The Orthodontics Professors
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Does Maxillary Expansion provide a long-term solution for children with a narrow maxilla and obstructive sleep apnea? Data from a 12-year follow-up study say yes.
BY TATE H. JACKSON
This study, published in Sleep Medicince by Pirelli and co-workers, followed children who were initially diagnosed with obstructive sleep apnea and maxillary constriction. At baseline, all of the 31 pre-pubertal Caucasian children (age 6-12) had maxillary constriction with either a unilateral or bilateral crossbite and no evidence of enlarged tonsils or adenoids, as determined by ENT exam. The diagnosis of sleep-disordered breathing was made using polysomnography (PSG). The average Apnea-Hypopnea Index (AHI) at baseline for the group was 12, which is considered moderate-severe in children of this age.
Immediately following expansion, the mean AHI dropped to less than 1, a level considered to indicate success and warrant no further treatment. All crossbites were resolved with an average of 3mm of opening measured at the incisors.
23 of the 31 (73%) children were available for long-term follow-up at an average of 12 years later, when the children were adults (mean age= 21 years). None were reported to be overweight; the average BMI was 23. At that time, AHI was again measured by PSG, and was found to have remained stable at an average level of less than 1.
Crossbite correction was maintained for all of the subjects, and skeletal expansion was confirmed as stable by comparison of CBCT scans at baseline and final follow-up. Additionally, the authors report that yearly evaluation by both an orthodontist and ENT confirmed that crossbites and sleep apnea correction remained stable over the period from treatment to final observation.
WHAT THE PROFESSOR THINKS
The use of PSG to diagnose and measure the presence of sleep-disordered breathing was important since that is the gold standard for this medical condition – rather than examination of static anatomic factors, such as airway morphology from a CBCT. It is key to note that these children did not have enlarged tonsils or adenoids and that that determination was made by an ENT physician. The loss to follow-up rate was acceptable, and the prospective time period for follow-up was long enough to be meaningful.
This study is particularly relevant to orthodontists because it evaluated the effects of maxillary expansion on sleep apnea in the presence of crossbites. Based on the results here, should orthodontists routinely tout the positive treatment and preventive effects of maxillary expansion on the airway to his or her patients? Certainly not.
When a physician has diagnosed a child with sleep-disordered breathing, however, this study provides good evidence that in the absence of enlarged tonsils or increased BMI, orthopedic expansion to correct the crossbite can also have a very meaningful and long-lasting positive corrective impact on breathing.
Article Reviewed: Pirelli P, et al. Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up. Sleep Med. (16) 933-935. May 2015.
Tate H. Jackson, DDS, MS