Carla E. Itikawa

Cephalometric evaluation of facial pattern and hyoid bone position in children with obstructive sleep apnea syndrome.

OBJECTIVES To assess the development of face and hyoid bone in children with obstructive sleep apnea syndrome (OSAS) through lateral cephalometries. MATERIALS AND METHODS Children aged 7-10 years with mixed dentition and with no previous otorhinolaryngologic, orthodontic or speech therapy treatments were studied. Twenty nasal breathers were compared to 20 mouth breathing children diagnosed as OSAS patients. All children underwent otorhinolaryngologic evaluation and cephalometries; children with OSAS also underwent nocturnal polysomnography in a sleep laboratory. RESULTS Children with OSAS presented increase in total and lower anterior heights of the face when compared to nasal breathers. In addition, children with OSAS presented a significantly more anterior and inferior position of the hyoid bone than nasal breathers. No significant differences in upper, anterior or posterior heights of the face were observed between groups. CONCLUSION The results suggest that there are evident and early changes in facial growth and development among children with OSAS, characterized by increased total and inferior anterior heights of the face, as well as more anterior and inferior position of the hyoid bone.

Does rapid maxillary expansion increase nasopharyngeal space and improve nasal airway resistance

OBJECTIVE To evaluate the effect of rapid maxillary expansion (RME) on the dimension of the nasopharyngeal space and its relation to nasal airway resistance. METHODS Twenty-five school-age children (from 7 to 10 year-old) with mouth and/or mixed breathing, with mixed dentition and uni- or bilateral posterior crossbite involving the deciduous canines and the first permanent molars, were evaluated. RME was placed and remained during 90 days. Rhinomanometry and orthodontic documentation were performed at four different times, i.e., before (T(1)), immediately after (T(2)), 90 days (T(3)) and 30 months (T(4)) after RME. RESULTS Differences in nasopharyngeal area and in nasal airway resistance were observed only 30 months after RME, and could be explained by facial growth, and not because of the orthodontic procedure. CONCLUSION RME does not influence on nasopharyngeal area or nasal airway resistance in long-term evaluation.

Long-term effects of rapid maxillary expansion on nasal area and nasal airway resistance

Background Rapid maxillary expansion (RME) may improve the nasal respiratory pattern. This study was performed to evaluate the effect of RME on the nasal cavity by acoustic rhinometry and computed rhinomanometry and to determine nasal and maxillary width by posteroanterior cephalometric radiography, up to 30 months after the orthodontic procedure. Methods Twenty-seven children with oral breathing, ranging in age from 7 to 10 years, and with mixed dentition were selected. The children had unior bilateral posterior crossbite involving deciduous canines and the first permanent molars. All subjects were submitted to nasofibroscopy, acoustic rhinometry, and computed rhinomanometry and posteroanterior cephalometric radiography at four different times, i.e., before expansion, immediately, 90 days and 30 months after expansion. Results The mean linear left-to-right nasal cavity lateral prominence and left-to-right jugal points cephalometric measures increased considerably after expansion and this increase was maintained throughout the period of evaluation. There was an immediate significant decrease in nasal resistance, up to 90 days after RME, but the nasal resistance increased 30 months after the procedure. The acoustic rhinometry results did not show any difference in values throughout time. Conclusion RME significantly increased nasal and maxillary width as measured by frontal cephalometry, but the nasal mucosal effects were more subtle. Also, the influence of RME on nasal resistance was not stable, and nasal resistance values returned to close to the initial ones after 30 months.

Predictors of uvulopalatopharyngoplasty success in the treatment of obstructive sleep apnea syndrome.

OBJECTIVE Uvulopalatopharyngoplasty (UPPP) has been described as an option for treating obstructive sleep apnea syndrome (OSAS), with variable success rates. The main purpose of our study was to correlate UPPP success to craniofacial bony structure and orofacial muscles function. METHODS Clinical variables, including body mass index (BMI), age, and preoperative apnea-hypopnea index (AHI); cephalometric measurements of the craniofacial region and hyoid bone position; and muscle function variables including clinical protocol and tongue strength measures were evaluated in 54 patients who underwent UPPP in the last 7years. The measurements were related to the success or failure of UPPP based on the results of preoperative and postoperative polysomnography (PSG). RESULTS The variables BMI, preoperative AHI, and cephalometric measurements showed no influence on surgical success. The clinical muscle protocol also was similar between groups. However, the muscle strength of the anterior portion of the tongue was significantly greater in the group that showed surgical success compared to those with surgical failure. CONCLUSION OSAS is a multifactorial disease and diagnostic symptom assessments should be individualized. In addition, special attention should be given to functional muscle alterations of the airways, as they might influence the evolution of the disease.

Influence of adenotonsillectomy on hard palate dimensions

OBJECTIVE To evaluate hard palate width and height in mouth-breathing children pre- and post-adenotonsillectomy. METHODS We evaluated 44 children in the 3-6 year age bracket, using dental study casts in order to determine palatal height, intercanine width, and intermolar width. The children were divided into two groups: nasal breathing (n=15) and mouth breathing (n=29). The children in the latter group underwent adenotonsillectomy. The study casts were obtained prior to adenotonsillectomy, designated time point 1 (T1), at 13 months after adenotonsillectomy (T2), and at 28 months after adenotonsillectomy (T3). Similar periods of observation were obtained for nasal breathing children. RESULTS At T1, there was a significantly lower intercanine width in mouth breathing children; intermolar width and palate height were similar between groups. After surgery, there was a significant increase in all the analyzed parameters in both groups, probably due to facial growth. Instead, the increase in intercanine width was substantially more prominent in mouth breathing children than in nasal breathing children, and the former difference failed in significance after the procedure. CONCLUSIONS There were no significant differences between the nasal-breathing and mouth-breathing children in terms of intermolar width and palatal height prior to or after tonsillectomy. Although intercanine width was initially narrower in the mouth-breathing children, it showed normalization after the surgical procedure. These results confirm that the restoration of nasal breathing is central to proper occlusal development.

Effect of rapid maxillary expansion on the dimension of the nasal cavity and on facial morphology assessed by acoustic rhinometry and rhinomanometry

OBJECTIVE: To assess the effects of rapid maxillary expansion on facial morphology and on nasal cavity dimensions of mouth breathing children by acoustic rhinometry and computed rhinomanometry. METHODS: Cohort; 29 mouth breathing children with posterior crossbite were evaluated. Orthodontic and otorhinolaryngologic documentation were performed at three different times, i.e., before expansion, immediately after and 90 days following expansion. RESULTS: The expansion was accompanied by an increase of the maxillary and nasal bone transversal width. However, there were no significant differences in relation to mucosal area of the nose. Acoustic rhinometry showed no difference in the minimal cross-sectional area at the level of the valve and inferior turbinate between the periods analyzed, although rhinomanometry showed a statistically significant reduction in nasal resistance right after expansion, but were similar to pre-treatment values 90 days after expansion. CONCLUSION: The maxillary expansion increased the maxilla and nasal bony area, but was inefficient to increase the nasal mucosal area, and may lessen the nasal resistance, although there was no difference in nasal geometry. Significance: Nasal bony expansion is followed by a mucosal compensation.

Predictors of Uvulopalatopharyngoplasty Success in the Treatment of Obstructive Sleep Apnea Syndrome

Objectives: Uvulopalatopharyngoplasty (UPPP) has been described as an option for treating obstructive sleep apnea syndrome (OSAS), with variable success rates. The main purpose of this study is to correlate UPPP success to craniofacial bony structure and orofacial muscle function. Methods: Prospective longitudinal study in a tertiary clinical center. Fifty-four patients who underwent UPPP in the last 7 years were followed, and UPPP succeeded or failed based on the results of pre-operative and post-operative polysomnography. Clinical variables’ body mass index (BMI), age, and pre-operative apnea-hypopnea index (AHI)’s cephalometric measurements (craniofacial region and hyoid bone position), and muscle function variables (clinical protocol and tongue strength measures) were evaluated and compared between the groups (failure or success after UPPP). Results: The variables BMI, pre-operative AHI, and cephalometric measurements showed no influence on surgical success. The clinical muscle protocol was also similar between groups. However, the muscle strength of the anterior portion of the tongue was significantly greater in the group that showed surgical success compared to those with surgical failure. This movement is primarily performed by genioglossus muscle. Conclusions: OSAS is a multifactorial disease, and diagnostic symptom assessments should be individualized. In addition, special attention should be given to functional muscle alterations of the airways, because they might influence the evolution of the disease.

Cephalometric Evaluation of Facial Pattern and Hyoid Bone Position in Children with OSAS

Objective: The relation between craniofacial changes and OSAS in nonsyndromic children is not well established. The objective of the present study was to assess the development of face and hyoid bone in children with OSAS through lateral cephalometries. Method: Twenty nasal breathing children aged 7 to 10 years were compared with 20 matched in age children polysomnographically diagnosed as OSAS patients. All children underwent otorhinolaryngological evaluation and cephalometries. Results: Children with OSAS presented an increase in total and inferior anterior heights of the face when compared to nasal breathers. In addition, children with OSAS presented a significantly more anterior and inferior position of the hyoid bone than nasal breathers. No significant differences in superior anterior or posterior heights of the face were observed between groups. Conclusion: The results suggest that there are evident and early changes in facial growth and development among children with OSAS, characterized by increased total and inferior anterior heights of the face, as well as a more anterior and inferior position of the hyoid bone.