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Correlation between craniofacial changes and respiratory improvement after nasomaxillary skeletal expansion in

Jung-Eun Kim1, Kyoung-Jin Hwang2, Sung-Wan Kim3

  • 1Department of Dentistry, Graduate School, Kyung Hee University, Seoul, South Korea.

Sleep & Breathing = Schlaf & Atmung
|June 28, 2021
PubMed

Insights

Nasomaxillary skeletal expansion (NMSE) improved respiratory function in pediatric obstructive sleep apnea (OSA) patients by enlarging upper airways. Treatment success was linked to airway dimensions, not just bone structure, improving breathing and sleep quality.

Area of Science:

  • Orthodontics and Dental Sleep Medicine
  • Pediatric Sleep Medicine
  • Craniofacial Imaging and Analysis

Background:

  • Pediatric obstructive sleep apnea (OSA) is often associated with craniofacial abnormalities, including a constricted nasomaxillary complex (NMC).
  • Nasomaxillary skeletal expansion (NMSE) is a treatment modality aimed at widening the maxilla and improving nasal airway dimensions.
  • The relationship between NMSE-induced structural changes and functional respiratory improvements in pediatric OSA remains an area of active investigation.

Purpose of the Study:

  • To investigate the correlation between changes in respiratory function and the dimensions of the nasomaxillary complex (NMC) and upper airway (UA) compartments following NMSE in pediatric OSA patients.
  • To determine which dimensional parameters of the NMC and UA are most predictive of functional improvements in respiratory parameters after NMSE.

Main Methods:

  • A cohort of nonobese pediatric OSA patients with transverse nasomaxillary constriction underwent NMSE.
  • Evaluations included pre- and post-treatment cone-beam computed tomography (CBCT) for dimensional analysis, home sleep testing for apnea-hypopnea index (AHI), and the modified pediatric sleep questionnaire (m-PSQ).
  • Paired t tests and multiple regression analyses were used to assess treatment-related changes and identify predictive dimensional parameters.

Main Results:

  • NMSE significantly increased NMC and UA dimensions, excluding the glossopharyngeal airway.
  • Concurrent improvements were observed in AHI, oxygen desaturation index, lowest oxygen saturation (LSaO2), flow limitation (FL), snoring, and m-PSQ scores.
  • AHI reduction correlated with UA enlargement, while FL reduction was associated with NMC expansion; minimal cross-sectional area was the strongest predictor of functional improvement.

Conclusions:

  • NMSE is an effective treatment for pediatric OSA, enhancing nasal and pharyngeal airway patency.
  • Improvements in respiratory function are linked to UA enlargement and potentially NMC expansion, leading to reduced pharyngeal collapsibility and improved nasal airflow.
  • The minimal cross-sectional area of the airway is a key indicator for predicting the success of NMSE in improving respiratory outcomes in pediatric OSA.
Abstract

Keywords:
Nasomaxillary skeletal expansionPediatric obstructive sleep apneaRespiratory functionUpper airway compartment

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