Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study

Abstract

Introduction When both narrow maxilla and moderately enlarged tonsils are present in children with obstructive sleep apnea, the decision of which treatment to do first is unclear. A preliminary randomized study was done to perform a power analysis and determine the number of subjects necessary to have an appropriate response. Thirtyone children, 14 boys, diagnosed with OSA based on clinical symptoms and polysomnography (PSG) findings had presence of both narrow maxillary complex and enlarged tonsils. They were scheduled to have both adeno-tonsillectomy and RME for which the order of treatment was randomized: group 1 received surgery followed by orthodontics, while group 2 received orthodontics followed by surgery. Each child was seen by an ENT, an orthodontist, and a sleep medicine specialist. The validated pediatric sleep questionnaire and PSG were done at entry and after each treatment phase at time of PSG. Statistical analyses were ANOVA repeated measures and t tests. Results The mean age of the children at entry was 6.5± 0.2 years (mean ± SEM). Overall, even if children presented improvement of both clinical symptoms and PSG findings, none of the children presented normal results after treatment 1, at the exception of one case. There was no significant difference in the amount of improvement noted independently of the first treatment approach. Thirty children underwent treatment 2, with an overall significant improvement shown for PSG findings compared to baseline and compared to treatment 1, without any group differences. Conclusion This preliminary study emphasizes the need to have more than subjective clinical scales for determination of sequence of treatments.

Rapid maxillary expansion before and after adenotonsillectomy in children with obstructive sleep apnea

“…Recently, a randomized study performed in Caucasian prepubertal children with OSA mostly recruited from an otolaryngological practice showed that many children would benefit from both otolaryngological and orthodontic treatment; in that report, one out of all the children treated initially with orthodontics maneuvers did not need further otolaryngological treatment [7]. Our investigation looks further at this interaction between otolaryngologic and orthodontic treatment in OSA.…”

“…Some of these previous reports present typical cases of obstructive sleep apnea in children but without having polygraphic demonstration of SDB [20,21,22,25,26]. Investigation of the role of orthodontics in nonsyndromic OSA children has been more systematic in recent times [6,7,14,15,28]. But the first line of treatment for Review many children with OSA is still AT.…”

“…But the first line of treatment for Review many children with OSA is still AT. Several studies, however, have shown that many children subjected to AT surgery present residual SDB [3,4,5,7,29,30,31,32]. The addition of orthodontic treatment in these children may help to further reduce the residual AHI, but many questions remain unresolved, i.e., role of orthodontics in the treatment of OSA and its placement compared to adenotonsillectomy.…”

Repercusiones de la roncopatía y respiración bucal en el crecimiento facial

“…Esta interrogante no está del todo clara y generalmente se tiende a realizar el tratamiento que ofrece el especialista a quien consulta primero el paciente. Guilleminault y cols 16 , realizaron un estudio randomizado con 31 pacientes diagnosticados de SAOS por hiperplasia adenoamigdalina con maloclusiones con indicación de ERM. Se dividieron en 2 grupos, el primer grupo fue sometido a adenoamigdalectomía seguido de ERM mientras que el segundo grupo fue tratado primero con ERM y luego adenoamigdalectomía.…”

Current Treatment of Selected Pediatric Sleep Disorders

“…Such approaches, alone and in combination with adenotonsillectomy, have been published for almost a decade although numbers are quite small [29,30]. I However, despite near-normalization of sleep architecture and significantly improved AHI one year after intervention, some aspects of sleep microstructure were disturbed, suggesting incomplete response to therapy [31].…”