Maxillary Arch Expansion and Adenotonsillectomy in Prepubertal Children Diagnosed with Paediatric Obstructive Sleep...

Background: In many children aged 7-9 years diagnosed with obstructive sleep apnoea (OSA) the decision of which treatment to perform still remains unclear. This is particularly relevant when the children have both a narrow maxilla and enlargement of tonsils and adenoids. Current guidelines recommend adenotonsillectomy (TA) as first-line therapy, but residual OSA is common, prompting interest in adjunctive semi-rapid maxillary expansion (SRME). This study evaluated the effects of TA and SRME on the respiratory disturbance index (RDI) in prepubertal children with OSA, both individually and in combination, regardless of treatment sequence. Materials and Methods: In this retrospective cohort study, 80 children (aged 7-9 years) with polysomnography-confirmed obstructive sleep apnoea, narrow maxillary arches, and adenotonsillar enlargement underwent TA first followed by SRME (n = 39) or SRME first followed by TA (n = 41). Level 1 polysomnography was performed at baseline and 3 months after each intervention. Repeated-measures analyses investigated the RDI profiles of the two groups over time, in each case adjusting for relevant background variables. Results: Baseline mean RDI was 18.99 ± 1.66 events/hour. Adjusted for background variables (including, most importantly, BMI), the initial reduction was significantly greater after SRME than TA (adjusted mean difference 1.49 events/hour, p = 0.002), and this difference persisted until after both treatments were applied (adjusted mean difference 1.42, p = 0.007). Conclusions: Combined TA and SRME produced substantial RDI reductions compared to individual interventions in children with dual soft-tissue and skeletal OSA contributors, with treatment order (as well as BMI) significantly associated with different final outcomes. These findings support a flexible, multidisciplinary approach to optimise airway management and reduce residual disease.