for the correction of nasal septum deviations in children. Nasal-breathing restoration may favor a physiological and harmonious development of craniofacial and dental structures in offspring.
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Santo MD. Treatment of adult patient with hyperdivergent retrognathic phenotype and anterior open bite: report of a case with non-surgical orthodontic approach. Dental Press J Orthod 2020; 25:75-84. [PMID: 32965391 PMCID: PMC7510490 DOI: 10.1590/2177-6709.25.4.075-084.bbo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022] Open
Abstract
Adult patients with anterior open bite and hyperdivergent retrognathic phenotype demand complex treatments, as premolar extractions, molar intrusion or orthognathic surgery. In the present clinical case, a young adult patient without significant growth, with Class I and anterior open bite, was treated with four premolar extractions. The therapeutic result shows good intercuspation, good facial esthetic, good function balance, and stability in a two-year post-fixed treatment follow-up.
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Affiliation(s)
- Marinho Del Santo
- Orthodontist, private practice (São Paulo/SP, Brazil). American
Board of Orthodontics certified. Board Brasileiro de Ortodontia certified
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Markkanen S, Rautiainen M, Niemi P, Helminen M, Peltomäki T. Is securing normal dentofacial development an indication for tonsil surgery in children? A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2020; 133:110006. [PMID: 32220727 DOI: 10.1016/j.ijporl.2020.110006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Tonsil surgeries are common operations in the field of paediatric otorhinolaryngology. Often, the indication for these operations is hypertrophied tonsils. Paediatric sleep-disordered breathing and mouth-breathing are conventional situations caused by the hypertrophied tonsils. Both of these are further associated with dentofacial development alterations. Securing normal dentofacial development, or restoring it, is often used as an indication for tonsil surgery. In this review and meta-analysis, we assessed the contemporary literature to clarify whether tonsil surgery has an effect on dentofacial development in children. METHODS Studies with children aged 3-10 years who underwent tonsil surgery and were compared to non-operated controls using dentofacial parameters were included to the review. Search strategies were planned for specific databases. The Newcastle-Ottawa scale was used to assess the risk of bias. A meta-analysis was performed when the data was methodologically homogenous enough to be pooled. RESULTS The inclusion criteria for the review were fulfilled in 8 studies. The overall quality of the individual studies was judged to be moderate at best. The data were methodologically homogenous enough to be pooled for the meta-analysis in only 2 studies. The results of the meta-analysis revealed that tonsil surgery has a positive effect on the growth direction of the mandible (p < 0.001). CONCLUSIONS There is modest evidence that suggests that tonsil surgery has a positive effect on the dentofacial development in children with hypertrophied tonsils. Securing normal dentofacial development should be one component, but not the only one, when the indications for tonsil surgery in children are considered.
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Affiliation(s)
- Saara Markkanen
- Department of Ear and Oral Diseases, Tampere University Hospital, SKS/TAYS PL 2000 33521, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Markus Rautiainen
- Department of Ear and Oral Diseases, Tampere University Hospital, SKS/TAYS PL 2000 33521, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Pekka Niemi
- Department of Maxiollofacial Surgery and Oral Diseases, Satakunta Central Hospital, Pori, Finland.
| | - Mika Helminen
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland; Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.
| | - Timo Peltomäki
- Department of Ear and Oral Diseases, Tampere University Hospital, SKS/TAYS PL 2000 33521, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.
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Hsu YB, Lan MY, Huang YC, Kao MC, Lan MC. Association Between Breathing Route, Oxygen Desaturation, and Upper Airway Morphology. Laryngoscope 2020; 131:E659-E664. [PMID: 32473063 DOI: 10.1002/lary.28774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/26/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to assess the role of capnography in objectively evaluating breathing routes during drug-induced sleep endoscopy (DISE) and further elucidate the relationship between breathing route, obstructive sleep apnea (OSA) severity, and DISE findings. STUDY DESIGN Prospective observational study. METHODS Nighty-five patients with established OSA were recruited for this study from May 2017 to May 2019. DISE was performed in the operating room. Sedation was maintained with propofol using a target-controlled infusion system and the depth of sedation was monitored based on the bispectral index. The breathing routes, which included oral breathing, oronasal breathing, and nasal breathing, were detected using capnography. DISE findings were recorded using the VOTE (velum, oropharynx, base of tongue, and epiglottis) classification. RESULTS Patients with mouth breathing were associated with increased OSA severity, worse oximetric variables, and higher body mass index in comparison with those with other breathing routes. Mouth breathing was associated with a higher degree and higher prevalence of lateral pharyngeal wall collapse and tongue base collapse during DISE. CONCLUSIONS Mouth breathing was significantly associated with worse oxygen desaturation and increased degree of upper airway collapse. Therefore, patients with mouth breathing during propofol-based intravenous anesthesia should be carefully monitored. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E659-E664, 2021.
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Affiliation(s)
- Yen-Bin Hsu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Ying Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Chen Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Chang Kao
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ming-Chin Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Garrec P, Legris S, Soyer Y, Vi-Fane B, Jordan L. [Orthodontic management of obstructive sleep-disordered respiratory disorders]. Orthod Fr 2019; 90:321-335. [PMID: 34643519 DOI: 10.1051/orthodfr/2019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through his/her knowledge of cranio-facial growth, the orthodontist plays a leading role within the multidisciplinary team that tracks and treats sleep-disordered breathing (SDB) in children. Correction of craniofacial risk factors (maxillary deficiency and retrognathia) is commonly used by practitioners alongside orthodontic treatment such as OMA and RME in the optimal conditions afforded by childhood growth. Myofunctional therapies are performed to restore correct stomatognathic function and play a central role in the management of SDB in children. The orthodontist is therefore a key player in the medical treatment chain of these children.
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Affiliation(s)
- Pascal Garrec
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Sylvie Legris
- AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Yves Soyer
- Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Brigitte Vi-Fane
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Laurence Jordan
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, PSL Research University, Institut de Recherche de Chimie Paris, UMR 8247-Chimie ParisTech, 75005 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
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Li X, Wang H, Li S, Bai Y. Treatment of a Class II Division 1 malocclusion with the combination of a myofunctional trainer and fixed appliances. Am J Orthod Dentofacial Orthop 2019; 156:545-554. [PMID: 31582126 DOI: 10.1016/j.ajodo.2018.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 11/16/2022]
Abstract
This case report describes the combined use of a myofunctional Trainer for Braces and fixed appliances to treat a 10-year-old girl with a Class II Division 1 malocclusion that featured severe maxillary incisor protrusion, a large overjet, and a V-shaped maxillary arch. She had a convex profile with an underdeveloped mandible. The superiority of myofunctional training in the case was to eliminate mouth breathing and lip sucking habits, train the oral musculature, stimulate mandibular growth, and make braces work more efficiently. The posttreatment facial photographs show improvement in the facial profile. Proper occlusion and facial balance were created, which were quite stable as demonstrated by the patient's 4-year follow-up records.
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Affiliation(s)
- Xiaowei Li
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Hongmei Wang
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Song Li
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China
| | - Yuxing Bai
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China.
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Calvo-Henriquez C, Martins-Neves S, Martinez-Capoccioni G, Neves-Leal D, Ruano-Ravina A, Faraldo-García A, Lowy-Benoliel A, Martin-Martin C. Validation of the Vertical Facial Growth Screening Test. Clin Pediatr (Phila) 2019; 58:1187-1193. [PMID: 31402692 DOI: 10.1177/0009922819868684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Vertical facial growth has a high prevalence. Nonspecialized professionals have shown low sensitivity to identify patients at risk. In the face of this difficulty, we designed and validated a screening checklist for vertical facial growth. Methods. A multidisciplinary team of 5 members developed the Vertical Facial Growth Screening Test. A sample of 160 evaluations was obtained. We consider as the gold standard the evaluation of 2 specialists in dentofacial orthopedics. Results. Consistency measured with Cronbach α was .675 for 10 items. Test-retest reliability was .956. The interobserver concordance was .886. The receiver operating characteristic curve has .987 area under the curve. Conclusion. This is the first study to design and validate a screening checklist for vertical facial growth for nonexpert evaluators. We think that given its good performance, ease of use, inexpensiveness, and availability, the test could be useful for nontrained professionals dealing with children.
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Affiliation(s)
| | | | | | | | | | - Ana Faraldo-García
- Hospital Complex of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | | | - Carlos Martin-Martin
- Hospital Complex of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
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Koehne T, Müller-Stöver S, Köhn A, Stumpfe K, Lezius S, Schmid C, Lukacs Z, Kahl-Nieke B, Muschol N. Obstructive sleep apnea and craniofacial appearance in MPS type I-Hurler children after hematopoietic stem cell transplantation. Sleep Breath 2019; 23:1315-1321. [PMID: 31332621 DOI: 10.1007/s11325-019-01900-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disorder characterized by severe multi-systemic organ manifestations including obstructive sleep apnea syndrome (OSAS). Hematopoietic stem cell transplantation (HSCT) is the treatment of choice in severe MPS I (MPS IH, Hurler syndrome). However, the effect of HSCT on OSAS in MPS IH still remains unclear. The purpose of this study was to analyze respiratory patterns during sleep following HSCT in MPS IH children and to relate these findings to craniofacial abnormalities. METHODS Overnight polysomnographies of nine MPS IH children (mean age: 8.2 years) previously treated with HSCT were retrospectively analyzed. Magnetic resonance images of the head were assessed with regard to soft and hard tissue abnormalities of the upper respiratory tract. RESULTS The mean apnea hypopnea index (AHI) was 5.3 events/h (range, 0.3-12.2), and the majority of apnea/hypopneas were obstructive. Whereas two patients had severe OSAS (AHI > 10) and two moderate OSAS (5 > AHI < 10), five patients had no evidence of OSAS (AHI < 2.0). Donor cell chimerism was significantly lower in MPS IH patients with OSAS as compared to patients without OSAS (p < 0.001). The upper airway space and the maxilla were significantly smaller and the adenoids larger in MPS IH patients with OSAS as compared to those of non-OSAS patients. CONCLUSION OSAS was only observed in MPS IH patients with graft failure or low donor cell chimerism. Conversely, successful HSCT seems to ameliorate adenoid hyperplasia and maxillary constriction in MPS IH patients and thereby minimizes the risk of OSAS at least at younger ages.
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Affiliation(s)
- Till Koehne
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Sarah Müller-Stöver
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Köhn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Stumpfe
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Lezius
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carmen Schmid
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bärbel Kahl-Nieke
- Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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do Nascimento RR, Masterson D, Trindade Mattos C, de Vasconcellos Vilella O. Facial growth direction after surgical intervention to relieve mouth breathing: a systematic review and meta-analysis. J Orofac Orthop 2018; 79:412-426. [PMID: 30232505 DOI: 10.1007/s00056-018-0155-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A systematic review was performed to assess the prognosis for facial growth direction documented by mandibular plane inclination and anterior face height in growing subjects who had undergone surgical intervention to relieve mouth breathing (PROSPERO database, registration no. CRD 42013005707). METHODS PubMed, Scopus, Web of Science, the Cochrane Library and LILACS were searched based on the guidelines of the PRISMA statement. Included were longitudinal studies with mouth-breathing patients who had undergone surgical interventions to relieve their respiratory pattern, with a minimum follow-up of one year. RESULTS A total of 1555 studies were identified, whereby only three nonrandomized clinical trials comprising 155 participants met the inclusion criteria. Primary outcome was change between the initial and final measurements of the mandibular plane-SN angle (95% confidence interval [CI] -2.13° [-3.08, -1.18]). Secondary outcomes included changes in total anterior face height (AFH; 95% CI -0.76 mm [-1.91, 0.38]), upper AFH (95% CI 0.09 mm [-0.57, 0.74]), and lower AFH (95% CI 0.06 mm [-0.87, 0.99]). Risk of bias was low for most of bias domains and the quality of evidence across the studies was considered to be very low. The design, the small number of participants, and the absence of blinding generated imprecision. CONCLUSIONS There is very low evidence that the mandibular growth direction became more horizontal during the first year after surgery to treat mouth breathing. The total anterior facial height decreased, although not always significantly.
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Affiliation(s)
- Rizomar Ramos do Nascimento
- Department of Orthodontics, School of Dentistry, Universidade Federal Fluminense, Rua Mário Santos Braga 30, Room 214, ZC 24040-110, Niterói (RJ), Brazil.
| | - Daniele Masterson
- The Central Library of the Health Sciences Center, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Claudia Trindade Mattos
- Department of Orthodontics, School of Dentistry, Universidade Federal Fluminense, Niterói (RJ), Brazil
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16
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Abstract
PURPOSE Orofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action. METHODS We conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were "obstructive sleep apnea" in combination with "myofunctional therapy" OR "oropharyngeal exercises" OR "speech therapy". We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). The primary outcomes of interest for this review were objective measurement derived from PSG and subjective sleep symptoms. The secondary outcome was the evaluation of orofacial myofunctional status. RESULTS Eleven studies were included in this review. The studies reviewed reveal that several benefits of OMT were demonstrated in adults, which include significant decrease of apnea-hypopnea index (AHI), reduced arousal index, improvement in subjective symptoms of daytime sleepiness, sleep quality, and life quality. In children with residual apnea, OMT promoted a decrease of AHI, increase in oxygen saturation, and improvement of orofacial myofunctional status. Few of the studies reviewed reported the effects of OMT on the musculature. CONCLUSION The present review showed that OMT is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure. However, randomized and high-quality studies are still rare, and the effects of treatment should also be analyzed on a long-term basis, including measures showing if changes occurred in the musculature.
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Affiliation(s)
- Cláudia Maria de Felício
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil,
- Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil,
| | - Franciele Voltarelli da Silva Dias
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil,
- Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil,
| | - Luciana Vitaliano Voi Trawitzki
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil,
- Craniofacial Research Support Center, University of São Paulo (USP), Ribeirão Preto, Brazil,
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Hotwani K, Sharma K, Jaiswal A. Evaluation of tongue/mandible volume ratio in children with obstructive sleep apnea. Dental Press J Orthod 2018; 23:72-78. [PMID: 30304156 PMCID: PMC6150701 DOI: 10.1590/2177-6709.23.4.072-078.oar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/20/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The present study was an attempt to investigate tongue/mandible volume ratio in children, using volumetric magnetic resonance imaging (MRI) for early screening and to aid in treatment planning. METHODS Volumetric evaluation of tongue volume/mandible volume ratio (TV/MV ratio) in children with obstructive sleep apnea (OSA) using MRI was carried out retrospectively on available DICOM MR images of children in the age group of 10-14 years. MRI image records of patients diagnosed with OSA were obtained from interventional radiology department records, at Sharad Pawar Dental College and Hospital (Datta Meghe Institute of Medical Sciences, Nagpur/India). The age, gender, height and weight of the subjects were retrieved from patient database and registered. For the control group, available MRI images of healthy subjects without OSA were retrieved. Body mass index (BMI) was also calculated using the height and the weight present in the records. Measurements from MR images were made using DICOM image processing software. Soft tissue and bony structure segmentation was performed by manual tracing. The tongue volume and mandible volume were directly computed using the software. The tongue volume/mandible volume ratio (TV/MV) was generated using the above values and expressed as a percentage for both groups. RESULTS The difference between OSA group and control group with respect to TV/MV ratio was found to be highly significant at 0.05 level of significance. There was no significant correlation between BMI and TV/MV ratio in OSA group (p= 0.451) as well as in control group (p= 0.094). CONCLUSION TV/MV ratio may be an appropriate variable to evaluate the risk of OSA, representing the balance between skeletal morphology and soft tissue morphology in craniofacial complex.
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Affiliation(s)
- Kavita Hotwani
- VSPM Dental College and Research Center, Department of Pediatric and Preventive Dentistry (Nagpur/MH, India)
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18
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Stupak HD, Park SY. Gravitational forces, negative pressure and facial structure in the genesis of airway dysfunction during sleep: a review of the paradigm. Sleep Med 2018; 51:125-132. [PMID: 30165336 DOI: 10.1016/j.sleep.2018.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Abstract
The recent and distant literature has extensive discussion of how sleep apnea, adeno-tonsillar growth, and facial structural deformity are related. Conventionally, the order of cause and effect is as follows: (1) Inflammatory/infectious process→tonsillar/adenoid tissue growth→(2) airway obstruction and mouth breathing/Obstructive Sleep Apnea (OSA)→(3) altered facial structure (adenoid facies). Using this same reasoning, adenotonsillectomy is the first line of treatment in the prevention of structural abnormalities. However, through a lifetime of clinical research Christian Guilleminault and his colleagues have challenged this paradigm. Through multiple articles and studies, Guilleminault et al., teach that even slight (subclinical) facial structure/muscle tone variations may be the inciting event triggering mouth-breathing and the eventual adenotonsillar growth in most patients. Essentially, this is the reverse of the conventional paradigms. Initial treatments therefore shift from simplified removal of inflammatory tissue to limiting mouth-breathing via musculo-skeletal modification. The purpose of this paper is to synthesize and analyze the recent (and distant) relevant literature to provide support for, and provide a potential anatomic mechanism for Guilleminault et al.'s paradigm-questioning clinical observations.
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Affiliation(s)
- Howard D Stupak
- Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, USA.
| | - Steven Y Park
- Albert Einstein College of Medicine, Department of Otorhinolaryngology, Bronx, NY, USA
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Zhao T, Ngan P, Hua F, Zheng J, Zhou S, Zhang M, Xiong H, He H. Impact of pediatric obstructive sleep apnea on the development of Class II hyperdivergent patients receiving orthodontic treatment: A pilot study. Angle Orthod 2018; 88:560-566. [PMID: 29782200 DOI: 10.2319/110617-759.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To conduct a pilot study to determine if the presence of obstructive sleep apnea (OSA) influences the orthodontic treatment outcome of Class II hyperdivergent patients receiving comprehensive orthodontic treatment. MATERIALS AND METHODS Patients between the ages of 12 and 14 who received orthodontic treatment at the Hospital of Stomatology, Wuhan University, China, were included in this study. Patients were divided into two groups: the OSA group and the control group, based on the outcome of pretreatment polysomnography findings and lateral cephalometric radiograph examination. Patients in the control group were matched with the OSA group for age, sex, ethnicity, weight, and height. Cephalometric measurements were used to record the skeletal and dental changes from before to after treatment. Data were analyzed using the t-test. RESULTS Twenty three OSA patients and 23 control patients were included. After comprehensive orthodontic treatment, the mandibular plane angle (SN-GoMe), articular angle (SArGo), sum of Jarabak angles (SUM) and the lower gonial angle (NGoMe) were found to increase significantly in the OSA group but remained unchanged or decreased slightly in the control group ( P < .05). In the non-OSA group, the growth pattern became more horizontal. In contrast, in the OSA group the growth pattern became more vertical. Otherwise, similar treatment results were obtained for both groups in terms of sagittal change and occlusion. CONCLUSIONS The presence of OSA in pediatric patients has a deleterious effect on the development of hyperdivergent malocclusions. Early diagnosis and management of pediatric OSA can affect the orthodontic treatment outcome of these patients.
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20
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Laine-Alava MT, Murtolahti S, Crouse UK, Warren DW. Guideline Values for Minimum Nasal Cross-Sectional Area in Children. Cleft Palate Craniofac J 2018; 55:1043-1050. [PMID: 29589981 DOI: 10.1177/1055665618767107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose was to determine age-specific values of the minimum cross-sectional area of the nasal airway in children without cleft lip or palate and to assess whether gender differences occur with growth in order to develop guidelines for assessment in children with clefts. PARTICIPANTS All schoolchildren aged 8 to 17 years who met the research criteria were studied during rest breathing using the pressure-flow technique. The children came from a rural area of 3800 inhabitants. Consecutive age cohorts were used for comparisons. RESULTS Nasal cross-sectional area increased in females from 0.38 cm2 in 8-year-olds to 0.58 cm2 in 17-year-olds. There was a decrease in size at ages 10 to 11 and 14 to 15 years. In males, the area increased from 0.40 to 0.68 cm2 and decreased slightly from 9 to 10 and 14 to 15 years. The annual changes were statistically significant in females between 8 and 9 and 11 to 13 years of age, and in males from 11 to 12, 13 to 14, and 15 to 17 years of age. Across gender, the only significant difference occurred at age 16. CONCLUSIONS Our results indicate that the increase in nasal airway size is not consistent during growth. Nasal airway size showed almost equal values for both genders in young children but was systematically larger in boys from 14 years of age on. The results refer that by 17 years of age nasal airway may not have reached adult size in males.
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Affiliation(s)
- Maija T Laine-Alava
- 1 Department of Orthodontics, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Siiri Murtolahti
- 2 Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ulla K Crouse
- 3 Department of Orthodontics, University of Michigan, Ann Arbor, MI, USA
| | - Donald W Warren
- 4 Craniofacial Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Naini FB, Gill DS. Principles of Orthognathic Surgical Correction of Skeletal Anterior Open Bite. APOS TRENDS IN ORTHODONTICS 2017. [DOI: 10.4103/apos.apos_81_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This article describes the principles of orthognathic surgical correction of skeletal anterior open bite (AOB), including a description of the aetiological factors involved in the development of predominantly skeletal AOBs, description of the presenting diagnostic features, the principles of treatment planning, orthodontic preparation, and postoperative requirements.
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Affiliation(s)
- Farhad B. Naini
- Maxillofacial Unit, Kingston and St George’s Hospitals and Medical School, London, United Kingdom
| | - Daljit S. Gill
- Craniofacial Unit, Great Ormond Street Hospital NHS Foundation Trust and UCLH Eastman Dental Hospital, London, United Kingdom
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Becking BE, Verweij JP, Kalf-Scholte SM, Valkenburg C, Bakker EWP, van Merkesteyn JPR. Impact of adenotonsillectomy on the dentofacial development of obstructed children: a systematic review and meta-analysis. Eur J Orthod 2017; 39:509-518. [DOI: 10.1093/ejo/cjx005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Idris G, Galland B, Robertson CJ, Farella M. Efficacy of a Mandibular Advancement Appliance on Sleep Disordered Breathing in Children: A Study Protocol of a Crossover Randomized Controlled Trial. Front Physiol 2016; 7:353. [PMID: 27594841 PMCID: PMC4990554 DOI: 10.3389/fphys.2016.00353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep-Disordered Breathing (SDB) varies from habitual snoring to partial or complete obstruction of the upper airway and can be found in up to 10% of children. SDB can significantly affect children's wellbeing, as it can cause growth disorders, educational and behavioral problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for pediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, or for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS) may represent a viable treatment option. Whilst the efficacy of these appliances has been consistently demonstrated in adults, there is little information about their effectiveness in children. AIMS To determine the efficacy of mandibular advancement appliances for the management of SDB and related health problems in children. METHODS/DESIGN The study will be designed as a single-blind crossover randomized controlled trial with administration of both an "Active MAS" (Twin-block) and a "Sham MAS." Eligible participants will be children aged 8-12 years whose parents report they snore ≥3 nights per week. Sixteen children will enter the full study after confirming other inclusion criteria, particularly Skeletal class I or class II confirmed by lateral cephalometric radiograph. Each child will be randomly assigned to either a treatment sequence starting with the Active or the Sham MAS. Participants will wear the appliances for 3 weeks separated by a 2-week washout period. For each participant, home-based polysomnographic data will be collected four times; once before and once after each treatment period. The Apnea Hypopnea Index (AHI) will represent the main outcome variable. Secondary outcomes will include, snoring frequency, masseter muscle activity, sleep symptoms, quality of life, daytime sleepiness, children behavior, and nocturnal enuresis. In addition, blood samples will be collected to assess growth hormone changes. TRIAL REGISTRATION This study was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR): [ACTRN12614001013651].
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Affiliation(s)
- Ghassan Idris
- Craniofacial Biology and Clinical Oral Physiology Research Programme, Sir John Walsh Research Institute, University of Otago Dunedin, New Zealand
| | - Barbara Galland
- Department of Women's and Children's Health, University of Otago Dunedin, New Zealand
| | - Christopher J Robertson
- Craniofacial Biology and Clinical Oral Physiology Research Programme, Sir John Walsh Research Institute, University of Otago Dunedin, New Zealand
| | - Mauro Farella
- Craniofacial Biology and Clinical Oral Physiology Research Programme, Sir John Walsh Research Institute, University of Otago Dunedin, New Zealand
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Macari AT, Haddad RV. The case for environmental etiology of malocclusion in modern civilizations—Airway morphology and facial growth. Semin Orthod 2016. [DOI: 10.1053/j.sodo.2016.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vieira-Andrade RG, Gomes GB, de Almeida Pinto-Sarmento TC, Firmino RT, Pordeus IA, Ramos-Jorge ML, Paiva SM, Granville-Garcia AF. Oral conditions and trouble sleeping among preschool children. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0734-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Kim KB. How has our interest in the airway changed over 100 years? Am J Orthod Dentofacial Orthop 2016; 148:740-7. [PMID: 26522033 DOI: 10.1016/j.ajodo.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 12/01/2022]
Abstract
Since the beginning of our specialty, our understanding of the link between function and facial growth and development has progressively improved. Today, we know that children with sleep-related breathing problems will often develop distinctive facial characteristics. In adults, sleep apnea can result in serious morbidity and mortality. Orthodontists can ask sleep-related questions in the health history to help identify sleep breathing disorders. Treating these patients presents unique opportunities for orthodontists to collaborate with other medical specialties to improve a patient's health and treatment outcome. Research presented in our Journal in the next century may shed new light that will help us better identify the problem and aid the specialty in developing more effective evidence-based treatment. Additional efforts are needed to understand the physiology, neurology, and genetics of sleep breathing disorders.
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Affiliation(s)
- Ki Beom Kim
- Associate professor, Department of Orthodontics, Center for Advanced Dental Education, Saint Louis University, St Louis, Mo.
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27
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Niemi P, Numminen J, Rautiainen M, Helminen M, Vinkka-Puhakka H, Peltomäki T. The effect of adenoidectomy on occlusal development and nasal cavity volume in children with recurrent middle ear infection. Int J Pediatr Otorhinolaryngol 2015; 79:2115-9. [PMID: 26454528 DOI: 10.1016/j.ijporl.2015.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of the study was to examine the effect of adenoidectomy on occlusal/dentoalveolar development and nasal cavity volume in children who underwent tympanostomy tube insertion with or without adenoidectomy due to recurrent episodes of middle ear infection. METHODS This prospective controlled study consisted of two randomly allocated treatment groups of children, younger than 2 years, who had underwent more than 3-5 events of middle ear infection during the last 6 months or 4-6 events during the last year. At the mean age of 17 months tympanostomy tube placement without adenoidectomy (Group I, n=63) tympanostomy tube placement with adenoidectomy (Group II, n=74) was performed. At the age of 5 years 41 children of the original Group I (14 females, 27 males, mean age 5.2 yrs, SD 0.17) and 59 children of the original Group II (17 females, 42 males, mean age 5.2 yrs, SD 0.18) participated in the re-examination, which included clinical orthodontic examination defining morphological and functional craniofacial status and occlusal bite index to measure upper dental arch dimensions. Acoustic rhinometry and anterior rhinomanometry was made by otorhinolaryngologist at the same day. RESULTS No statistically significant differences were found between the groups in the frequencies of morphological or functional characteristics or upper dental arch measurements or in the minimal cross-sectional areas or inspiratory nasal airway resistance measurements. CONCLUSION Combining adenoidectomy with tympanostomy tube insertion in the treatment of recurrent middle ear infection at an early age (under the age of 2 years) does not seem to make any difference in occlusal development in primary dentition at the age of 5 years as compared to tympanostomy tube insertion only. Since adenoid size was not evaluated, the findings do not allow interpretation that hypertrophic adenoids should not be removed in children with continuous mouth breathing or sleep disordered breathing.
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Affiliation(s)
- P Niemi
- Department of Maxillofacial Surgery and Oral Diseases, Satakunta Central Hospital, Pori, Finland
| | - J Numminen
- Department of Otorhinolaryngology, Tampere University Hospital, and University of Tampere, Finland
| | - M Rautiainen
- Department of Otorhinolaryngology, Tampere University Hospital, and University of Tampere, Finland
| | - M Helminen
- Science Centre, Pirkanmaa Hospital District and School of Health Sciences, University of Tampere, Finland
| | | | - T Peltomäki
- Field of Dentistry, University of Tampere, and Oral and Maxillofacial Unit, Tampere University Hospital, Finland.
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Abstract
Paediatric obstructive sleep apnea (OSA) is common and its prevalence is expected to increase due to the rise in childhood obesity. Recent research has shown that many children, both syndromic and non-syndromic, who exhibit mouth breathing as a result of upper airway obstruction, may also exhibit dentofacial anomalies. Although adenotonsillectomy and continuous positive airway pressure have been classically proposed as the primary treatment modalities for paediatric OSA, there are significant limitations to both therapies. Therefore newer treatment modalities are needed. Current research has focused on emerging dental treatment options for paediatric OSA, such as rapid maxillary expansion, oral appliances and distraction osteogenesis. However, there are few randomized trials assessing the effectiveness of these novel dental therapies for paediatric OSA, and hence further research is required to advance the field.
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29
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Letter to the Editor regarding "does septoplasty improve the quality of life in children?". Int J Pediatr Otorhinolaryngol 2014; 78:2333-4. [PMID: 25455528 DOI: 10.1016/j.ijporl.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/04/2014] [Indexed: 11/23/2022]
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30
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Major MP, Witmans M, El-Hakim H, Major PW, Flores-Mir C. Agreement between cone-beam computed tomography and nasoendoscopy evaluations of adenoid hypertrophy. Am J Orthod Dentofacial Orthop 2014; 146:451-9. [DOI: 10.1016/j.ajodo.2014.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 06/01/2014] [Accepted: 06/01/2014] [Indexed: 11/25/2022]
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Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis. J Am Dent Assoc 2014; 144:269-77. [PMID: 23449902 DOI: 10.14219/jada.archive.2013.0113] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors conducted a systematic review to consolidate the current knowledge regarding craniofacial morphological characteristics associated with obstructive sleep apnea syndrome (OSAS) in nonsyndromic pediatric patients. TYPES OF STUDIES REVIEWED The authors included clinical studies in which participants were younger than 18 years, polysomnography was performed to determine the presence and severity of OSAS and the study group was compared with a control group or normative growth center data. The authors excluded studies with syndromic participants or participants who had received orthodontic treatment, orthognathic treatment or both previously. RESULTS The authors identified nine articles. They conducted a meta-analyses of the data from all but one of the studies to evaluate the eight most common cephalometric variables in children with OSAS. The I(2) values were 79.53 percent for the angle from the basion point to the sella nasion (SN) line, 89.54 percent for the angle between the SN and palatal plane lines and 96.82 percent for the angle between the mandibular plane and SN lines (MP-SN). Therefore, for these three variables, the authors conducted a random-effect model meta-analysis. For the remaining five variables (MP-SN, the angle from SN to Apoint, the angle from SN to B point [SNB], the angle from A point to nasion point to B point [ANB] and the angle from articulare point to gonion point to gnathion point), I(2) values were all less than 40 percent, and therefore the authors conducted a fixed-effects model meta-analysis. Three of the evaluated cephalometric variables (MP-SN, SNB and ANB) had statistically significant differences in comparison with those in a control group. Although the values of these variables were increased in children with OSAS, results of the meta-analysis should be considered cautiously owing to the limited number of cephalometric variables included. PRACTICAL IMPLICATIONS Dentists who identify patients with a craniofacial morphology consistent with pediatric OSAS (retrusive chin, steep mandibular plane, vertical direction of growth and a tendency toward Class II malocclusion) should inquire further into their patients' medical histories. When the craniofacial morphology is accompanied by a history of snoring, inability to breathe through the nose, significant allergies, asthma or obesity, the dentist should refer the patient to an otolaryngologist for assessment.
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Buschang PH, Jacob H, Carrillo R. The Morphological Characteristics, Growth, and Etiology of the Hyperdivergent Phenotype. Semin Orthod 2013. [DOI: 10.1053/j.sodo.2013.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kallunki J, Marcusson A, Ericsson E. Tonsillotomy versus tonsillectomy--a randomized trial regarding dentofacial morphology and post-operative growth in children with tonsillar hypertrophy. Eur J Orthod 2013; 36:471-8. [PMID: 24253034 DOI: 10.1093/ejo/cjt082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The primary aim of this study was to analyse two different methods of tonsil surgery, tonsillectomy (TE) and tonsillotomy (TT), regarding post-operative dentofacial growth in children with tonsillar hypertrophy. A secondary aim was to analyse these results in relation to cephalometric standards. MATERIAL AND METHODS The study group consisted of 64 subjects (39 boys and 25 girls), mean age 4.8 years ± 4 months. They were randomized to a complete removal of the pharyngeal tonsil, TE, (n = 31) or a partial removal, TT, (n = 33). Pre-operative and 2 years post-operative study material were obtained and analysed. The results were compared with cephalometric standards. RESULTS Pre-operative, children with hypertrophic tonsils displayed an increased vertical relation (P < 0.05) compared with cephalometric standards. Post-operative, no significant difference could be detected between the two surgical procedures regarding dentofacial growth. Mandibular growth with an anterior inclination was significant (P < 0.001/TE, P < 0.01/TT) for both groups. An increased upper and lower incisor inclination was noted (P < 0.01/TE,TT). The vertical relation decreased (P < 0.001/TE, P < 0.05/TT) as well as the mandibular angle (P < 0.01/TE, P < 0.001/TT). Reduction was also significant for the sagittal intermaxillar (P < 0.001/TE,TT) relation. These post-operative results, together with a more prognatic mandible (P < 0.05/TE,TT) and chin (P < 0.001/TE, P < 0.01/TT), might indicate a more horizontal direction of mandibular growth. CONCLUSION TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils. This result should be considered when deciding upon surgical technique.
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Affiliation(s)
| | - Agneta Marcusson
- **Departments of Dentofacial Orthopaedics, University Hospital and
| | - Elisabeth Ericsson
- ***Medical and Health Sciences, Linköping University and Anesthesia and Intensive Care , County Council of Östergötland, Linköping, Sweden
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Korayem MM, Witmans M, MacLean J, Heo G, El-Hakim H, Flores-Mir C, Major PW. Craniofacial morphology in pediatric patients with persistent obstructive sleep apnea with or without positive airway pressure therapy: a cross-sectional cephalometric comparison with controls. Am J Orthod Dentofacial Orthop 2013; 144:78-85. [PMID: 23810049 DOI: 10.1016/j.ajodo.2013.02.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Compression on the midface with nasal mask-delivered positive airway pressure (PAP) therapy in growing patients might contribute to midface retrusion. The objective of this study was to investigate the association between long-term PAP use and craniofacial morphologic pattern in children with persistent obstructive sleep apnea. METHODS Images generated with cone-beam volumetric imaging were used to complete lateral cephalometric analyses of anteroposterior projection of the midface region. The study group included 12 subjects (10 boys, 2 girls; mean age, 9.0 years) who used PAP therapy for at least 6 months and at least 6 hours per night. Measurements from this group were compared with those of a control group of 11 subjects (5 boys, 6 girls; mean age, 9.6 years) with obstructive sleep apnea who did not have PAP. Measurements were taken at 1 time point. RESULTS No significant differences were identified between the groups for any cephalometric variable. Multivariate linear regression analysis also did not identify a significant association between the number of months of PAP therapy and the cephalometric variables. Cephalometric data for both groups were pooled for comparison with appropriate published normative values for age and sex. Anterior cranial base length, overall anteroposterior length of the maxillary base, and mandibular body length were significantly shorter than normal in the subjects compared with published normative values. CONCLUSIONS No association was demonstrated between midface projection and PAP use in growing patients. When compared with normative data for anterior cranial base, children with obstructive sleep apnea had shorter maxillary and mandibular lengths.
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Affiliation(s)
- Mohammed M Korayem
- Clinical instructor, Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Huynh NT, Emami E, Helman JI, Chervin RD. Interactions between sleep disorders and oral diseases. Oral Dis 2013; 20:236-45. [PMID: 23815461 DOI: 10.1111/odi.12152] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 01/29/2023]
Abstract
Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice.
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Affiliation(s)
- N T Huynh
- Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
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Li H, Lu XF, Shi J, Shi HM, Dai J. Measurements of normal nasal airway assessed by 3-dimensional computed tomography in Chinese children and adolescents. Int J Pediatr Otorhinolaryngol 2013; 77:180-3. [PMID: 23164502 DOI: 10.1016/j.ijporl.2012.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 10/14/2012] [Accepted: 10/19/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish normative data of nasal airway dimensions in Chinese children and adolescents by age and sex. METHODS CT images of 281 Chinese children and adolescents (140 girls and 141 boys) aged from 6 to 18 years (yr) were selected among the patients who visited in Shanghai Ninth People's Hospital from September 2009 to August 2010. Subjects were divided into four age groups as group 1 (6-9 yr), group 2 (10-12 yr), group 3 (13-15 yr), and group 4 (16-18 yr). Child was defined as 6-12 yr, and adolescent as 13-18 yr. Nasal parameters were as follow: nasal volume (NV), length of nasal airway (NL), minimal cross-section area (CSA 1) and its location (D 1), inferior turbinate head's location (D 2) and its airway cross-section area (CSA 2), and cross-sectional area of choanal (CSA 3). RESULTS There was no significant sex dimorphism in nasal parameters in children (group 1 and group 2). In adolescents, male's nasal dimension were larger than female's. CSA 1, D 1, CSA 2, CSA 3, NL and NV correlated with age in male and female respectively. CONCLUSIONS Volume, length and cross-section area of nasal airway were correlated with age in Chinese children and adolescents aged from 6 to 18 yr. In children, nasal conformations of male and female are similar. In adolescents, sex dimorphisms in nasal parameters were significant.
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Affiliation(s)
- Hui Li
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Nasal airway function after maxillary surgery: a prospective cohort study using the nasal obstruction symptom evaluation scale. J Oral Maxillofac Surg 2012; 71:343-50. [PMID: 22883318 DOI: 10.1016/j.joms.2012.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine nasal airway function using a disease-specific quality-of-life survey instrument in subjects undergoing Le Fort I osteotomy without simultaneous rhinosurgical procedures. MATERIALS AND METHODS We conducted a prospective cohort study of nasal airway function in consecutive Le Fort I osteotomy patients, who had not received simultaneous rhinosurgical procedures, between 2007 and 2008 at Kaiser Permanente Oakland Medical Center. We administered the Nasal Obstruction Symptom Evaluation (NOSE) survey before and 3 months after surgery. Clinical and radiographic examinations were performed, and the relevant medical and demographic factors were analyzed. RESULTS The initial study sample comprised 55 patients, of whom 5 were excluded. Of the remaining 50 patients (median age 21 years, 60% women), the maxilla was advanced (median 4 mm, interquartile range 3 to 5) with minimal vertical change. During the follow-up period (median 5.5 months), significant improvement was seen in the NOSE scores for the cohort, with a median decrease of 10 units (P = .0005). Patients with moderate nasal obstruction (preoperative NOSE score >25) had the greatest improvement (P < .001). Those with severe nasal obstruction (preoperative NOSE score >50) improved, however, this did not reach statistical significance (P < .0625). The NOSE scores worsened in 10 patients; of these, 6 had minimal change. However, 4 had significant worsening, with 2 having symptomatic complaints. No predictor variables were identified in this small subgroup; however, individual case analyses revealed 1 subject with postoperative turbinate inflammation on the side of maxillary segmentalization and 1 had nasal septal buckling. CONCLUSIONS Our overall findings have suggested that nasal airway function improved after maxillary advancement and that subjects with greater preoperative NOSE scores (>25) were more likely to experience relief of nasal obstructive symptoms.
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Itikawa CE, Valera FCP, Matsumoto MAN, Lima WTA. Effect of rapid maxillary expansion on the dimension of the nasal cavity and on facial morphology assessed by acoustic rhinometry and rhinomanometry. Dental Press J Orthod 2012. [DOI: 10.1590/s2176-94512012000400024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To assess the effects of rapid maxillary expansion on facial morphology and on nasal cavity dimensions of mouth breathing children by acoustic rhinometry and computed rhinomanometry. METHODS: Cohort; 29 mouth breathing children with posterior crossbite were evaluated. Orthodontic and otorhinolaryngologic documentation were performed at three different times, i.e., before expansion, immediately after and 90 days following expansion. RESULTS: The expansion was accompanied by an increase of the maxillary and nasal bone transversal width. However, there were no significant differences in relation to mucosal area of the nose. Acoustic rhinometry showed no difference in the minimal cross-sectional area at the level of the valve and inferior turbinate between the periods analyzed, although rhinomanometry showed a statistically significant reduction in nasal resistance right after expansion, but were similar to pre-treatment values 90 days after expansion. CONCLUSION: The maxillary expansion increased the maxilla and nasal bony area, but was inefficient to increase the nasal mucosal area, and may lessen the nasal resistance, although there was no difference in nasal geometry. Significance: Nasal bony expansion is followed by a mucosal compensation.
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Abstract
Imaging plays a role in the anatomic assessment of the airway and adjacent structures. This article discusses the use of 3-dimensional (3D) imaging (cone beam computed tomography [CBCT]) to evaluate the airway and selected regional anatomic variables that may contribute to obstructive sleep-disordered breathing (OSDB) in patients. CBCT technology uses a cone-shaped x-ray beam with a special image intensifier and a solid-state sensor or an amorphous silicon plate for capturing the image. Incorporation of 3D imaging into daily practice will allow practitioners to readily evaluate and screen patients for phenotypes associated with OSDB.
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Bastos LVW, Tesch RDS, Denardin OVP. Cephalometric deviations present in children and adolescents with temporomandibular joint disorders. Dental Press J Orthod 2012. [DOI: 10.1590/s2176-94512012000100011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mattar SEM, Valera FCP, Faria G, Matsumoto MAN, Anselmo-Lima WT. Changes in facial morphology after adenotonsillectomy in mouth-breathing children. Int J Paediatr Dent 2011; 21:389-96. [PMID: 21599769 DOI: 10.1111/j.1365-263x.2011.01117.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Morphological and dentofacial alterations have been attributed to impaired respiratory function. OBJECTIVE To examine the influence of mouth breathing (MB) on children facial morphology before and after adenoidectomy or adenotonsillectomy. METHODS Thirty-three MB children who restored nasal breathing (NB) after surgery and 22 NB children were evaluated. Both groups were submitted to lateral cephalometry, at time 1 (T1) before and at time 2 (T2) 28 months on average postoperatively. RESULTS Comparison between the MB and NB groups at T1 showed that mouth breathers had higher inclination of the mandibular plane; more obtuse gonial angle; dolichofacial morphology; and a decrease in the total and inferior posterior facial heights. Twenty-eight months after the MB surgical intervention, they still presented a dolichofacial morphologic pattern. During this period, MB altered the face growth direction and decreased their mandible plane inclination, with reduction in the SN.GoGn, PP.MP, SNGn, and ArGo.GoMe parameters as well as an increase in BaN.PtGn. CONCLUSION After the MB rehabilitation, children between 3 and 6 years old presented significant normalization in the mandibular growth direction, a decrease in the mandible inclination, and an increase in the posterior facial height. Instead, they still persisted with a dolichofacial pattern when compared with nasal breathers.
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Affiliation(s)
- Sara E M Mattar
- Department of Orthodontics of Dentistry School of Ribeirão Preto, University of São Paulo, Brazil
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Stellzig-Eisenhauer A, Meyer-Marcotty P. Interaction between otorhinolaryngology and orthodontics: correlation between the nasopharyngeal airway and the craniofacial complex. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 9:Doc04. [PMID: 22073108 PMCID: PMC3199830 DOI: 10.3205/cto000068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In terms of pathophysiology, an anatomically narrow airway is a predisposing factor for obstruction of the upper respiratory tract. The correlation between the nasopharyngeal airway and the craniofacial structures is discussed in this context. Thus a mutual interaction between the pharynx and the mandibular position was demonstrated, whereby the transverse dimension of the nasopharynx was significantly larger in patients with prognathism than in patients with retrognathism. The influence of chronic obstruction of the nasal airway on craniofacial development was also discussed. The form-and-function interaction, which ought to explain the causal relationship between nasal obstruction and craniofacial growth, appears to be of a multifactorial rather than a one-dimensional, linear nature. It is not disputed, however, that expanding the maxilla improves not only nasal volume and nasal flow, but also the subjective sensation of patients, although it is not possible to make a prognostic statement about the extent of this improvement because of the differing reactions of individuals. Orthodontic appliances for advancing the mandible can also be successfully used in the treatment of mild obstructive sleep apnea syndrome. This treatment method should be considered particularly for patients who are unwilling to undergo or cannot tolerate CPAP (continuous positive airway pressure) treatment.
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Godt A, Koos B, Hagen H, Göz G. Changes in upper airway width associated with Class II treatments (headgear vs activator) and different growth patterns. Angle Orthod 2011; 81:440-6. [PMID: 21261483 DOI: 10.2319/090710-525.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the upper airways for anteroposterior width against different growth patterns and for alterations during various Class II treatments. MATERIALS AND METHODS Cephalograms from three treatment groups (headgear, activator, and bite-jumping appliance) were evaluated by a single investigator at baseline and at the end of orthodontic treatment. Cephalograms were used to determine upper airway width at different levels in the anteroposterior plane. Patients in the headgear group were additionally divided into six subsets on the basis of y-axis values to assess the influence of different growth patterns. RESULTS Small increases in pharyngeal width were noted at all vertical level segments, both at baseline and during orthodontic treatments. No significant differences in these small increases were noted across various treatment modalities and growth patterns. CONCLUSION Upper airway changes did not significantly vary with the different treatment modalities investigated in the present study. Nevertheless, reductions in pharyngeal width potentially triggering or exacerbating obstructive sleep apnea syndrome (OSAS) are always possible in the headgear phase.
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Affiliation(s)
- Arnim Godt
- Department of Orthodontics, Eberhard-Karls-Universität, Tübingen, Germany.
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Feres MFN, Hermann JS, Cappellette M, Pignatari SSN. Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: a systematic review. Int J Pediatr Otorhinolaryngol 2011; 75:1-11. [PMID: 21126775 DOI: 10.1016/j.ijporl.2010.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/30/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy. METHODS Searching was conducted on Pubmed, Lilacs, Cochrane Library, Embase, and Web of Knowledge databases; and was restricted to studies published in English, Portuguese or Spanish languages, carried out on humans under 18 years of age. All the obtained publications were first submitted to a pre-selection, and then, full-texts (n=66) were analyzed and selected by independent examiners. The resultant studies (n=11) were systematically and critically analyzed, and qualified according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) questionnaire, an assessment tool designed to qualify diagnostic tests accuracy studies. RESULTS Searching and selection procedures generated 11 studies which were considered adequate to be systematically analyzed. Accordingly, large variation was observed concerning the evaluation methods of radiographic and fibronasoendoscopic exams, and the sample characteristics. Additionally, little amount of scientific evidences could be provided, since few radiographic variables were analyzed simultaneously. Moreover, assessment methods were, at most, subjective or poorly described. QUADAS application revealed other significant limitations related to the sampling, such as inadequate spectrum of the investigated "disease" (adenoid hypertrophy), and poor report of the subjects' enrollment and participation process. Further, QUADAS revealed inadequacies regarding methodological features, including poor description of the radiographic exams and assessment methods. In addition, it was also shown that most of the studies did not specify the moment in clinical time when both exams were performed; neither reported a strategy of "blindness" by the examiners. CONCLUSIONS Despite such limitations, the majority of the resultant data indicates that lateral X-rays might be considered somewhat useful, even though it could not be clearly demonstrated. Future research should then adhere to greater methodological rigor, in order to investigate the significance of radiographies as a screening test.
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Affiliation(s)
- Murilo Fernando Neuppmann Feres
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, Federal University of São Paulo, Sorocaba, SP, Brazil.
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D'Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study. Int J Pediatr Otorhinolaryngol 2010; 74:1180-3. [PMID: 20696485 DOI: 10.1016/j.ijporl.2010.07.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nasal-breathing impairment has been described as a possible determinant of maxillofacial development in children with adenoids/tonsils hypertrophy. However little is known about the possible influence of nasal septum deviation on craniofacial growth in childhood. We conducted a multicenter cephalometric study to compare skeletal and dental features in children with chronic nasal-breathing obstruction secondary to nasal septum deviation and nose-breathing controls. METHODS Ninety-eight children (59M, 39F; mean age 8.8 years; age range 7-12 years) with obligate mouth-breathing secondary to nasal septum deviation (group 1) and 98 age- and sex-matched nasal-breathing controls (group 2) were evaluated. Nasal-breathing function was assessed in all patients with clinical history, ENT instrumental examination and anterior active rhinomanometry. Cephalometric parameters were recorded in all subjects. RESULTS Patients of group 1 showed a statistically significant increase of upper anterior facial height (N-palatal plane) and total anterior facial height (N-Me) with regards to group 2. The angular relationships of the sella-nasion, palatal, and occlusal planes to the mandibular plane were greater in group 1 in comparison to controls. The gonial angle (Ar-Go-Me), palatal height and overjet were significantly higher in the mouth-breathing group. A significantly retrognatic position of the maxilla and mandible was recorded in group 1 in comparison to group 2. Most mouth-breathing children showed class II malocclusion, while the majority of control subjects presented normal occlusion. The prevalence of cross-bite was higher in group 1 with respect to controls (p=0.02). CONCLUSION Children with obligate mouth-breathing due to nasal septum deviations show facial and dental anomalies in comparison to nose-breathing controls. Possible physiologic explanations of our findings are reported.
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Affiliation(s)
- Luca D'Ascanio
- Department of Otolaryngology - Head & Neck Surgery, Città di Castello Civil Hospital, Città di Castello, Perugia, Italy.
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Souki BQ, Pimenta GB, Franco LP, Becker HMG, Pinto JA. Changes in vertical dentofacial morphology after adeno-/tonsillectomy during deciduous and mixed dentitions mouth breathing children--1 year follow-up study. Int J Pediatr Otorhinolaryngol 2010; 74:626-32. [PMID: 20363511 DOI: 10.1016/j.ijporl.2010.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 03/02/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this 1 year follow-up study was to investigate, in mouth breathing children, the impact of respiration normalization on vertical dentofacial growth during two stages of dental development after adeno-/tonsillectomy. METHOD Linear and angular cephalometric measurements, as well as tracing superimposition of serial lateral cephalograms of 39 patients in the treatment group were compared with those of 31 untreated mouth breathing controls. Cephalometric records in the treatment group comprised registrations made at baseline before surgery (T(0)), and then at approximately 1 year post-operatively (T(1)). Corresponding registrations were available for the control group, with a baseline cephalometric radiograph taken approximately 1 year before the second one (T(0) and T(1), respectively). Treatment and untreated groups were divided into deciduous and mixed dentition groups to aid the identification of an optimum timing for normalizing the respiration after T&A, under a vertical dentofacial perspective. RESULTS After 1 year of follow up, no statistically significant difference on vertical dentofacial growth was observed in deciduous or mixed dentitions treatment groups compared to the same occlusal developmental stage of untreated control groups. CONCLUSION The results indicate that regarding the vertical dentofacial growth pattern normalization of the mode of respiration after T&A in young children (deciduous dentition) is not more effective than in older children (mixed dentition).
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Affiliation(s)
- Bernardo Q Souki
- Federal University of Minas Gerais, Outpatient Clinic for Mouth-Breathers, Belo Horizonte, Brazil.
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Patency of nasopharynx and a cephalometric image in the children with orthodontic problems. Int J Pediatr Otorhinolaryngol 2009; 73:1803-9. [PMID: 19879660 DOI: 10.1016/j.ijporl.2009.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 09/29/2009] [Accepted: 10/01/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To study a possible impact of adenoidectomy on malocclusion on the base of cephalometry. METHODS Retrospective analysis of 148 patients qualified into the orthodontic treatment (77 girls and 71 boys) at the age of 9-11 years (an average age: 10 years and 3 months). Material was divided into three groups, equalized regarding sex and age. The first one consisted of the patients after adenoidectomy, at the moment of orthodontic assessment without any organic pathology within a nasal cavity or nasopharynx. To the second group were included children who for different reasons were not a subject of adenoidectomy despite clinical diagnosis of adenoid hypertrophy. In the third group were patients whose only problem was malocclusion. X-ray pictures taken on a cephalostate were scanned and given to cephalometric assessment. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used. RESULTS The significant differences with respect to many skull parameters appeared among the groups. The inappropriate respiratory habits find their reflection mainly within anterior and lower anterior facial height, angle of mandibular plane, nasopharyngeal flow and dental parameters. An evident beneficial influence of adenoidectomy is observed within a period of 36-41 months after an operation. Nasopharyngeal flow is the most sensitive parameter indicating the respiratory conditions, and is strongly connected with the key cephalometric parameters. CONCLUSIONS In cases of malocclusion of skeletal character, coexisting with adenoid hypertrophy, adenoidectomy should be carried out as early as possible.
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D'Ascanio L, Manzini M. Safe and rapid approach to the deviated nasal septum in children. Laryngoscope 2009; 119:2000-3. [PMID: 19598215 DOI: 10.1002/lary.20545] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Luca D'Ascanio
- Department of Otolaryngology-Head & Neck Surgery, Città di Castello Civil Hospital, Via Engels, Città di Castello, Italy.
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Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2009; 135:468-79. [PMID: 19361733 DOI: 10.1016/j.ajodo.2007.04.043] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 04/28/2007] [Accepted: 04/30/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Changes in the normal pattern of nasal respiration can profoundly affect the development of the craniofacial skeleton in both humans and experimental animals. The orthodontist is often the first clinician to notice that a child is breathing primarily through the mouth, either at the initial examination or later during treatment. The lateral headfilm, part of the patient's normal records, might show increased adenoid masses, suggesting that these could be part of the problem. Previous studies have, however, questioned the validity of the information from lateral headfilm. METHODS Our aim was to compare imaging information about nasopharyngeal airway size between a lateral cephalometric headfilm and a 3-dimensional cone-beam computed tomography scan in adolescent subjects. The nasopharyngeal airway area and volume were measured in 35 subjects (8 boys, 27 girls; average age, 14 years). RESULTS Volumetric measurement errors ranged from 0% to 5% compared with known physical airway phantoms used to calibrate. A moderately high (r = 0.75) correlation was found between airway area and volume; the larger the area, the larger the volume. However, there was considerable variability in the airway volumes of patients with relatively similar airways on the lateral headfilms. Nine of the 35 patients had over 25% of the potential nasopharyngeal airway volume occupied by inferior turbinate protuberances, leading to significant airway restriction in some patients. CONCLUSIONS The cone-beam 3-dimensional scan is a simple and effective method to accurately analyze the airway.
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Affiliation(s)
- Cameron Aboudara
- Division of Orthodontics, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143-0438, USA
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