Caterina Malagola

Rapid Maxillary Expansion for the Treatment of Nasal Obstruction in Children Younger Than 12 Years

OBJECTIVE To assess short- and long-term effects of rapid maxillary expansion (RME) on nasal flow in young children. Since RME has been reported to positively influence nasal obstruction in subjects with respiratory problems by reducing nasal resistance, a similar efficacy of RME could be expected in children with deciduous and/or mixed dentition who are affected by maxillary constriction and nasal obstruction from a different cause. DESIGN Prospective study of children younger than 12 years, with different grades of malocclusion and oral breathing. Data included active anterior rhinomanometry in both the supine and orthostatic positions, as well as radiographic cephalometric measurements. SETTING Tertiary care university hospital. Data were prospectively collected from 2005 to 2007. PATIENTS Nasal flow and resistance were measured in 65 children younger than 12 years, with mixed or deciduous dentition and different grades of malocclusion and oral breathing. MAIN OUTCOME MEASURE Efficacy of RME for resolution of maxillary constriction. RESULTS After RME, an improvement of nasal flow and resistance has been recorded in patients, in the supine position, who presented both anterior and posterior obstruction. Less notable changes were shown in isolated forms of obstruction and in the orthostatic position. CONCLUSION In cases of maxillary constriction and nasal airway obstruction, RME has proved to be efficient for the improvement of nasal respiration in children via a widening effect on the nasopharyngeal cavity.

Rapid maxillary expansion outcomes in treatment of obstructive sleep apnea in children

OBJECTIVES The objectives of this study were to confirm the efficacy of rapid maxillary expansion in children with moderate adenotonsillar hypertrophy in a larger sample and to evaluate retrospectively its long-term benefits in a group of children who underwent orthodontic treatment 10 years ago. METHODS After general clinical examination and overnight polysomnography, all eligible children underwent cephalometric evaluation and started 12 months of therapy with rapid maxillary expansion. A new polysomnography was performed at the end of treatment (T1). Fourteen children underwent clinical evaluation and Brouilette questionnaire, 10 years after the end of treatment (T2). RESULTS Forty patients were eligible for recruitment. At T1, 34/40 (85%) patients showed a decrease of apnea-hypopnea index (AHI) greater than 20% (ΔAHI 67.45% ± 25.73%) and were defined responders. Only 6/40 (15%) showed a decrease <20% of AHI at T1 and were defined as non-responders (ΔAHI -53.47% ± 61.57%). Moreover, 57.5% of patients presented residual OSA (AHI > 1 ev/h) after treatment. Disease duration was significantly lower (2.5 ± 1.4 years vs 4.8 ± 1.9 years, p <0.005) and age at disease onset was higher in responder patients compared to non-responders (3.8 ± 1.5 years vs 2.3 ± 1.9 years, p <0.05). Cephalometric variables showed an increase of cranial base angle in non-responder patients (p <0.05). Fourteen children (mean age 17.0 ± 1.9 years) who ended orthodontic treatment 10 years previously showed improvement of Brouilette score. CONCLUSION Starting an orthodontic treatment as early as symptoms appear is important in order to increase the efficacy of treatment. An integrated therapy is needed.

Modulo sperimentale di registrazione delle procedure diagnostiche e terapeutiche in ambito odontostomatologico

Riassunto Obiettivi Scopo del lavoro e presentare un repository (Italian Recording for the Appropriate Management of Odontoiatric Patient, IRAMOP) per la registrazione delle prestazioni odontoiatriche effettuate sui pazienti afferenti a cinque sedi universitarie italiane relativamente alle specialita ortodontiche, chirurgiche, implantologiche, parodontali ed endodontiche. Materiali e metodi Si descrivono i singoli percorsi clinici programmati indicando nel dettaglio procedure, strumenti e farmacoterapia associata. I vari operatori nelle proprie sedi, attenendosi alle recenti raccomandazioni cliniche in odontostomatologia pubblicate dal Ministero della Salute, avranno la possibilita di registrare su piattaforma informatica condivisa i dati relativi alle prestazioni effettuate e alla risposta clinica ottenuta nei singoli trattamenti. Terapie farmacologiche, procedure cliniche e chirurgiche, strumentario utilizzati verranno inseriti nel database. Risultati e conclusioni I dati raccolti e rielaborati potranno fornire importanti spunti di riflessione sul corretto approccio odontoiatrico, riguardo sia alle procedure terapeutiche effettuate sia alle terapie farmacologiche somministrate. Le valutazioni post-trattamento saranno registrate dagli operatori non solo in relazione alla valutazione clinica, ma anche in base a quanto riferito dai pazienti in termini di dolore percepito e misurato con la Numeric Rating Scale (NRS).