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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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Liu Y, Zhou JR, Xie SQ, Yang X, Chen JL. The Effects of Orofacial Myofunctional Therapy on Children with OSAHS’s Craniomaxillofacial Growth: A Systematic Review. CHILDREN 2023; 10:children10040670. [PMID: 37189919 DOI: 10.3390/children10040670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Orofacial myofunctional therapy (OMT) is one of the therapeutic methods for neuromuscular re-education and has been considered as one of the auxiliary methods for obstructive sleep apnea hypopnea syndrome (OSAHS) and orthodontic treatment. There is a dearth of comprehensive analysis of OMT’s effects on muscle morphology and function. This systematic review examines the literature on the craniomaxillofacial effects of OMT in children with OSAHS. This systematic analysis was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards, and the research was scanned using PICO principles. A total of 1776 articles were retrieved within a limited time, with 146 papers accepted for full-text perusing following preliminary inspection and 9 of those ultimately included in the qualitative analysis. Three studies were rated as having a severe bias risk, and five studies were rated as having a moderate bias risk. Improvement in craniofacial function or morphology was observed in most of the 693 children. OMT can improve the function or morphology of the craniofacial surface of children with OSAHS, and its effect becomes more significant as the duration of the intervention increases and compliance improves. In the majority of the 693 infants, improvements in craniofacial function or morphology were seen. The function or morphology of a kid’s craniofacial surface can be improved with OMT, and as the duration of the intervention lengthens and compliance rises, the impact becomes more pronounced.
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Bernardes R, Di Bisceglie Ferreira LM, Machado Júnior AJ, Jones MH. Effectiveness of functional orthopedic appliances as an alternative treatment among children and adolescents with obstructive sleep apnea: Systematic review and meta-analysis. Sleep Med 2023; 105:88-102. [PMID: 37004341 DOI: 10.1016/j.sleep.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION The objective here was to review the efficacy of functional jaw orthopedic appliances for treating children/adolescents with obstructive sleep apnea (OSA), through correlating the apnea/hypopnea index (AHI) and oxygen saturation (SaO2) in polysomnography (PSG), in addition to questionnaire scores from the obstructive sleep apnea-18 (OSA-18). METHODS The PRISMA 2020 guidelines1 were followed. A search was conducted in October 2021, with updating to May 2022, in the MEDLINE/PubMed, BVS (LILACS/BBO), ISI, SciELO (Web of Science), COCHRANE, EMBASE, SCOPUS and WHO databases and the gray literature. Data selection and extraction were performed by two independent reviewers, with Cohen kappa testing. All articles included in the meta-analyses showed good quality and low risk of bias. Statistical analyses were performed in the "R" software, using means with standard deviations, and differences in the means were represented graphically in forest plots. Heterogeneity was tested using I2, in random-effect models. RESULTS From before to after treatment, treated individuals showed improved AHI, SaO2 and OSA-18 scores2. Comparing treated individuals and controls, AHI decreased in treated individuals and increased in controls. For SaO2, the increase in treated individuals was greater than in controls. For OSA-18, daytime/nighttime symptoms decreased in treated individuals and increased in controls. CONCLUSION Functional jaw orthopedic appliances are appropriate and effective for children/adolescents with OSA whose etiology is deficient maxillomandibular growth and development. Functional jaw orthopedics treats the form and function of the stomatognathic system, thereby enhancing quality of life. PROSPERO REGISTRATION PROTOCOL CRD42021253341.
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Affiliation(s)
- Rossana Bernardes
- Postgraduate Medicine Program - Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga 6681, Partenon, Porto Alegre, RS, 90619-900, Brazil.
| | - Liege Maria Di Bisceglie Ferreira
- Postgraduate Program in the Department of Oral and Dental Biology, Anatomy Sector, Piracicaba School of Dentistry, UNICAMP, Avenida Limeira 901, Areião, Piracicaba, SP, Brazil.
| | - Almiro José Machado Júnior
- Postgraduate Program on Surgical Sciences, Department of Ophthalmology- Otorhinolaryngology, School of Medical Sciences, UNICAMP, Rua Vital Brasil 80, Cidade Universitária, Campinas, SP, Brazil.
| | - Marcus Herbert Jones
- Postgraduate Medicine Program - Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga 6681, Partenon, Porto Alegre, RS, 90619-900, Brazil.
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Baptista PM, Martin F, Ross H, O’Connor Reina C, Plaza G, Casale M. A systematic review of smartphone applications and devices for obstructive sleep apnea. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S188-S197. [PMID: 35210182 PMCID: PMC9801062 DOI: 10.1016/j.bjorl.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Sleep is fundamental for both health and wellness. The advent of "on a chip" and "smartphone" technologies have created an explosion of inexpensive, at-home applications and devices specifically addressing sleep health and sleep disordered breathing. Sleep-related smartphone Applications and devices are offering diagnosis, management, and treatment of a variety of sleep disorders, mainly obstructive sleep apnea. New technology requires both a learning curve and a review of reliability. Our objective was to evaluate which app have scientific publications as well as their potential to help in the diagnosis, management, and follow-up of sleep disordered breathing. METHODS We search for relevant sleep apnea related apps on both the Google Play Store and the Apple App Store. In addition, an exhaustive literature search was carried out in MEDLINE, EMBase, web of science and Scopus for works of apps or devices that have published in the scientific literature and have been used in a clinical setting for diagnosis or treatment of sleep disordered breathing performing a systematic review. RESULTS We found 10 smartphone apps that met the inclusion criteria. CONCLUSIONS The development of these apps and devices has a great future, but today are not as accurate as other traditional options. This new technology offers accessible, inexpensive, and continuous at home data monitoring of obstructive sleep apnea, but still does not count with proper testing and their validation may be unreliable.
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Affiliation(s)
- Peter M. Baptista
- Clínica Universidad de Navarra, Otorhinolaryngology Department, Pamplona, Spain,Corresponding author.
| | - Fabricio Martin
- Hospital de Trauma y Emergencias Dr. Federico Abete, Otorhinolaryngology Department, Malvinas Argentinas, Buenos Aires, Argentina
| | - Harry Ross
- 3405 Penrose place, Suite 201, Boulder, CO, United States
| | | | - Guillermo Plaza
- Universidad Rey Juan Carlos, Hospital Sanitas La Zarzuela, Hospital Universitario de Fuenlabrada, Otorhinolaryngology Department, Madrid, Spain
| | - Manuele Casale
- Campus Bio-Medico University, Otorhinolaryngology Department, Roma, Italy
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Much Ado about Sleep: Current Concepts on Mechanisms and Predisposition to Pediatric Obstructive Sleep Apnea. CHILDREN 2021; 8:children8111032. [PMID: 34828745 PMCID: PMC8623682 DOI: 10.3390/children8111032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 12/22/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a form of sleep-disordered breathing characterized by upper airway collapse during sleep resulting in recurring arousals and desaturations. However, many aspects of this syndrome in children remain unclear. Understanding underlying pathogenic mechanisms of OSA is critical for the development of therapeutic strategies. In this article, we review current concepts surrounding the mechanism, pathogenesis, and predisposing factors of pediatric OSA. Specifically, we discuss the biomechanical properties of the upper airway that contribute to its primary role in OSA pathogenesis and examine the anatomical and neuromuscular factors that predispose to upper airway narrowing and collapsibility.
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McKeown P, O’Connor-Reina C, Plaza G. Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. J Clin Med 2021; 10:jcm10030471. [PMID: 33530621 PMCID: PMC7865730 DOI: 10.3390/jcm10030471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.
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Affiliation(s)
- Patrick McKeown
- Buteyko Clinic International, Loughwell, Moycullen, Co., H91 H4C1 Galway, Ireland;
| | - Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain;
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28023 Madrid, Spain
- Correspondence:
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Gozal D, Tan HL, Kheirandish-Gozal L. Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision. J Clin Med 2020; 9:jcm9030888. [PMID: 32213932 PMCID: PMC7141493 DOI: 10.3390/jcm9030888] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.
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Affiliation(s)
- David Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
- Correspondence:
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK;
| | - Leila Kheirandish-Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
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Stupak HD. Strategies for Addressing Mouth-Breathing Treatment with an “Adequate” Nose. RETHINKING RHINOPLASTY AND FACIAL SURGERY 2020. [PMCID: PMC7200074 DOI: 10.1007/978-3-030-44674-1_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Now that we have discussed and analyzed strategies to surgically achieve an adequately functioning and appearing nose, additional treatments are still required in many cases to achieve jaw closure due to limited musculoskeletal tone of the maxilla and mandible, as we described in Chaps. 4 and 5. From surgical jaw expansion, orthodontic treatments to jaw closure straps and appliances, these strategies are considered and evaluated in this chapter.
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Vecchierini MF. [Medical treatment of obstructive sleep-disordered breathing in children and adolescents]. Orthod Fr 2019; 90:311-320. [PMID: 34643518 DOI: 10.1051/orthodfr/2019027] [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
Obstructive sleep disordered breathing (OSDB), in children and adolescents, need to be treated quite soon to avoid complications. A paediatrician, a sleep specialist, an orthodontist, an ENT and a myofunctional therapist will examine together the children with OSDB and determine the best personalised surgical and medical treatments for each of them. Only medical treatments are reviewed in this article. An international consensus recommended adenotonsillectomy as the first line therapy in young with OSDB. Usually adenotonsillectomy is combined with several important adjunctive medical treatments. Overweight and obesity frequent in adolescents, worsen OSDB and increase persistent OSDB after adenotonsillectomy. Weight loss is obtained by dietary restriction, physical activity, psychological support and sleep hygiene rules. Anti-inflammatory drugs (corticosteroids and leukotriene receptor antagonists) have shown their efficacy in children with moderate OSDB. Orthodontic treatments, rapid maxillary expansion or oral appliance, are used in selected patients according to their maxillo-facial disturbances in adjunction to adenotonsillectomy. Nasal CPAP is rarely useful except in severe OSDB specially in persistent OSDB after adenotonsillectomy. Finally, active or passive, myofunctional therapy is, according to some authors, an indispensable adjunct treatment to avoid persistent OSDB after adenotonsillectomy. These personalized medical treatments of OSDB are either administered jointly with adenotonsillectomy or in a hierarchal order.
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Affiliation(s)
- Marie-Françoise Vecchierini
- Centre du sommeil et de la vigilance, Hôtel-Dieu, Université Paris-Descartes, 1 place du Parvis Jean-Paul II, 75181 Paris cedex 04, France
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Guilleminault C, Hervy-Auboiron M, Huang YS, Li K, Amat P. [Obstructive sleep-disordered breathing and orthodontics. An interview with Christian Guilleminault, Michèle Hervy-Auboiron, Yu-Shu Huang and Kasey Li]. Orthod Fr 2019; 90:215-245. [PMID: 34643512 DOI: 10.1051/orthodfr/2019038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Yu-Shu Huang
- Department of Pediatric Psychiatry and Sleep Center, Chang Gung Memorial Hospital, No. 5, Fusing St, Kwei-Shan Township, Taoyuan Country, 333, Taiwan
| | - Kasey Li
- 1900 University Ave #105, East Palo Alto, CA 94303, États-Unis
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