Cephalometric and Pharyngometric Evaluation in Snoring Children with Sleep-Disordered Breathing and Adenotonsillar Hypertrophy Under an Orthodontic or Orthopedic Treatment

Abstract

Altered craniofacial growth has been implicated in sleep-disordered breathing (SDB) in children. The authors aimed to evaluate the cephalometric measurements and pharyngeal dimensions related to SDB in snoring children with adenotonsillar hypertrophy (ATH) treated with an orthodontic and orthopedic oral appliance (OOA). Forty habitually snoring children, 6 to 9 years old with evidence of grade 3 to 4 ATH, maxillary constriction, and class II dental malocclusion were enrolled, with 24 children being treated with OOA, and 16 remaining untreated children as controls. All children underwent a cephalometric X-ray and acoustic pharyngometry for airway measurements at the start and 6 months after. Cephalometric measurements related to SDB reduced in the treated group (p < 0.01) as follows: maxillary–mandibular relationship: –2.2 ± 1.70°; maxillary–mandibular planes angle: –2.4 ± 3.80°; and hyoid bone position: –4 ± 3.8 mm (p < 0.001). OOA treatment revealed improvements in pharyngeal minimum cross-section area (MCA) (0.2 ± 0.2 cm²) and volume (V) (3.15 ± 2.5 cm³), while reductions in MCA (–0.2 ± 0.3 cm²) and in V (–1.25 ± 1.3 cm³) occurred in controls (p < 0.001 vs. OOA). Six months of OOA treatment in snoring children with SDB promotes enlargement of the pharyngeal dimensions and beneficial cephalometric changes.

Keywords

child - maxillofacial development - orthodontics - snoring - tonsil

• References

• 1 Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2013; 143 (01) 20-30.e3
• 2 Peltomäki T. The effect of mode of breathing on craniofacial growth--revisited. Eur J Orthod 2007; 29 (05) 426-429
• 3 Nunes Jr WR, Di Francesco RC. Variation of patterns of malocclusion by site of pharyngeal obstruction in children. Arch Otolaryngol Head Neck Surg 2010; 136 (11) 1116-1120
• 4 Hunter SJ, Gozal D, Smith DL, Philby MF, Kaylegian J, Kheirandish-Gozal L. Effect of sleep-disordered breathing severity on cognitive performance measures in a large community cohort of young school-aged children. Am J Respir Crit Care Med 2016; 194 (06) 739-747
• 5 Marcus CL, Moore RH, Rosen CL. , et al; Childhood Adenotonsillectomy Trial (CHAT). A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013; 368 (25) 2366-2376
• 6 Deyoung PN, Bakker JP, Sands SA. , et al. Acoustic pharyngometry measurement of minimal cross-sectional airway area is a significant independent predictor of moderate-to-severe obstructive sleep apnea. J Clin Sleep Med 2013; 9 (11) 1161-1164
• 7 Monahan KJ, Larkin EK, Rosen CL, Graham G, Redline S. Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing. Am J Respir Crit Care Med 2002; 165 (11) 1499-1503
• 8 Gozal D, Burnside MM. Increased upper airway collapsibility in children with obstructive sleep apnea during wakefulness. Am J Respir Crit Care Med 2004; 169 (02) 163-167
• 9 Bates C, Mc Donald J. The relationship between severity of OSAHS and lateral cephalometric radiograph values: a clinical diagnostic tool. Surgeon 2005; 3: 338-346
• 10 Pirilä-Parkkinen K, Löppönen H, Nieminen P, Tolonen U, Pirttiniemi P. Cephalometric evaluation of children with nocturnal sleep-disordered breathing. Eur J Orthod 2010; 32 (06) 662-671
• 11 Marino A, Ranieri R, Chiarotti F, Villa MP, Malagola C. Rapid maxillary expansion in children with obstructive sleep apnoea syndrome (OSAS). Eur J Paediatr Dent 2012; 13 (01) 57-63
• 12 Löfstrand-Tideström B, Hultcrantz E. The development of snoring and sleep related breathing distress from 4 to 6 years in a cohort of Swedish children. Int J Pediatr Otorhinolaryngol 2007; 71 (07) 1025-1033
• 13 Löfstrand-Tideström B, Hultcrantz E. Development of craniofacial and dental arch morphology in relation to sleep disordered breathing from 4 to 12 years. Effects of adenotonsillar surgery. Int J Pediatr Otorhinolaryngol 2010; 74 (02) 137-143
• 14 Huang YS, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol 2013; 3: 184
• 15 Katyal V, Pamula Y, Daynes CN. , et al. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2013; 144 (06) 860-871
• 16 Huynh NT, Desplats E, Almeida FR. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis. Sleep Med Rev 2016; 25: 84-94
• 17 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
• 18 Camacho M, Chang ET, Song SA. , et al. Rapid maxillary expansion for pediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2017; 127 (07) 1712-1719
• 19 Guilleminault C, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH. Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med 2013; 14 (06) 518-525
• 20 Ciavarella D, Lo Russo L, Mastrovincenzo M. , et al. Cephalometric evaluation of tongue position and airway remodelling in children treated with swallowing occlusal contact intercept appliance (S.O.C.I.A.). Int J Pediatr Otorhinolaryngol 2014; 78 (11) 1857-1860
• 21 Brodsky L, Koch RJ. Anatomic correlates of normal and diseased adenoids in children. Laryngoscope 1992; 102 (11) 1268-1274
• 22 Cohen D, Konak S. The evaluation of radiographs of the nasopharynx. Clin Otolaryngol Allied Sci 1985; 10 (02) 73-78
• 23 Chervin RD, Weatherly RA, Garetz SL. , et al. Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg 2007; 133 (03) 216-222
• 24 Sawchuk D, Currie K, Vich ML, Palomo JM, Flores-Mir C. Diagnostic methods for assessing maxillary skeletal and dental transverse deficiencies: a systematic review. Korean J Orthod 2016; 46 (05) 331-342
• 25 Angle E. Treatment of Malocclusion of the Teeth. Philadelphia, PA: SS White Dental Manufacturing Co.; 1907
• 26 Defraia E, Marinelli A, Baroni G, Tollaro I. Dentoskeletal effects of a removable appliance for expansion of the maxillary arch: a postero-anterior cephalometric study. Eur J Orthod 2008; 30 (01) 57-60
• 27 Moss ML. The functional matrix hypothesis revisited. 4. The epigenetic antithesis and the resolving synthesis. Am J Orthod Dentofacial Orthop 1997; 112 (04) 410-417
• 28 Fränkel R. Lip seal training in the treatment of skeletal open bite. Eur J Orthod 1980; 2 (04) 219-228
• 29 Molfenter SM. The reliability of oral and pharyngeal dimensions captured with acoustic pharyngometry. Dysphagia 2016; 31 (04) 555-559
• 30 Rosen CL, Wang R, Taylor HG. , et al. Utility of symptoms to predict treatment outcomes in obstructive sleep apnea syndrome. Pediatrics 2015; 135 (03) e662-e671
• 31 Jena AK, Singh SP, Utreja AK. Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible. Angle Orthod 2013; 83 (04) 728-734
• 32 Huynh NT, Morton PD, Rompré PH, Papadakis A, Remise C. Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations. Am J Orthod Dentofacial Orthop 2011; 140 (06) 762-770
• 33 Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up. Sleep Med 2015; 16 (08) 933-935
• 34 Ngiam J, Cistulli PA. Dental treatment for paediatric obstructive sleep apnea. Paediatr Respir Rev 2015; 16 (03) 174-181