Cephalometric Evaluation of Craniofacial Morphology in Pediatric Patients With Fully Diagnosed OSA With Distinct Sagittal Skeletal Malocclusions

Abstract

Study Objectives: To establish whether craniofacial and nasopharyngeal morphology, assessed through lateral cephalometry, in children properly diagnosed with obstructive sleep apnea (OSA) differed from that of non-likely OSA control children stratified based on sagittal malocclusion and to evaluate if there is any association with apneahypopnea index (AHI) severity. Materials and Methods: Various cephalometric measurements were compared between 22 children (mean age 8.8) with nocturnal polysomnography (nPSG) diagnosed OSA that had already adeno-tonsillectomy and a control group of 20 nonlikely OSA children (mean age 9.2) based on a negative pediatric sleep questionnaire (PSQ) results matched for age, sex and sagittal malocclusion. Results: Statistically significant increases in Go-Me and Ba^SN dimensions were observed among OSA children when higher AHI values (4.5 and 4 mm), whereas ANSPNS dimension was significantly increased in the Class II sample according to OSA severity (3.5 mm). No significant differences were identified for any variables among Class III based on OSA severity. In comparison to controls, in Class II both the angle between palatal plane and anterior cranial base and the angle of the flexure of cranial base were significantly reduced in OSA children (0.36 and 2.3 mm). In addition, an increased thickness of the upper adenoid profile and a reduced dimension of upper pharynx were observed (3.2 and 2.1 mm). In Class III a shorter bony nasopharynx was statistically significant (3.2 mm). Conclusions:The OSA sample showed some distinct craniofacial features compared to a non-likely OSA group. These differences were not consistently located when sagittal malocclusion was considered.

Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review

“…Both conditions determine a reduction of the overjet and overbite in the long term [105]. Although the clinical relevance of these findings remains questionable in most of the included studies, this review reinforces the need for OSAS patients to receive proper information about the potential occurrence of these dentoskeletal changes [109,110]. Occlusal monitoring should also be recommended, including the necessity for adjustments of prosthetic rehabilitations to maintain proper occlusal contact and function [111].…”

Pediatric obstructive sleep apnea—Dental professionals can play a crucial role

“…Increased total [10][11][12][13] and lower facial height, 12,[14][15][16] increased overjet, 8 increased open bite, 13 higher mandible angle, 11,14,17 retruded mandible, 4,8,16 labial incompetency, 4 and increased cervicomental angle 3 were observed in the pediatric OSA group. This group also presented inferiorly positioned hyoid bone, 12,16,18 shorter bony nasopharynx, 11,19 and reduced upper pharynx dimensions. 13,14,19 Additionally, some specific dental arch, upper airway volumetric and area differences were reported in children younger than six.…”

“…This group also presented inferiorly positioned hyoid bone, 12,16,18 shorter bony nasopharynx, 11,19 and reduced upper pharynx dimensions. 13,14,19 Additionally, some specific dental arch, upper airway volumetric and area differences were reported in children younger than six. In OSA children, the presence of narrow maxilla, 10 shorter mandibular dental arch, 10 lateral crossbites 10,14 and increased size of lower pharynx 14 were described.…”

“…In OSA children, the presence of narrow maxilla, 10 shorter mandibular dental arch, 10 lateral crossbites 10,14 and increased size of lower pharynx 14 were described. In a group of older children (7–14 years old), some other features were reported among an OSA group, including an increase in mandible length 19 and steeper mandibular plane 13 (Table 1).…”