Galeotti Angela, Gatto Roberto, Caruso Silvia, Piga Simone, Maldonato Wanda, Sitzia Emanuela, Viarani Valeria, Bompiani Gaia, Aristei Francesco, Marzo Giuseppe, Festa Paola
Dentistry Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
Children (Basel). 2023 Jan 30;10(2):244. doi: 10.3390/children10020244.
Obstructive Sleep Apnea (OSA) in children needs a multidisciplinary approach. Even if the first-line treatment of pediatric OSA is adenotonsillectomy, nowadays rapid palatal expansion (RPE) is considered a valid additional treatment. The aim of this study is to evaluate cephalometric changes in upper airways dimensions after rapid palatal expansion (RPE) in children suffering from Obstructive Sleep Apnea (OSA). A total of 37 children (range age 4-10 years) with diagnosis of OSA referred to Dentistry Unit of Bambino Gesù Children's Research Hospital IRCCS (Rome, Italy) were included in this pre-post study and underwent lateral radiographs at the start (T0) and at the end (T1) of a RPE treatment. Inclusion criteria were: diagnosis of OSA confirmed by cardiorespiratory polygraphy (AHI > 1) or pulse oximetry (McGill = >2), skeletal maxillary contraction evaluated by presence of posterior crossbite. A control group of 39 untreated patients (range age 4-11 years), in good general health, was set up. A paired T-test was used to investigate the statistical differences between T0 and T1 values in both groups. The results showed a statistically significant increase of nasopharyngeal width in the treated group after RPE treatment. Moreover, the angle that identifies mandibular divergence compared to palatal plane (PP-MP°) was significantly reduced. In the control group, no statistically significant differences were observed. The present study showed that RPE treatment determines a significant sagittal space increase in the upper airways space and a counterclockwise mandibular growth in children with OSA compared to a control group. These results suggest that a widening of the nasal cavities induced by RPE may support a return to physiological nasal breathing and promote a counterclockwise mandibular growth in children. This evidence confirms the crucial role of the orthodontist in the management of OSA in pediatric patients.
儿童阻塞性睡眠呼吸暂停（OSA）需要多学科方法来治疗。即使小儿OSA的一线治疗是腺样体扁桃体切除术，但如今快速腭扩展（RPE）也被认为是一种有效的辅助治疗方法。本研究的目的是评估患有阻塞性睡眠呼吸暂停（OSA）的儿童在快速腭扩展（RPE）后上气道尺寸的头影测量变化。本前瞻性研究纳入了37名被转诊至意大利罗马圣心儿童医院IRCCS牙科单元、诊断为OSA的儿童（年龄范围4 - 10岁），并在RPE治疗开始时（T0）和结束时（T1）拍摄了头颅侧位片。纳入标准为：通过心肺多导睡眠图（AHI > 1）或脉搏血氧饱和度测定（麦吉尔指数 =>2）确诊为OSA，通过存在后牙反合评估骨骼性上颌收缩。设立了一个由39名未接受治疗、总体健康状况良好的患者（年龄范围4 - 11岁）组成的对照组。采用配对t检验来研究两组T0和T1值之间的统计学差异。结果显示，RPE治疗后治疗组的鼻咽宽度有统计学显著增加。此外，与腭平面相比确定下颌发散的角度（PP - MP°）显著减小。在对照组中，未观察到统计学显著差异。本研究表明，与对照组相比，RPE治疗可使OSA儿童的上气道矢状空间显著增加，并使下颌逆时针生长。这些结果表明，RPE引起的鼻腔增宽可能有助于恢复生理性鼻呼吸，并促进儿童下颌逆时针生长。这一证据证实了正畸医生在小儿患者OSA管理中的关键作用。
