Outpatient Clinic for the Mouth-Breathers, Federal University of Minas Gerais, Av. Prof Alfredo Balena 190, Hospital São Geraldo, Belo Horizonte, MG, 30.130-100, Brazil.
School of Dentistry, Orthodontics, University of Lisbon, Rua Professora Teresa Ambrósio, Cidade Universitária, 1600-277, Lisbon, Portugal.
Prog Orthod. 2022 Aug 8;23(1):29. doi: 10.1186/s40510-022-00422-7.
To perform a case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA).
Retrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1).
PASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients.
Pulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.
对行扁桃体腺样体切除术（T&A）的阻塞性睡眠呼吸暂停（OSA）儿童的肺动脉收缩压（PASP）、鼻吸气流量（NIF）、上气道容积、阻塞性呼吸暂停/低通气指数（OAHI）和下颌骨三维（3D）形态的变化进行病例系列分析。
回顾性评估了 2012 年至 2020 年期间在一家以口呼吸为基础的转诊中心筛查的 1002 名儿童的档案。从这个范围内，选择了 15 名患有阻塞性睡眠呼吸暂停的儿童（7 名女性；8 名男性），年龄 4.1 至 8.9 岁（平均年龄为 5.4 岁±1.3 岁），他们有扁桃体切除术和/或腺样体切除术的指征。在 T&A 前进行了完整的基线检查（T0），并在 T&A 后 18.7 个月（12 至 30 个月）进行了第二次完整检查（T1）。11 名患者接受了 T&A，4 名患者有手术指征，但未获得公共卫生系统的手术授权。根据 OSA 患者门诊的方案，在 T0 和 T1 时进行了多普勒超声心动图、多导睡眠图、鼻阻力测量和计算机断层扫描成像。
T&A 后 PASP 降低 16.6%。T&A 患儿的 NIF 增加（40.3%）明显多于非 T&A 患儿（16.8%）。T&A 和非 T&A 患儿的上气道容积均增加，但 T&A 患儿的鼻咽部容积增加（45.6%）。T&A 组的 6 名儿童（55%）和非 T&A 组的 3 名儿童（75%）的 OAHI 没有变化。T&A 组的 6 名儿童（55%）和未治疗的 2 名儿童（50%）的上颌骨相对于颅底向下向后移位。9 名 T&A 患儿（85%）和 3 名未治疗患儿（75%）出现髁突广泛生长和下颌骨长度增加。3D 定性评估显示 T&A 组和非 T&A 组患者具有相似的形态学 3D 变化。
行扁桃体腺样体切除术（T&A）后，肺动脉收缩压下降，鼻吸气流量增加，鼻咽部容积增加，但手术和非手术患者的阻塞性呼吸暂停/低通气指数和下颌骨形态相似。
