Craniofacial and dental arch morphological changes in pediatric obstructive sleep apnea syndrome following rapid maxillary expansion.

BACKGROUND/PURPOSE: Rapid maxillary expansion (RME) is a non-invasive treatment option for children with obstructive sleep apnea syndrome (OSAS). Yet, there's limited research on the effects of RME on the craniofacial, dental arch morphology and polysomnographic measures in pediatric OSAS.

MATERIALS AND

METHODS

Medical records of patients aged 4-14 years with apnea-hypopnea index (AHI) > 1 event/hour and available cephalometric radiographs were reviewed. The Hyrax appliance was used for RME. Lateral and posterior-anterior cephalometric radiography, dental cast analysis and polysomnography (PSG) were performed before and after a six-month treatment. Statistical significance was defined as P < 0.05.

RESULTS

Due to data availability, 40 lateral cephalometric records, 33 posterior-anterior cephalometric images, 24 dental casts, and 40 polysomnographic records were analyzed. Significant increases were found in nasopharyngeal distances (PNS-AD1, PNS-AD2, and PNS-NPhp) and the minimal velopharyngeal distance (MinRPA). The length of the jugal process and the intermaxillary suture increased significantly. The intermaxillary suture opening in the frontal plane displayed an inverted V-shaped pattern. An inverse association was observed between the maxillary arch width and the arch length. RME also induced spontaneous dentoalveolar adaptations in the mandibular arch. The reductions in PSG measures were not statistically significant. A marked nominal decrease in AHI was seen in the moderate-to-severe obstructive sleep apnea (OSA) group compared with the mild group.

CONCLUSION

RME treatment modifies craniofacial structure and dental arch morphology in children with OSAS. However, these anatomical improvements do not translate into statistically significant reductions in AHI. A more pronounced nominal decrease in AHI occurs in patients with moderate-to-severe OSA, compared with those with mild OSA.