Impact of rapid palatal expansion on the size of adenoids and tonsils in children

Yoon, Audrey; Abdelwahab, Mohamed; Bockow, Rebecca; Vakili, Ava; Lovell, Katherine; Chang, Inwon; Ganguly, Rumpa; Liu, Stanley Yung‐Chuan; Kushida, Clete A.; Hong, Christine

doi:10.1016/j.sleep.2022.02.011

Cited by 22 publications

(16 citation statements)

References 35 publications

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“…Biondi and colleagues showed that there was an impact on the voice not only after RME, but also during the application. RME can cause modification of both fricatives and the vowel sound /i/, while palatal consonants usually do not change significantly [ 71 ]. The modifications correspond to a reduction in the volume of resonance cavities after RME, confirming that the tongue moves higher in the oral cavity, closer to the palate.…”

Section: Resultsmentioning

confidence: 99%

“…Hence, otorhinolaryngologists should routinely carefully consider the maxillary conformation of their little patients, since the individuation of an altered skeletal structure can lead to the right treatment, avoiding over-treatment choices (i.e., adenotonsillectomy or tympanic ventilation tube placement). In fact, a condition characterized by maxillary constriction, posterior crossbite, high palatal vault, elevation of nasal floor and mouth breathing (such as the skeletal development syndrome, first described by Laptook in 1981), could produce different detrimental effects on the whole maxillofacial development [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

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Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective

Cerritelli

Hatzopoulos

Catalano

et al. 2022

JCM

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Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected by transversal maxillary constriction. Methods. A literature search was performed using different databases (Medline/PubMed, EMBASE, and CINAHL), from May 2005 to November 2021, according to the PRISMA guidelines. Results. The application of RME in children has shown good results on nasal function, reducing nasal resistances, independently from a previous adenotonsillectomy. These results are not only related to the increasing of nasal transverse diameters and volume, but also to the stiffening of airway muscles, enabling the nasal filtrum function and avoiding mouth opening, thereby decreasing respiratory infections. Positive effects have also been reported for the treatment of conductive hearing loss and of OSA, with the reduction of Apnea Hypopnea Index (AHI), possibly due to (i) an increased pharyngeal dimensions, (ii) a new tongue posture, and (iii) reduced nasal respiratory problems. Conclusions. Otolaryngologists should be aware of the indications and benefits of the RME treatment, considering its possible multiple beneficial effects.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective

Cerritelli

Hatzopoulos

Catalano

et al. 2022

JCM

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“…As previously mentioned, the hypothesis posits that adenotonsillar hypertrophy, commonly regarded as the most common cause of pediatric OSA, is, in fact, a consequence of a high-arched, narrow hard palate rather than the reverse. Recent evidence from a case–control study provides additional support to this hypothesis, showing that RPE not only leads to improvements in OSA but also significantly reduces the size of both adenoids and tonsils [39 ▪▪ ].…”

Section: The Role Of Rapid Palatal Expansion In Treating Pediatric Sl...mentioning

confidence: 91%

Something to consider: rapid palatal expansion for treatment of obstructive sleep apnea in pediatric patients

Ahsan,

Narala,

Ednick

et al. 2023

Current Opinion in Pediatrics

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Purpose of review This review examines the potential of rapid palatal expansion (RPE) as a treatment for pediatric obstructive sleep apnea (OSA). The focus is on recent findings related to its efficacy, safety, patient selection, timing, appliance options, cost considerations, and long-term outcomes. Recent findings Recent studies indicate that RPE can lead to significant improvements in pediatric OSA, with a 70% reduction in the Apnea Hypopnea Index (AHI) and increased oxygen saturation levels. It has been particularly effective in children with small or absent tonsils and has been found to reduce adenoid and tonsil size. Long-term follow-up studies suggest the need for ongoing monitoring, as some patients may experience relapse over time. Summary RPE shows promise as an additional treatment for pediatric obstructive sleep apnea. It offers improvements in respiratory function and reduced symptoms in certain patients. However, long-term efficacy and safety require further investigation. Comparative studies and patient-reported outcomes are necessary to optimize treatment approaches. Collaboration between orthodontists, sleep specialists, and ear-nose-throat (ENT) specialists may be essential for optimal outcomes in pediatric OSA patients treated with RPE.

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“…Pharyngeal, lingual, and palatal tonsils are constituted by lymphoid tissue, with low density and radiopacity. 97 Nevertheless, the high contrast with respect to the airway makes the tonsils clearly visible via CBCT, allowing for direct measurements of their size 98 and of the intramural airway space. 8 This said, limited evidence is available about the validity of CBCT imaging for tonsils assessments and its application as a screening tool for tonsillar hypertrophy is questionable.…”

Section: Upper Airway Analysis On Cbct Scansmentioning

confidence: 99%

“…While palatine tonsil hypertrophy is present mainly in adults with OSA, 106 swollen lingual tonsils are more relevant among children. 107 Isolated reports of palatine 90 and lingual tonsil 98 assessment via CBCT are available, but there is no indication for routine clinical use. Compared to the adenoids, which are supported by the sphenoid bone, lingual tonsils are attached to the tongue, which makes them mobile and subject to motion artefacts.…”

Section: Upper Airway Analysis On Cbct Scansmentioning

confidence: 99%

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

Savoldi,

Dagassan-Berndt,

Patcas

et al. 2024

Dentomaxillofacial Radiology

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Applications of cone-beam computed tomography (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing (SDB). The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis—including soft tissue diagnosis and airway morphology—needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognised guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.

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Impact of rapid palatal expansion on the size of adenoids and tonsils in children

Cited by 22 publications

References 35 publications

Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective

Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective

Something to consider: rapid palatal expansion for treatment of obstructive sleep apnea in pediatric patients

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing

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