Orthodontic procedures in the treatment of obstructive sleep apnea in children.
BACKGROUND
Even minor dimensional changes in the child's upper airway can already affect the resistance therein. Craniofacial anomalies may constrict the upper airway and are suspected to be a direct cause of obstructive sleep apnea syndrome (OSAS) in children.


METHODS
In the present two cases we report on the successful orthodontic treatment of an 8-year-old girl and a 6 1/2-year-old boy with craniofacial anomalies and severe OSAS diagnosed during a sleep study. The primary treatment aim was to improve the cardio-respiratory situation during sleep by enlarging the upper airway and preventing its collapse. Prior to the onset of treatment we had ruled out the presence in both children of any adenotonsillar hypertrophy requiring surgical treatment. Patient 1 (the girl) presented mouth breathing predominantly while sleeping and a narrow skeletal maxilla that was treated via rapid maxillary expansion followed by a Fränkel-II appliance. A function regulator type-II was applied in the second patient, a boy suffering from OSAS, and spinal muscular dystrophy with a narrow skeletal upper jaw and mandibular retrognathism. We were able to successfully treat both cases of obstructive sleep apnea with these orthodontic procedures.


CONCLUSIONS
Orthodontic therapeutic measures should be considered as a causal treatment option in children with OSAS and craniofacial anomalies restricting the upper airway. Parents and patient cooperation, as well as good interdisciplinary care within the field of sleep medicine are mandatory for this kind of treatment.
Rose
Edmund
E
Department of Orthodontics, University of Freiburg, Germany. edmund.rose@uniklinik-freiburg.de
Schessl
Joachim
J
D000848:Anodontia / Q000150:complications* / Q000628:therapy*; D002648:Child; D019465:Craniofacial Abnormalities / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation / Q000379:methods; D009971:Orthodontics, Corrective / Q000295:instrumentation / Q000379:methods*; D010155:Palatal Expansion Technique / Q000295:instrumentation; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000517:prevention & control*; D016896:Treatment Outcome