Development of craniofacial and dental arch morphology in relation to sleep disordered breathing from 4 to 12 years. Effects of adenotonsillar surgery

Abstract

Objectives: To study the development of craniofacial and dental-arch morphology in children with sleep disordered breathing in relation to adeno-tonsillar surgery. Subjects and method:From a community based cohort of 644 children, 393 answered questionnaires at age 4, 6 and 12 years. Out of this group, twenty-five children who were snoring regularly at age 4 could be followed up to age 12 together with 24 controls not snoring at age 4, 6 and 12 years. Study casts were obtained from cases and controls and lateral cephalograms from the cases. Analysis regarding facial features and dento-alveolar development was performed.Results: Children snoring regularly at age 4 showed reduced transversal width of the maxilla and more frequently had anterior open bite and lateral cross-bite than the controls. These conditions persisted for most cases at age six, by which time 18/25 had been operated for snoring. In most of the cases, surgery cured the snoring temporarily, but their width of the maxilla was still smaller by age 12-even when nasal breathing was attained. At age 12, the frequency of lateral cross-bite was much reduced and anterior open bite was resolved, both in cases and controls. The children who snored regularly at age 12 showed a long face anatomy and were oral breathers; this applied even to those who were operated. The seven cases who were not operated and the five who were still snoring in spite of surgery at age 12, did not have reduced maxillary width as compared to the controls. Conclusion:Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief.

Influence of adenotonsillar hypertrophy on /s/-articulation in children—effects of surgery

“…In /s/-production the resonance cavity anterior to the midsaggital groove in the tongue is of particular importance to the sound quality (Lindblad, 1980). Several studies have shown that maxillar growth as well as dental arch morphology is affected by tonsillar hypertrophy (Lofstrand-Tidestrom and Hultcrantz, 2009;Lofstrand-Tidestrom et al, 1999). This can be a possible explanation to some of the speech problems that have been reported in connection to tonsillar hypertrophy.…”

Factors Influencing the Indication for Tonsillectomy: A Historical Overview and Current Concepts

“…1), such as eating problems, speech difficulties and orthodontic aberrations [20,24,25,26]. However, in almost all cases, these indications are combined with severe snoring or sleep apnea.…”

Tonsillotomy versus tonsillectomy on young children: 2 year post surgery follow-up

“…Also, in a nonlongitudinal study, Löfstrand-Tideström and Hultcrantz, found that a child who snored at age 4, had a six times greater risk for snoring at age 12 than a child who did not snore at age 4. This was regardless of whether surgery had been performed or not [26].…”

“…This reflects the fact that habitual mouth breathing is a sign of an oromotor disturbance that can be very difficult to change and may result in further negative impact on maxillary growth. One reason for the difficulties in converting the breathing mode could be the individual/genetic orofacial shape with a "narrow" maxilla, not allowing free nasal breathing even after surgery of the tonsils and adenoid [26]. To achieve maximum effect from surgery and avoid the risk of further cranio-facial aberrations, a certain emphasis on behavioral training is recommended if a child does not convert spontaneously to nasal breathing after surgery.…”