Efficacy comparison between dentofacial orthopedic treatment and adenotonsillectomy on children with obstructive sleep apnea and skeletal class II malocclusion: a retrospective study.

OBJECTIVE

This study aims to evaluate the effects of dentofacial orthopedic treatment (DOT) and adenotonsillectomy (AT) in Obstructive Sleep Apnea (OSA) children with skeletal Class II malocclusion and adenotonsillar hypertrophy (ATH), focusing on changes in sleep respiratory function, anatomic and aerodynamic characteristics of upper airway (UA).

METHODS

In this retrospective study, 38 OSA children (mean age: 8.42 years, 15 females and 23 males) were included consecutively. Patients were categorized into two groups: DOT group (n = 20) and AT group (n = 18). Baseline (T0) and follow-up (T1) assessments involved polysomnography and radiological examinations to evaluate improvements in sleep quality as well as changes in craniofacial morphology and UA variables. Aerodynamic parameters such as airflow velocity, airway resistance, and wall shear stress were quantified using computational fluid dynamics.

RESULTS

In the comparative analysis of sleep respiratory functions, there were no significant differences in apnea-hypopnea index changes between the treatment groups (DOT group: -3.72/h, AT group: -3.32/h, P = 0.600). In the DOT group, UA's volume average enlargements were observed in the nasopharynx, palatopharynx, glossopharynx, and hypopharynx by 54.5%, 41.6%, 34.0%, and 22.5%, respectively. In comparison, the AT group showed enlargements of 66.0%, 20.1%, 62.9%, and - 1.0%, respectively. In terms of UA aerodynamic characteristics, there were no significant differences between two groups.

CONCLUSIONS

In OSA children with skeletal Class II malocclusion and ATH, DOT as a non-invasive approach, has shown improvements in respiratory function comparable to AT, as evidenced by changes in the UA's anatomical and aerodynamic characteristics.