Search

La rééducation myofonctionnelle orofaciale a été montrée efficace dans la prise en charge multidisciplinaire du syndrome d’apnées obstructives du sommeil chez l’enfant, l’adolescent et l’adulte, et elle est prescrite à plusieurs étapes de ces prises en charge. Cependant, compte tenu du manque d’homogénéité des protocoles de traitement et de mesures des résultats, du manque de recherches sur le type, la fréquence et la durée des exercices myofonctionnels et sur les phénotypes spécifiques qui peuvent en bénéficier, il apparait nécessaire de définir des recommandations de bonne pratique. Un consensus de recommandations Delphi consacré à l’évaluation et au traitement myofonctionnel orofacial pour les patients atteints de SAOS, a été mis en œuvre à l’initiative de Marc Richard Moeller. Les deux premières étapes du consensus de recommandations Delphi sont achevées. La troisième étape, consacrée à l’élaboration du questionnaire aura lieu lors de la réunion conjointe de la World Sleep Society et de l’Academy of Applied Myofunctional Sciences, en mars 2022 à Rome. Les conclusions du consensus de recommandations Delphi seront publiées l’année suivante et largement diffusées.

Objective The first objective of this study was to evaluate skeletal changes and changes in dimensions and volume of the upper airways before and after rapid maxillary expansion (RME) therapy in children with obstructive sleep apnoea (OSA), by Cone Beam computed tomography (CBCT). The second objective was to evaluate if RME therapy could improve both the patency of the nasal airways and the Obstructive Sleep Apnoea Syndrome (OSAS). Methods 19 children with OSA and malocclusion took CBCT scans with a Dentascan and 3D reconstruction program before (T0) and 4 months after (T1) RME. Patients underwent an ENT visit with auditory and respiratory tests, including a daytime sleepiness questionnaire, a 19-channel polysomnography, and an orthognatodontic examination before orthodontic therapy (T0), after 2 months (T1) with the device still on, and 4 months after the end of the orthodontic treatment (T2). Results In all cases opening of the mid-palatal suture was demonstrated. Nasal osseous width, volume of the total upper airways, nasal cavity and nasopharynx and oropharynx increased significantly (P, .001). The increased W-ANS, W-mid and WPNS were closed linked to the enlarged midpalatal suture (P, .001). The increased WPNS were closed linked to the enlarged pterygoid processes (P, .001). The increased V-NC and V-NPA was closely linked to the enlarged W-PNS (P, .001) as well as VOPA and consequently to the enlarged midpalatal suture and pterygoid processes. Conclusion RME treatment had a positive effect on children affected by chronic snoring and OSA, causing an increase in volume of the nasal cavity and nasopharynx, with expansion of the nasal osseous width and maxillary width. Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed a direct correlation to increased airways volume, bringing a functional improvement. The results show that the RME therapy can restore and improve a normal nasal airflow with disappearance of obstructive sleep breathing disorder.

Study objectives To evaluate the objective and subjective long-term outcome of maxillomandibular advancement (MMA) in Far-East Asian patients with moderate to severe obstructive sleep apnea (OSA). Methods This is a long-term follow-up study to evaluate the treatment outcome of MMA in OSA patients by objective polysomnography (PSG) and subjective questionnaires (Pittsburgh Sleep Quality Index-PSQI, Insomnia Severity Index-ISI, Beck Anxiety Inventory-BAI, Beck Depression Inventory-BDI, Epworth Sleepiness scale-ESS, and Short Form-36 Quality of Life–SF–36). Evaluation was done before surgery and we followed these patients one and two years after surgery. We also assessed the neurocognitive function by Continuous performance test (CPT) and Wisconsin Card Sorting Test (WCST) before and after MMA. Results A total of 82 patients with OSA (female = 19) were enrolled and 53 participants (75.7% men, age 35.66 ± 11.66 years [mean ± SD], BMI = 24.80 ± 3.29) completed the two-year follow-up. The apnea-hypopnea index (AHI) decreased from a mean of 34.78 ± 26.01 to 3.61 ± 2.79 and 7.43 ± 6.70 events/hour (p = 0.007) at the first and second year evaluation. There was significant improvement in PSG (especially respiratory profile), questionnaires (PSQI and ISI total score), and neurocognitive testing (attention and executive function) after MMA. Meanwhile, no major complication such as avascular necrosis of bonny segments, facial nerve injury, blindness or compromise of airway was found after surgery. Conclusions MMA is a clinically effective treatment for patients with moderate-to-severe OSA as demonstrated by significant long-term decrease in AHI and improvement in neurocognitive testing.

Objective The objective of this study was to evaluate the skeletal effects of rapid maxillary expansion (RME) therapy performed using teeth as anchors, in obstructive sleep apnea (OSA) children, by low-dose computed tomography (CT) of the midpalatal suture opening, maxillary base width, nasal cavities width, first molar angulation and, unlike most studies in the literature, on the pterygoid processes distance. Methods Fourteen children (mean age 8.68 years) with OSA presenting a malocclusion characterized by upper-jaw contraction had 16-Multislice CT (MSCT) scans taken before (T0) and after (T1) RME. All exams were performed using a rigid protocol to ensure reproducibility of image collection over time, with a 16-row MSCT scanner equipped with a Dentascan reconstruction program. Scanning parameters were as follows: scout view in the anteroposterior (AP) and laterolateral (LL); 1.25-mm slice thickness with 0.6-mm collimation from the dentoalveolar and basal areas of the maxilla up to the nasal cavity, parallel to the palatal plane; 80 kV, 100 mA with an 11.25-mm table speed/rotation, rotation time 0.6 s. Matrix size was 512 × 512. Results Opening of the midpalatal suture was demonstrated in all cases. The results showed statistically significant T0 to T1 increments in all treated cases and clear imaging findings. Conclusion Use of three-dimensional (3D)-CT for follow-up studies requires a very rigid protocol to maintain reproducible positions in the scanner over time. The images confirm the real remodeling of craniofacial structure. However, to be valid such an imaging approach needs great attention to reproducibility of anatomic images over time. The changes in volume of the UA, even with a rigid protocol, cannot be affirmed with 3D-CT. There is a need to improve the definition of markers using this imaging approach when performing longitudinal studies; currently this issue is unresolved.

Objectives/Hypothesis To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA). Data Sources PubMed/MEDLINE and eight additional databases. Review Methods Three authors independently and systematically reviewed the international literature through February 21, 2016. Results Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea–hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI 3-year follow-up (range = 6.5–12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction). Conclusions Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (

Adenotonsillectomy is not always successful in controlling obstructive sleep apnea (OSA) in children, and orthodontic treatment may be a helpful adjunction and sometime an important alternative. A total of 80 nonoverweight children (37 girls) with a high and narrow hard palate, based on an indepth orthodontic evaluation, were subdivided into two groups based on presence/absence of chronic adenotonsillar inflammatory problems as determined by full otolaryngological examination, with recruitment of 40 children in each group. Patients with evidence of chronic inflammation were treated with adenotonsillectomy first (group II), while all other children had rapid maxillary expension (RME) first (group I). In all children, clinical interviews and clinical evaluations, frontal and lateral cephalometry, and polysomnography were performed at entry. Four months after end of treatment, the initial evaluation was repeated in all children. Children incompletely treated were offered to cross-over to the other treatment venue. At entry, there was no significant difference between the monitored respiratory polygraphic variables between the two groups. At the 4-month follow-up, 15 subjects treated with RME were considered as cured compared to 6 patients after adenotonsillectomy, and absence of improvement was observed in 8 children with RME and 16 with adenotonsillectomy. After cross-over to the other treatment, involving 42 subjects due to 17 drop-outs between treatment 1 and 2,, three children were still having residual sleep disordered breathing at the 12-month follow-up, while normal breathing during sleep was observed in all others. With appropriate clinical investigation, prepubertal children with OSA and narrow maxilla may have better treatment outcome when treated with orthodontics than with adenotonsillectomy; and polygraphic and even better polysomnographic documentation of clinical impression is always needed posttreatment.

When both narrow maxilla and moderately enlarged tonsils are present in children with obstructive sleep apnea, the decision of which treatment to do first is unclear. A preliminary randomized study was done to perform a power analysis and determine the number of subjects necessary to have an appropriate response. Thirty-one children, 14 boys, diagnosed with OSA based on clinical symptoms and polysomnography (PSG) findings had presence of both narrow maxillary complex and enlarged tonsils. They were scheduled to have both adeno-tonsillectomy and RME for which the order of treatment was randomized: group 1 received surgery followed by orthodontics, while group 2 received orthodontics followed by surgery. Each child was seen by an ENT, an orthodontist, and a sleep medicine specialist. The validated pediatric sleep questionnaire and PSG were done at entry and after each treatment phase at time of PSG. Statistical analyses were ANOVA repeated measures and t tests.The mean age of the children at entry was 6.5 ± 0.2 years (mean ± SEM). Overall, even if children presented improvement of both clinical symptoms and PSG findings, none of the children presented normal results after treatment 1, at the exception of one case. There was no significant difference in the amount of improvement noted independently of the first treatment approach. Thirty children underwent treatment 2, with an overall significant improvement shown for PSG findings compared to baseline and compared to treatment 1, without any group differences.This preliminary study emphasizes the need to have more than subjective clinical scales for determination of sequence of treatments.

Objective The objective of this study was to prospectively evaluate the long-term efficacy of rapid maxillary expansion (RME) in a group of children with obstructive sleep apnea (OSA). Material and method Thirty-one children diagnosed with OSA were involved in the study. These children had isolated maxillary narrowing and absence of enlarged adenotonsils at baseline. Twenty-three individuals (73% of the initial group) were followed up annually over a mean of 12 years after the completion of orthodontic treatment at a mean age of 8.68 years. Eight children dropped out over time due to either moving out of the area ( n = 6) or refusal to submit to regular follow-up ( n = 2). Subjects underwent clinical reevaluation over time and repeat polysomnography (PSG) in the late teenage years or in their early 20s. During the follow-up period, eight children dropped out and 23 individuals (including 10 girls) underwent a final clinical investigation with PSG (mean age of 20.9 years). The final evaluation also included computerized tomographic (CT) imaging that was compared with pre- and post-initial treatment findings. Results Yearly clinical evaluations, including orthodontic and otolaryngological examinations and questionnaire scores, were consistently normal over time, and PSG findings remained normal at the 12-year follow-up period. The stability and maintenance of the expansion over time was demonstrated by the maxillary base width and the distance of the pterygoid processes measured using CT imaging. Conclusion A subgroup of OSA children with isolated maxillary narrowing initially and followed up into adulthood present stable, long-term results post RME treatment for pediatric OSA.

Objective: To evaluate the effect of rapid maxillary expansion on children with nasal breathing and obstructive sleep apnea syndrome. Method: Recruitment of children with maxillary contraction, without of adenoid hypertrophy, with a body mass index < 24 kg/m2, with obstructive sleep apnea syndrome demonstrated by polysomnography, and whose parents signed informed consent. Otolaryngologic and orthognathic-odontologic evaluation with clinical evaluation, anterior rhinometry and nasal fibroscopy, panoramic radiographs, anteroposterior and laterolateral telecephalometry were performed at entry and follow-up. Intervention: Rapid maxillary expansion (ie, active phase of treatment) was performed for 10 to 20 days; maintenance of device (for consolidation) and orthodontic treatment on teeth lasted 6 to 12 months. Results: 31 children (19 boys), mean age 8.7 years, participated in the study. The mean apnea-hypopnea index was 12.2 events per hour. At the 4-month follow-up, the anterior rhinometry was normal, and all children had an apnea-hypopnea index < 1 event per hour. The mean cross-sectional expansion of the maxilla was 4.32 +/- 0.7 mm. There was a mean increase of the pyriform opening of 1.3 +/- 0.3 mm. Conclusion: Rapid maxillary expansion may be a useful approach in dealing with abnormal breathing during sleep.

Children who suffer from respiratory problems and obstructive sleep apnea (OSA) commonly exhibit disturbances of craniofacial morphology. A significant number have nasal obstruction associated with a narrow maxilla; maxillary constriction may increase nasal resistance and alter the tongue posture, leading to narrowing of the retroglossal airway and OSA. Sixty children with a case history of oral breathing, snoring, and night time apneas were studied. An orthognathodontic investigation was performed using radiographs that included not only the usual examinations (posteroanterior cephalographs and intraoral radiographs) but also computed tomographic scans. This article discusses the materials and methods and the results of this study.