Sleep-disordered breathing. A view at the beginning of the new Millennium.
Obstructed sleep apnea syndrome and UARS are often missed in clinical practice. The pediatric population presenting with UARS or mild OSAS is the most commonly ignored because the symptoms are insidious. Often, their craniofacial morphology is not as altered as in the adult population because the effects of airway obstruction may not have been fully established. This is, however, the group in which trials aimed at redistributing bone growth and functional readaptations may be attempted. Dentists and orthodontists have the greatest opportunity to see these young individuals and may help identify them and participate in treatment options. Undoubtedly, functional appliances are not the ideal solution, but if used appropriately with the goal of enlarging the upper airway, they may obviate the need for aggressive surgical treatments later in life. Orthopedic palatal and transverse expansion appliances can widen the jaw bases at the level of the basal bone. Orthodontically uprighting lingually tipped teeth to widen the alveolar bone housing the teeth can help improve the oropharyngeal space indirectly by altering the resting posture of the tongue. These measures in conjunction with other simultaneous, noninvasive modalities may prove to be effective.
Guilleminault
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Stanford Sleep Disorders Clinic and Research Center, Stanford, California, USA. cguil@leland.stanford.edu
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D000328:Adult; D000402:Airway Obstruction / Q000473:pathology*; D000403:Airway Resistance; D002648:Child; D049673:History, 20th Century; D006801:Humans; D019186:Mandibular Advancement; D008445:Maxillofacial Development / Q000235:genetics; D017090:Occlusal Splints; D009960:Oropharynx / Q000503:physiopathology; D012886:Skull / Q000033:anatomy & histology; D020181:Sleep Apnea, Obstructive / Q000235:genetics / Q000266:history / Q000473:pathology / Q000628:therapy; D009626:Terminology as Topic