Sex-dependent differences in the craniofacial morphology of children with a sleep-related breathing disorder

Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis

STUDY OBJECTIVES

This review aimed to evaluate the association between craniofacial features in children and adolescents with pediatric obstructive sleep apnea (OSA).

METHODS

Seven databases were searched to fulfill our research objectives. Clinical studies that included participants younger than 18 years with fully diagnosed OSA or without OSA and that evaluated skeletal, soft craniofacial features, or dental arch morphology were considered for this review. The risk of bias and certainty of evidence were assessed. A meta-analysis was performed when low methodological and clinical heterogeneity were detected. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA-2020) guidelines.

RESULTS

Nine studies were identified at the end of the selection process, from which 5 did not report differences. Four studies reported differences between craniofacial features when OSA was compared to an asymptomatic control group. Mandibular retrognathia, reduced anteroposterior linear dimensions of the bony nasopharynx (decreased pharyngeal diameters at the levels of the adenoids), longer facial profile, and a narrower intercanine width were described among children with OSA. A meta-analysis was performed considering the studies with a similar methodological approach, and no differences were observed in all the considered cephalometric angles (SNA, SNB, ANB, NSBa, U1-L1, U1-SN). All the included studies were considered at low risk of bias even though some limitations were noted.

CONCLUSIONS

Due to the very low to moderate level of certainty, neither an association nor a lack thereof between craniofacial morphology and pediatric OSA can be supported by these data.

CITATION

Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2022;18(7):1865-1875.

Correlation between Malocclusion and Allergic Rhinitis in Pediatric Patients: A Systematic Review

BACKGROUND

Oral breathing, nasal obstruction and airway space reduction are usually reported as associated to allergic rhinitis. They have been linked to altered facial patterns and dento-skeletal changes. However, no firm correlation based on the evidence has been established. This systematic review has been undertaken to evaluate the available evidence between malocclusion and allergic rhinitis in pediatric patients.

METHODS

The research refers to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines, databases (Medline, Cochrane Library, Pubmed, Embase and Google Scholar) were screened, the quality was evaluated through Quality Assessment of Diagnosfic Accuracy Studies (QUADAS-2).

RESULTS

The articles selected (6 out of initial 1782) were divided on the basis of the study design: two observational randomized study, three case-control study, one descriptive cross-sectional study, and one longitudinal study. A total of 2188 patients were considered. Different results were reported as related to allergic rhinitis ranging from a higher incidence of dental malocclusion, to an increase of palatal depth, and in posterior cross-bite about anterior open-bite and to longer faces and shorter maxillas.

CONCLUSIONS

Most of the studies selected found a rise in the prevalence of both malocclusion and allergic rhinitis in children. However, the level of bias is high, impaired by a poor design and no conclusive evidence can be drawn.

Does Gender Have an Effect on Craniofacial Measurements?

Objective

The aim of this cross-sectional study was to evaluate craniofacial structures in terms of different sagittal relations and gender in adolescent individuals.

Methods

Pre-treatment dental models, lateral cephalometric, and hand-wrist radiographs of 223 adolescent subjects (102 male, 121 female) were evaluated. Subjects were divided into the Angle Class I, II, and III (skeletally) subgroups according to the ANB angle. Four angular and 33 linear measurements were used to evaluate the lateral cephalometric radiographs relative to the R1 and R2 coordinate system. The Kolmogorov-Smirnov test was performed to assess the normal distribution of the data. The independent samples t-test and Mann-Whitney U test were used for the comparison of male and female subjects in each group. The values were considered statistically significant at p<0.05.

Results

The vertical facial dimension was found to be significantly greater in Class I male subjects than in female subjects (SGo, p=0.023; ANS-M, p=0.036), and there was a protrusive maxilla (R2ANS, p=0.038; R2A, p=0.016), while the mandibular sagittal position and the mandibular dimension were similar. The maxilla was placed protrusively (R2ANS, p=0.001; R2A, p=0.002), while the mandible was found to be larger both in the position and dimension (CoGn, p=0.003; R2M, p=0.014) in Class II male subjects. Class III male and female subjects were found to have similar maxillary and mandibular vertical and sagittal location and dimensions.

Conclusion

Class I and II subjects showed more gender variation than Class III subjects. The gender-related results of this study declare that treatment planning of malocclusions should be based on gender differences rather than general treatment procedures, which will be useful in achieving successful orthodontic treatment results.

Dental Arch Dimensions of Nigerian Children with Hypertrophied Adenoids

OBJECTIVE

The study objective was to assess the effect of adenoid hypertrophy on the dental arch dimensions of children in Ile-Ife, Nigeria.

METHODS

Ninety patients aged 3-12 years attending the Otorhinolaryngology Clinic at Obafemi Awolowo University Teaching Hospital Ile-Ife diagnosed as having hypertrophied adenoids and 90 children from the Child Dental Health Clinic were recruited as adenoid and control subjects respectively. Arch and palatal vault dimensions, including total arch length; inter-canine, inter-premolar, and inter-molar widths; palatal length; and palatal heights measured at three levels and palatal volume were determined for both groups from dental casts.

RESULTS

Maxillary arch dimensions were shorter in the adenoid group than the control group; however, only total maxillary arch length was significantly shorter (p=0.049). Mandibular arch dimensions with the exception of inter-molar width were significantly shorter in the adenoid group (p<0.05). Adenoid subjects had significantly increased palatal heights at canine, premolar, and molar levels and reduced palatal volume compared to the control subjects (p<0.05).

CONCLUSION

Adenoid subjects demonstrated shorter maxillary and mandibular arch dimensions compared with control subjects, with the differences being more evident in the lower arch. They also exhibited increased palatal heights at all levels and reduced palatal volume compared with control subjects.

Obstructive sleep apnea prevents the expected difference in craniofacial growth of boys and girls

OBJECTIVES

It was to compare cephalometric measures of mouth-breather boys and girls and with the cephalometric pattern observed in obstructive sleep apnea syndrome (OSAS) patients.

METHODS

Craniofacial measurements of lateral cephalometric radiographs obtained from 144 children aged 7-14 years were compared between boys and girls, and both were compared to cephalometric pattern of OSAS patients.

RESULTS

Mouth-breather boys and girls had no gender differences regarding to craniofacial morphology while nose-breather boys and girls showed those expected differences. Nose-breather boys presented a more retruded mandible and proinclined upper incisor when compared to nose-breather girls, but mouth-breather boys and girls had no differences. The measure NS.GoGn was the only variable with an interaction with gender and breathing.

CONCLUSIONS

There were no cephalometric difference in mouth breather-boys and girls related to normal growth, suggesting that oral breathing make the same craniofacial morphology and both have craniofacial morphology close to that of OSAS patients.

It takes a mouth to eat and a nose to breathe: abnormal oral respiration affects neonates' oral competence and systemic adaptation

Mammalian, including human, neonates are considered to be obligate nose breathers. When constrained to breathe through their mouth in response to obstructed or closed nasal passages, the effects are pervasive and profound, and sometimes last into adulthood. The present paper briefly surveys neonates' and infants' responses to this atypical mobilisation of the mouth for breathing and focuses on comparisons between human newborns and infants and the neonatal rat model. We present the effects of forced oral breathing on neonatal rats induced by experimental nasal obstruction. We assessed the multilevel consequences on physiological, structural, and behavioural variables, both during and after the obstruction episode. The effects of the compensatory mobilisation of oral resources for breathing are discussed in the light of the adaptive development of oromotor functions.

Dentofacial characteristics as indicator of obstructive sleep apnoea-hypopnoea syndrome in patients with severe obesity

Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a complex disease with a multifactor aetiology. OSAHS is strongly associated with obesity, but there are many other clinical risk factors, such as the dentofacial characteristics of hard and soft tissues, hyoid bone position, neck circumference, upper airway spaces and nasal respiration. A descriptive cross-sectional study was carried out involving 13 patients (one man and 12 women) with severe obesity in order to evaluate specific physical dentofacial characteristics through a cephalometric examination. Cephalometry was analysed using 29 measurements of the hard and soft tissues of the craniofacial structures and dimensions of the upper airways. The demographic data revealed a mean body mass index of 48 ± 6.26 kg m(-2) and cervical circumference of 43 ± 3.69 cm. No patient exhibited important facial asymmetry and facial types 1 (normal) and 3 (mandible forward) were the most prevalent. Septal deviation was observed in 46% of patients. The most prevalent modified Mallampati index score was between 3 and 4, while grade 1 was the most prevalent tonsillar hypertrophy index score (46%). Cephalometry revealed angular and linear measurements with normally acceptable values for the hard tissues. Obese patients seem to have a normal craniofacial structure and the risk of developing OSAHS is especially related to obesity.

Cross-sectional growth changes in skeletal and soft tissue cephalometric landmarks of children

In order to provide standard values for craniofacial growth of normal children, we evaluated the growth changes of skeletal and soft tissue cephalometric landmarks from lateral cephalograms of 180 Japanese children. They were divided into three groups: primary dentition, mixed dentition, and permanent dentition. Specific skeletal angles and distances showed significant gender differences with increasing age. The only significant soft tissue gender difference was nose height in the oldest group. Upper pharynx dimension and nose height differed significantly among the groups in both genders. Positions of both the upper and lower lip changed significantly between the intermediate and oldest groups of both genders. Nasolabial angle did not change significantly with growth. The results of this study should be useful for predicting craniofacial growth and development or determining the effect of orthodontic treatment.

Breathing mode influence in craniofacial development

AIM

The aim of this study was to evaluate the differences in facial proportions of nose and mouth breathing children using cephalometric analysis.

STUDY DESIGN

Transversal cohort.

MATERIAL AND METHOD

Sixty cephalometric radiographs from pediatric patients aged 6 to 10 years were used. After otorhinolaryngological evaluation, patients were divided into two groups: Group I, with mouth breathing children and group II, with nose breathers. Standard lateral cephalometric radiographs were obtained to evaluate facial proportions using the following measures: SN.GoGn, ArGo.GoMe, N-Me, N-ANS, ANS-Me and S-Go; and the following indexes: PFH-AFH ratio: S-Go/N-Me; LFH-AFH ratio: ANS-Me/N-Me and UFH-LFH ratio: N-ANS/ANS-Me.

RESULTS

It was observed that the measurements for the inclination of the mandibular plane (SN.GoGn) in mouth breathing children were statistically higher than those in nasal breathing children. The posterior facial height was statistically smaller than the anterior one in mouth breathing children (PFH-AFH ratio). Thus, the upper anterior facial height was statistically smaller than the lower facial height (UFH-LFH ratio).

CONCLUSION

We concluded that mouth breathing children tend to have higher mandibular inclination and more vertical growth. These findings support the influence of the breathing mode in craniofacial development.