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Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement
K Agren1, B Nordlander, S Linder-Aronsson
1Department of Otorhinolaryngology, Söder Hospital, Stockholm, Sweden.
Insights
Adenotonsillectomy effectively treats childhood obstructive sleep apnea, even when initial breathing tests appear normal. Surgical intervention also significantly improves associated craniofacial abnormalities in children.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Orthodontics
Background:
- Childhood obstructive sleep apnea (OSA) is often linked to adenotonsillar hypertrophy.
- Clinical presentation of OSA in children can be variable, with some exhibiting normal polysomnography (PSG) findings despite symptoms.
Purpose of the Study:
- To evaluate the effectiveness of adenotonsillectomy in children with suspected obstructive breathing during sleep.
- To assess the impact of surgical intervention on respiratory parameters and craniofacial development.
Main Methods:
- Twenty children (aged 4-9 years) with obstructive breathing underwent adenotonsillectomy.
- Preoperative assessments included polysomnography (apnea-hypopnea index, oxygen saturation), respiratory labor monitoring (EMG), cephalometry, and dental models.
- Postoperative follow-up included respiratory recordings and orthodontic assessments at one year.
Main Results:
- Preoperative apnea-hypopnea index was elevated in most children, but oxygen desaturation was minimal in some.
- Significant craniofacial changes, including lateral cross-bite and vertical mandibular growth, were noted.
- Adenotonsillectomy led to prompt symptom resolution.
- Respiratory function improved in the majority, and all children showed normalized or improved orthodontic variables after one year.
Conclusions:
- Adenotonsillectomy is beneficial for children with obstructive breathing, even with normal or near-normal oximetry and airflow recordings.
- Surgical treatment of airway obstruction significantly improves common craniofacial deformities in pediatric OSA patients.
Unlabelled:
Twenty children, aged 4-9 years, underwent adeno/tonsillectomy because of unequivocal anamnestic nocturnal obstructive breathing. Preoperatively, apnea-hypopnea index was > 5 in 10 cases only, AI > 1 in 17. Nineteen children had signs of increased respiratory labour in movement recordings and inspiratory EMG-activity. Oxygen desaturation index was 0 in 7 children, and nadir SaO2 was > or = 90% in 10. Cephalometry and dentition study models initially revealed significant changes, chiefly lateral cross-bite (n = 11) and vertical growth direction of the mandible. Tonsillar size or duration of disease was not correlated with the severity of polysomnographic findings, nor were orthodontic variables. Symptoms disappeared promptly postoperatively. After one year, respiratory recordings were normalized or improved in the majority of children, and orthodontic variables normalized or improved in all children.
Conclusion:
Oximetry and airflow recordings may be normal in children who benefit from treatment of anamnestic nocturnal obstruction. Craniofacial deformities are common and improve significantly with surgical treatment of the airway obstruction.