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Bazargani F, Knode V, Plaksin A, Magnuson A, Ludwig B. Three-dimensional comparison of tooth-borne and tooth-bone-borne RME appliances: a randomized controlled trial with 5-year follow-up. Eur J Orthod 2023; 45:690-702. [PMID: 37253126 PMCID: PMC10687513 DOI: 10.1093/ejo/cjad024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To compare the long-term skeletal effects of tooth-borne (TB) and tooth-bone-borne (TBB) rapid maxillary expansion in growing children, using 3D imaging. MATERIALS AND METHODS In total, 52 consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years (SD 1.3), or the TBB group, mean age 9.5 years (SD 1.2). Cone-beam computed tomography records and plaster models were taken before (T0), directly after (T1), 1 year after (T2), and 5 years after expansion (T3). RANDOMIZATION Participants were randomly allocated in blocks of different sizes, using the concealed allocation principle in a 1:1 ratio. The randomization list was also stratified by sex to ensure homogeneity between groups. BLINDING Due to clinical limitations, only the outcome assessors were blinded to the groups to which the patients were allocated. RESULTS At T1, the midpalatal suture at its anterior part showed a statistically significant difference between the groups with a mean of 0.6 mm (CI 0.2-1.1) more expansion in the TBB group (P < 0.01). This difference was also more evident in boys at T1 with a mean of 0.8 mm (CI 0.2-1.4) (P < 0.01). These differences, however, blotted out at T2 and T3. The nasal width also showed similar differences between the groups, with a significantly larger expansion in the TBB group by a mean of 0.7 mm (CI 0.1-1.4) (P = 0.03). This group difference in favour of the TBB group was maintained at T2 (1.6 mm) and T3 (2.1 mm) (P < 0.01 T2 and T3, respectively). CONCLUSIONS Skeletal expansion in the midpalatal suture was significantly higher in the TBB group; however, the magnitude of this expansion was around 0.6 mm more and may not be clinically significant. Skeletal expansion at the level of the nasal cavity was significantly higher in the TBB group. There were no differences between boys and girls with regard to skeletal expansion. TRIAL REGISTRATION This trial was not registered on any external sites.
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Affiliation(s)
- Farhan Bazargani
- Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Vanessa Knode
- Private orthodontic office, Traben-Trarbach, Germany
| | | | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - Björn Ludwig
- Private orthodontic office, Traben-Trarbach, Germany
- Department of Orthodontics, University of Saarland, Homburg/Saar, Germany
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Garrocho-Rangel A, Rosales-Berber MÁ, Ballesteros-Torres A, Hernández-Rubio Z, Flores-Velázquez J, Yáñez-González E, Ruiz-Rodríguez S, Pozos-Guillén A. Rapid maxillary expansion and its consequences on the nasal and oropharyngeal anatomy and breathing function of children and adolescents: An umbrella review. Int J Pediatr Otorhinolaryngol 2023; 171:111633. [PMID: 37421834 DOI: 10.1016/j.ijporl.2023.111633] [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] [Received: 03/05/2023] [Revised: 06/03/2023] [Accepted: 06/11/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To identify, qualify, and summarize the evidence from different systematic reviews about the outcomes of Rapid Maxillary Expansion (RME) on upper airway dimensions and breathing function in young patients. METHODS A literature search (from 2000 to December 2022) was conducted through PubMed (MEDLINE), the Cochrane Library, EMBASE, and Dentistry & Oral Science Source. The authors conducted the following umbrella review phases: research question, study selection criteria (systematic reviews involving randomized clinical trials and longitudinal observational designs), data extraction, and critical appraisal (bias risk assessment) of selected articles through the ROBIS tool. RESULTS The initial search yielded 65 potential references. After screening titles and summaries, and the elimination of duplicated publications, 15 articles were eligible for the evaluation of the full-text document. Finally, 11 systematic reviews (5 combined with meta-analysis) were selected, reporting 132 single studies; 38 of them were unrepeatable. Risk-of-bias assessment showed an average global moderate/high quality among the included studies. There was high heterogeneity between the systematic reviews' (and meta-analyses') methodologies used. CONCLUSIONS The present umbrella review concludes that significant and stable increases in the nasal and oropharyngeal space volumes and a decrease in airway resistance of growing children and adolescents, occur immediately after RME and at 3, 6- and 12-months follow-up.
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Affiliation(s)
- Arturo Garrocho-Rangel
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | | | | | - Zaira Hernández-Rubio
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Joselin Flores-Velázquez
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Esthela Yáñez-González
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Socorro Ruiz-Rodríguez
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico
| | - Amaury Pozos-Guillén
- Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, University of San Luis Potosí, Mexico.
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Sakoda-Iwata R, Iwasaki T, Tsujii T, Hisagai S, Oku Y, Ban Y, Sato H, Ishii H, Kanomi R, Yamasaki Y. Does rapid maxillary expansion improve nasal airway obstruction? A computer fluid dynamics study in patients with nasal mucosa hypertrophy and obstructive adenoids. Am J Orthod Dentofacial Orthop 2023:S0889-5406(23)00228-7. [PMID: 37191595 DOI: 10.1016/j.ajodo.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Rapid maxillary expansion (RME) expands the maxillary dentition laterally and improves nasal airway obstruction. However, the incidence of nasal airway obstruction improvement after RME is approximately 60%. This study aimed to clarify the beneficial effects of RME on nasal airway obstruction in specific pathologic nasal airway diseases (nasal mucosa hypertrophy and obstructive adenoids) using computer fluid dynamics. METHODS Sixty subjects (21 boys; mean age 9.1 years) were divided into 3 groups according to their nasal airway condition (control, nasal mucosa hypertrophy, and obstructive adenoids), and those requiring RME had cone-beam computed tomography images taken before and after RME. These data were used to evaluate the nasal airway ventilation condition (pressure) using computer fluid dynamics and measure the cross-sectional area of the nasal airway. RESULTS The cross-sectional area of the nasal airway significantly increased after RME in all 3 groups. The pressures in the control and nasal mucosa groups significantly reduced after RME but did not change significantly in the adenoid group. The incidence of improvement in nasal airway obstruction in the control, nasal mucosa, and adenoid groups was 90.0%, 31.6%, and 23.1%, respectively. CONCLUSIONS The incidence of improvement in nasal airway obstruction after RME depends on the nasal airway condition (nasal mucosa hypertrophy and obstructive adenoids). In patients with nonpathologic nasal airway conditions, the obstruction may be sufficiently improved with RME. Furthermore, to some extent, RME may be effective in treating nasal mucosa hypertrophy. However, because of obstructive adenoids, RME was ineffective in patients with nasal airway obstruction.
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Affiliation(s)
- Rina Sakoda-Iwata
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
| | - Toshiya Tsujii
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Soujiro Hisagai
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoichiro Oku
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yuusuke Ban
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hideo Sato
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Barbosa DF, Bana LF, Michel MCB, Meira E Cruz M, Zancanella E, Machado Júnior AJ. Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review. Braz J Otorhinolaryngol 2023; 89:494-502. [PMID: 36894478 DOI: 10.1016/j.bjorl.2023.02.004] [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: 08/28/2022] [Revised: 12/26/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To compare polysomnographic parameters with others from the literature in order to provide more accurate information about Rapid Maxillary Expansion (RME) for treating Obstructive Sleep Apnea (OSA) in children, through raising the question: Is RME a good option for treating OSA in children? Prevention of mouth breathing during children's growth remains a challenge with significant clinical consequences. In addition, OSA induces anatomofunctional changes during the critical period of craniofacial growth and development. METHODS The Medline, PubMed, EMBASE, CINAHL, Web of Science, SciELO and Scopus electronic databases were searched up to February 2021 for systematic reviews with meta-analysis in the English language. Among 40 studies on RME for treating OSA in children, we selected seven in which polysomnographic measurements of the Apnea-Hypopnea Index (AHI) had been made. Data were extracted and examined in order to clarify whether any consistent evidence exists for indicating RME as a treatment for OSA in children. RESULTS We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up. CONCLUSION Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.
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Affiliation(s)
- Denise Fernandes Barbosa
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Laura Fernandes Bana
- Universidade de Campinas (FOP-UNICAMP), Faculdade de Odontologia, Departamento de Morfologia, Piracicaba, SP, Brazil
| | | | - Miguel Meira E Cruz
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Unidade de Sono, Lisboa, Portugal
| | - Edilson Zancanella
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Almiro José Machado Júnior
- Universidade de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Luzzi V, DE Filippo M, Guarnieri R, Fioravanti M, Guaragna M, Marasca B, Pirro V, Altieri F, Vozza I, Ndokaj A, Brindisi G, Barbato E, Polimeni A, Zicari AM. Evaluation of nasal airway resistance in a cohort of children with primary snoring and maxillary deficiency. Minerva Dent Oral Sci 2023; 72:54-59. [PMID: 36345835 DOI: 10.23736/s2724-6329.22.04727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to test whether rapid palatal expansion is effective to improve nasal airway patency in a sample of pediatric patients with primary snoring. METHODS A group of 21 subjects, 11 girls (52%) and 10 boys (48%), with a mean age of 7.1 years (SD=1.3; range 4-9 years) were treated with a rapid maxillary expansion (RME) device. Nasal airway resistance was assessed via rhinomanometric exam before (pre-) and 6 months after (post-) the rapid palatal expansion treatment. RESULTS Data analysis showed a statistically significant increase in the mean scores of the results of the rhinomanometric exam between the pre- and post-measurements with a significant reduction in total inspiratory and expiratory air resistance values after rapid palatal expansion. CONCLUSIONS Our results show that RME treatment is associated with an improvement in nasal airway resistance due to a substantial reduction in nasal resistance associated with the orthopedic action of the orthodontic device.
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Affiliation(s)
- Valeria Luzzi
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Maria DE Filippo
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Rosanna Guarnieri
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Miriam Fioravanti
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy -
| | - Mariana Guaragna
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Beatrice Marasca
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Valentina Pirro
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Federica Altieri
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Iole Vozza
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Artnora Ndokaj
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Giulia Brindisi
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Ersilia Barbato
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal, Child Health and Urological Sciences, Sapienza University, Rome, Italy
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Effects of Rapid Palatal Expansion on the Upper Airway Space in Children with Obstructive Sleep Apnea (OSA): A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020244. [PMID: 36832373 PMCID: PMC9954808 DOI: 10.3390/children10020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4-10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children's Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4-11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients.
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Balasubramanian S, Kalaskar R, Kalaskar A. Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing. Int J Clin Pediatr Dent 2022; 15:617-630. [PMID: 36865716 PMCID: PMC9973120 DOI: 10.5005/jp-journals-10005-2421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective Rapid maxillary expansion (RME) has been extensively used in orthodontic practice for over a century, and it is claimed to benefit upper airway morphology. However, its effect in actually alleviating mouth breathing has remained unexplored. This systematic review was planned with an objective to provide a comprehensive synthesis of the effects of RME on upper airway volume and most importantly, its role in alleviating mouth breathing. Methods A literature search of electronic databases were done for the time period of 2000-2018. Randomized controlled trials (RCTs) and non-RCTs conducted on 8-15-year-old children who received bonded or banded RME and upper airway measured using three-dimensional (3D) imaging were included. Results Twelve studies (two RCTs, nine nonrandomized clinical trials, and one non-RCT) were included in this systematic review, and nine studies were included for meta-analysis. Among the evaluated parameters, nasal cavity volume showed a significant increase which was maintained even after the retention phase, whereas nasopharyngeal and oropharyngeal volume did not report a significant change. Conclusion Based on this systematic review, it can be concluded that RME causes a significant increase in nasal cavity volume, but its effect on nasopharyngeal and oropharyngeal volume is not statistically significant in majority of studies. This increase in volume may not be considered as an equivalent for enhancement of airway and function unless proven so. In order to establish its significance in the improvement of breathing, it is necessary to conduct more well-designed RCTs with samples actually comprising mouth breathers. How to cite this article Balasubramanian S, Kalaskar R, Kalaskar A. Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing. Int J Clin Pediatr Dent 2022;15(5):617-630.
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Affiliation(s)
- Shruti Balasubramanian
- Department of Pediatric & Preventive Dentistry, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Ritesh Kalaskar
- Department of Pediatric & Preventive Dentistry, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Ashita Kalaskar
- Department of Oral Medicine and Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
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Abd El-Ghafour M, Aboalnaga AA, Mostafa YA. Is maxillary expansion effective in treatment of obstructive sleep apnoea syndrome? A systematic review of systematic reviews. Evid Based Dent 2022:10.1038/s41432-022-0283-6. [PMID: 35986211 DOI: 10.1038/s41432-022-0283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Maxillary expansion (ME) might be beneficial in improving airway dimensions and obstructive sleep apnoea syndrome (OSAS) in patients with constricted maxillae. The aim of this overview is to present clinicians with a summary of the evidence. Data from systematic reviews and meta-analyses were evaluated to investigate the effect of ME on OSAS.Methods An electronic search was commenced in five databases, in addition to a manual search until July 2021. Screening of articles started with title and abstract followed by full-text assessment. Systematic reviews with/without meta-analyses were included. Critical appraisal was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, Level of Research Design scoring and criteria of body of evidence scores. The search, study selection and critical appraisal were completed by three reviewers.Results In total, 14 systematic reviews with/without meta-analyses were included. The quality of available evidence ranged between low to high, based on the overall quality evaluation.Conclusions Based on the available evidence, maxillary expansion might be able to improve the nasal airway volume and OSAS in both growing and adult patients in the short term. ME can be considered as one of the treatment options in cases with OSAS.
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Affiliation(s)
- Mohamed Abd El-Ghafour
- Lecturer, Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Amira Ahmed Aboalnaga
- Lecturer, Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Yehya Ahmed Mostafa
- Professor, Department of Orthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt; Professor, Department of Orthodontics, Faculty of Dentistry, Future University, Egypt
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Fernández-Barriales M, Lafuente-Ibáñez de Mendoza I, Alonso-Fernández Pacheco JJ, Aguirre-Urizar JM. Rapid maxillary expansion versus watchful waiting in pediatric OSA: a systematic review. Sleep Med Rev 2022; 62:101609. [DOI: 10.1016/j.smrv.2022.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
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Calvo-Henriquez C, Branco AM, Lechien JR, Maria-Saibene A, DeMarchi MV, Valencia-Blanco B, Boronat-Catalá B, Rangel-Chávez J, Martin-Martin C. What is the relationship between the size of the adenoids and nasal obstruction? A systematic review. Int J Pediatr Otorhinolaryngol 2021; 151:110895. [PMID: 34537548 DOI: 10.1016/j.ijporl.2021.110895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE adenoidectomy is one of the most common surgical procedure in pediatric otolaryngology practice. Clinical guidelines (such as the Spanish or American) suggest adenoidectomy when the enlargement of the adenoids is associated with nasal obstruction. Nasal endoscopy and cephalograms are adequate methods to estimate the size of the adenoids. However, they do not measure nasal patency. This systematic review is designed with the objective of exploring the relationship between adenoid size and nasal ventilation through rhinomanometry. REVIEW METHODS 3 authors members of the YO-IFOS rhinology study group independently analyzed the data sources (Pubmed, the Cochrane Library, EMBASE, SciELO) for papers assessing both nasal resistance and/or nasal airflow in rhinomanometry and adenoid size by any method (endoscopy, cephalogram, direct examination). RESULTS A total of 10 studies with a total population of 969 participants met the inclusion criteria. 5 authors explored the size of the adenoids through endoscopy. 4 authors explored the adenoids through lateral cephalograms. Finally, a further 2 authors explored adenoid size studying the resected tissue. Five studies explored the correlation between adenoid size and nasal resistance in rhinomanometry, which ranged from 0.20 to 0.84. Finally, 5 studies used nasal decongestant. It was found higher sensitivity and specificity, a higher area under the curve for the receiver operating characteristic curve, and higher correlation with adenoid size for rhinomanometry under nasal decongestion. CONCLUSION Up to now, there is no ideal diagnostic method for adenoid hypertrophy. Therefore, it seems prudent to use a combination of all currently available tools, as they provide complementary, rather than supplementary information. Available evidence suggests that rhinomanometry combined with nasal decongestant could help to elucidate the existence of nasal obstruction in intermediate cases of adenoid hypertrophy, as well as throw light on other possible causes for nasal obstruction, mainly turbinate hypertrophy.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology. Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Ana María Branco
- College of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Foch Hospital, University of Paris Saclay, Paris, France
| | - Alberto Maria-Saibene
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Maria Victoria DeMarchi
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Italiano, Buenos Aires, Argentina
| | - Beatriz Valencia-Blanco
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology. Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Borja Boronat-Catalá
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology. Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jesús Rangel-Chávez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Nuestra Señora de La Salud, San Luis de Potosi, Mexico
| | - Carlos Martin-Martin
- Service of Otolaryngology. Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Pithon MM, Marañón-Vásquez GA, da Silva LP, Coqueiro RDS, Lacerda Dos Santos R, Tanaka OM, Maia LC. Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial. Am J Orthod Dentofacial Orthop 2021; 161:172-181. [PMID: 34711482 DOI: 10.1016/j.ajodo.2021.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children. METHODS Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after the appliance removal (T3). Generalized mixed models were used for data analysis (α = 0.05). RESULTS Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T1 and T2, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T1 95% confidence interval [CI], 1.08-1.26; T2 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T3 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T3 (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T1 and T2. CONCLUSIONS Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE. REGISTRATION This trial was not registered. PROTOCOL The protocol was not published before trial commencement. FUNDING This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.
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Affiliation(s)
- Matheus Melo Pithon
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Health I, School of Dentistry, Southwest Bahia State University, Jequié, Bahia, Brazil.
| | - Guido Artemio Marañón-Vásquez
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luciana Pereira da Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Sitzia E, Santarsiero S, Tucci FM, De Vincentiis G, Galeotti A, Festa P. Balloon dilation and rapid maxillary expansion: a novel combination treatment for congenital nasal pyriform aperture stenosis in an infant. Ital J Pediatr 2021; 47:189. [PMID: 34530869 PMCID: PMC8447711 DOI: 10.1186/s13052-021-01124-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition that may occur alone or as part of a multi-formative syndrome. Management remains difficult. There is no specific treatment protocol. Traditional surgery would be anachronistic; a non-invasive or minimally invasive therapeutic option is required. However, the rarity of the disease and the infantile context render randomised clinical trials difficult. CASE PRESENTATION We present the case of a one-month-old Caucasian boy with CNPAS. He presented to the Emergency Department of the Bambino Gesù Pediatric Hospital with nasal obstruction, noisy breathing, feeding difficulties, and suspected sleep apnoea. During hospitalisation, he underwent overnight pulse oximetry, airway endoscopy, and maxillofacial computed tomography (CT); the final diagnosis was CNPAS with moderate obstructive sleep apnoea syndrome. We successfully treated the patient using an innovative strategy that involved collaboration between ear-nose-and-throat surgeons and orthodontists. CONCLUSIONS A combination of minimally invasive balloon surgery and placement of a palatal device may successfully treat CNPAS; it may also treat other types of nasal bone stenosis. Future studies may allow the development of practice consensus treatment strategies.
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Affiliation(s)
- Emanuela Sitzia
- Unit of Otolaryngology, Bambino Gesù Children's Hospital, 00165, Rome, Italy
| | - Sara Santarsiero
- Unit of Otolaryngology, Bambino Gesù Children's Hospital, 00165, Rome, Italy.
| | - Filippo Maria Tucci
- Unit of Otolaryngology, Bambino Gesù Children's Hospital, 00165, Rome, Italy
| | | | - Angela Galeotti
- Unit of Dentistry, Bambino Gesù Children's Hospital, 00165, Rome, Italy
| | - Paola Festa
- Unit of Dentistry, Bambino Gesù Children's Hospital, 00165, Rome, Italy
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Iwasaki T, Papageorgiou SN, Yamasaki Y, Ali Darendeliler M, Papadopoulou AK. Nasal ventilation and rapid maxillary expansion (RME): a randomized trial. Eur J Orthod 2021; 43:283-292. [PMID: 33564835 DOI: 10.1093/ejo/cjab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess three rapid maxillary expansion (RME) appliances in nasal ventilation. TRIAL DESIGN Three-arm parallel randomized clinical trial. METHODS Sixty-six growing subjects (10-16 years old) needing RME as part of their orthodontic treatment were randomly allocated (1:1:1 ratio) to three groups of 22 patients receiving Hyrax (H), Hybrid-Hyrax (HH), or Keles keyless expander (K). The primary outcome of nasal ventilation (pressure and velocity) and secondary outcomes (skeletal, dental, soft tissue, and nasal obstruction changes) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone-beam computed tomography (CBCT) data by applying computational fluid dynamics (CFD) method. Differences across groups were assessed with crude and adjusted for baseline values and confounders (gender, age, skeletal maturation, expansion amount, mucosal/adenoid hypertrophy, nasal septum deviation) regression models with alpha = 5%. RESULTS Fifty-four patients were analysed (19H, 21HH, 14K). RME reduced both nasal pressure (H: -45.8%, HH: -75.5%, K: -63.2%) and velocity (H: -30%, HH: -58.5%, K: -35%) accompanied with nasal obstruction resolution (H: 26%, HH: 62%, K: 50%). Regressions accounting for baseline severity indicated HH expander performing better in terms of post-expansion maximum velocity (P = 0.03) and nasal obstruction resolution (P = 0.04), which was robust to confounders. Mucosal/adenoid hypertrophy and nasal septum deviation changes were variable, minimal, and similar across groups. The HH resulted in significantly greater increase in the nasal cross-sectional area (62.3%), anterior (14.6%), and posterior (10.5%) nasal widths. Nasal obstruction resolution was more probable among younger (P = 0.04), skeletally immature (P = 0.03), and male patients (P = 0.02) without pre-treatment mucosal hypertrophy (P = 0.04), while HH was associated with marginal greater probability for obstruction resolution. CONCLUSIONS RME resulted in improvement of nasal skeletal parameters and simulated ventilation with the former being in favour of the HH and the latter not showing significant differences among the three appliances. LIMITATION Attrition in the K group due to blocked activation rods possibly leading to limited sample to identify any existing group differences. HARMS Replacement of blocked Keles expanders for finalizing treatment. PROTOCOL The protocol was not published before the trial commencement. REGISTRATION Australian and New Zealand Clinical Trial Registry; ACTRN12617001136392.
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Affiliation(s)
- Tomonori Iwasaki
- Department of Pediatric Dentistry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Youichi Yamasaki
- Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - M Ali Darendeliler
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
| | - Alexandra K Papadopoulou
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Orthodontics, Sydney Dental Hospital, Sydney Local Health District, Australia
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14
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Looking for a cutoff value for the decongestant test in children suffering with turbinate hypertrophy. Eur Arch Otorhinolaryngol 2021; 278:3821-3826. [PMID: 33566176 DOI: 10.1007/s00405-021-06657-0] [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: 12/23/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The main causes for objectively confirmed chronic impaired nasal breathing in children are adenoid and turbinate hypertrophy. Turbinate hypertrophy may be addressed by turbinate surgery. However, specialized guidelines include no specific indications for pediatric patients. The decongestant test consists of simulating the effect of turbinate surgery by means of a nasal decongestant. This project, developed by the YO-IFOS rhinology group, aims to establish a cutoff value for the nasal decongestant test with rhinomanometry to select children for turbinate surgery. METHODS Children between 4 and 15 years of age were included. Cases were consecutively selected from children affected by turbinate hypertrophy undergoing turbinate radiofrequency ablation with or without adenoidectomy. Controls were consecutively selected from a sample of healthy children. All the subjects were examined with anterior active rhinomanometry with and without nasal decongestant. RESULTS Sample included 72 cases and 24 healthy controls. There was a statistically significant difference in the improvement with the decongestant between cases (57.91%) and controls (15.67%). The ROC curve revealed an area under the curve of 0.97. The highest amount of correctly classified individuals (93.44%) corresponded to the cutoff value of 31.66%. However, the value with the highest specificity and highest Youden's index was the 38.88% improvement in nasal resistance with nasal decongestant. CONCLUSIONS In conclusion, a preliminary cutoff value for the decongestant test used with rhinomanometry in children has been established. This test could help identify children for turbinate surgery.
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