A review on the influence of rapid maxillary expansion and mandibular advancement for treating obstructive sleep apnea in children

Abstract

This article reviews the orthodontic alternatives for treating pediatric obstructive sleep apnea (OSA). OSA is a multifactorial disease that impairs craniofacial growth and the general health of a developing child and negatively worsens their quality of life. Therefore, it is important to timely diagnose and treat OSA to avoid the progress of the disease, which could otherwise lead to systemic, neurocognitive and social consequences in the patients. In the transverse direction, compression of the maxilla could decrease the diameter of the upper airways and reduce airflow. In the sagittal direction, a retrognathic mandible positioned more posteriorly to the tongue could reduce the available upper airway space and decrease airflow during sleep. Orthopedic treatments for mild to moderate OSA include maxillary expansion using rapid maxillary expansion devices and mandibular advancement using mandibular advancement appliances, which are treatment options only when skeletal discrepancies exist and should be applied after appropriate individual diagnosis for each orthodontic patient. Currently, limited evidence suggests that these therapies could reduce the signs and symptoms and the apnea-hypopnea index (AHI) of OSA.

A Systematic Review of Oral Modifications Caused by the Prolonged Application of Continuous Positive Airway Pressure (CPAP) and Intraoral Appliances in Patients with Obstructive Sleep Apnea (OSA)

“…How-ever, oral appliances are preferred due to lower pain levels and, in some cases, dissatisfaction with symptom improvement in the alternative method [12]. Research has indicated that patients tend to favor oral appliances over CPAP or other treatments due to the comfort they provide and the resulting improvement in their quality of life [15,16].…”