Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case-control study

Abstract

Habitual snoring and obstructive sleep apnoea in children, which are frequently associated with adenotonsillar hypertrophy, may begin early in life and in relation with orocraniofacial features. The aim of this study was to detect the presence of early bone craniofacial modifications in young children with a long history of habitual snoring.Twenty-six habitually snoring children (mean age 4.6 yrs) were studied by nocturnal portable recording or diurnal polysomnography, cephalometry and orthodontic evaluation. A comparison of cephalometric findings was made between the studied group and 26 age-matched children (mean age 5.1 yrs) with no history of snoring or respiratory problems during sleep.The cephalometric analyses showed a significant increase in craniomandibular intermaxillar, lower and upper goniac angles with a retroposition and posterior rotation of the mandible (high angle face) and a reduction in the rhinopharynx space caused by higher thickness of adenoids in habitually snoring children compared with controls. Cross-bites and labial incompetence as well as daytime symptoms and familiarity for habitual snoring were found in most of the studied group of snorers compared with controls.The results indicate that upper airway obstruction during sleep is associated with mild but significant cephalometric and craniofacial modifications in children complaining of habitual snoring. Whether this skeletal conformation is genetically determined or influenced by the early onset of habitual snoring remains to be assessed. Eur Respir J 1999; 13: 411±417.

The development of sleep disordered breathing from 4 to 12 years and dental arch morphology

“…Dento-facial development and dental arch morphology have been studied in connection to different aspects of obstruction such as the influence of adenoids [9], tonsils [10] and habitual snoring and OSA [11][12]. With different ways of exploring the effect of obstructed breathing, it has been shown that severe obstruction is connected to specific anatomical traits, which seem to have been possible to reverse at least partially through surgery [13,14].…”

Síndrome da apnéia e hipopnéia obstrutiva do sono: análise cefalométrica

“…Cephalometry may allow observation of significant enlargement of the jaw and of intermaxillary structures, indicating posterior rotation of the mandible and significant retroposition of the mandible plane which may result in subsequent vertical facial growth -a typical mouth breather trace. Another finding that should be considered is the reduction of maxillary and/or mandibular growth 19 . Children with OSAHS may also present small jaw and high hard palate 20 .…”

Padrão morfológico e características oclusais de crianças respiradoras bucais após cirurgia para hipertrofia de tonsilas

“…No exame ortodôntico, por meio dos exames clínicos, extra e intra-oral e análise de modelos, pode-se evidenciar também o comprometimento da musculatura facial com hipotonia, ausência de selamento labial, alteração na postura da cabeça e coluna cervical, narinas estreitas, olheiras, face alongada com terço inferior mais evidente, gengivite marginal nos incisivos, estreitamento da arcada superior e/ou inferior, palato em ogiva, mordida aberta anterior, mordida cruzada posterior, alteração na posição dos incisivos, distância entre molares e caninos alterada, relação distal de molares e overjet aumentado (Linder -Aronson, 1970, 1979Bresolin et al, 1983Bresolin et al, , 1984Moreira, 1989;Ung et al, 1990;Warren, 1990;Hulcrantz et al, 1991;Aragão, 1991;Tourné, 1991;Gross et al, 1994;Oulis et al, 1994;Tourne e Schweiger, 1996;Zucconi et al, 1999;Weider et al, 2003;Arun et al, 2003;Lessa et al, 2005;Sousa et al, 2005;Peltomaki, 2007;Góis et al, 2008 (Subtelny, 1980). Conseqüentemente, esses indivíduos seriam mais facilmente afetados com mudanças no padrão respiratório, acarretando maiores seqüelas ao Sistema Estomatognático (Hiyama et al, 2003).…”

“…Zucconi et al (1999) A altura facial anterior analisada através das medidas (N-Me, N-ENA, ENA-Me) teve comportamento semelhante em T1 e T2 nos grupos RB e RN. Todas as medidas verticais lineares anteriores e posteriores (N-Me, N-ENA, ENA-Me, S-Go, S-Ar, Ar-Go) apresentaram aumento estatisticamente significante nos valores médios medidos em ambos os grupos entre T1 e T2.…”

“…Zucconi et al (1999) A relação ântero-posterior dos arcos dentários mensurados por meio da relação de caninos e do plano terminal dos segundos molares decíduos, também não está sujeita à interferência do tipo de respiração, corroborando os achados de Ung et al (1990) e Jabur et al (1997. No presente estudo, em T1, a maioria dos pacientes dos grupos RB e RN apresentaram plano terminal dos segundos molares decíduos reto e relação de caninos em Classe I. Em T2, mais de 50% dos planos terminais eram mesiais e mais de 60% das relações caninos direito e esquerdo se mantiveram em Classe I nos dois grupos.…”