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Bimaxillary expansion therapy for pediatric sleep-disordered breathing
Stacey D Quo1, Nelly Hyunh2, Christian Guilleminault3
1School of Dentistry, University of California at San Francisco, San Francisco, CA, USA.
Insights
Bimaxillary expansion improved sleep in most children with sleep-disordered breathing. However, specific mandibular growth patterns may predict treatment outcomes, especially in mild obstructive sleep apnea (OSA).
Area of Science:
- Orthodontics and Dental Sleep Medicine
- Pediatric Respiratory Medicine
Background:
- Sleep-disordered breathing (SDB) significantly impacts children's health and development.
- Bimaxillary expansion is a potential orthodontic intervention for SDB.
- Evaluating treatment efficacy and patient-specific factors is crucial.
Purpose of the Study:
- To assess the effectiveness of bimaxillary expansion in pediatric patients with SDB.
- To identify cephalometric predictors of treatment success.
Main Methods:
- Retrospective study of 45 children (3-14 years) with SDB undergoing bimaxillary expansion.
- Baseline and post-treatment clinical evaluations, polysomnography (sleep studies), and cephalometric X-rays.
- Nonparametric statistical analysis and correlation of facial structures with treatment outcomes.
Main Results:
- Most children (30/45) experienced improved sleep scores and symptoms post-expansion.
- Initial apnea-hypopnea index (AHI) severity was a key predictor of positive outcomes.
- In mild OSA, counterclockwise mandibular growth worsened outcomes, while clockwise growth improved them. Severe OSA patients with shorter mandibular bases showed less AHI improvement.
Conclusions:
- Bimaxillary expansion can improve respiratory parameters in children with SDB.
- Retrognathia with anterior growth rotation may indicate poor response to bimaxillary expansion.
Introduction:
The aim of this retrospective study was to evaluate the results of bimaxillary expansion as a treatment option for pediatric sleep-disordered breathing.
Methods:
Forty-five children, aged 3-14 years, with sleep-disordered breathing underwent bimaxillary expansion. They were subjected to baseline clinical evaluations, cephalometric X-rays, and polygraphic sleep studies. Three to six months after bimaxillary expansion, posttreatment sleep studies were performed. Data were analyzed with nonparametric Wilcoxon signed-rank test, and Spearman's correlations were performed to correlate cephalometric facial structures to the effectiveness of treatment.
Results:
The majority of the children (n = 30) showed improvement in their sleep scores and symptoms after bimaxillary expansion. The initial severity of the obstructive sleep apnea (OSA) indicated by the apnea-hypopnea index (AHI) was a much better predictor of positive results. However, in the "mild OSA" group, patients with smaller MP-SN or counterclockwise mandibular growth, worsened with bimaxillary expansion, while patients with clockwise mandibular growth showed greater improvement; in the "severe OSA" group, patients who initially had shorter mandibular base lengths showed lesser AHI improvements.
Conclusions:
Bimaxillary expansion can be a treatment option for improving respiratory parameters in children with sleep-disordered breathing. This study also suggests that retrognathia in an anterior growth rotation pattern may not respond to efforts of bimaxillary expansion.
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