Efficacy of Rapid Maxillary Expansion with or without Previous Adenotonsillectomy for Pediatric Obstructive Sleep Apnea Syndrome Based on Polysomnographic Data: A Systematic Review and Meta-Analysis

Abstract

Aim: To systematically review international literature related to rapid maxillary expansion (RME) as the treatment for obstructive sleep apnea syndrome (OSAS) in children less than 18 years-old, followed by a meta-analysis of the apnea-hypopnea index (AHI) before and after RME, with or without a previous adenotonsillectomy (AT). Methods: Literature on databases from PubMed, Wiley online library, Cochrane Clinical Trials Register, Springer link, and Science Direct were analyzed up to March 2020. Two independent reviewers (S.G. and R.J.M.) screened, assessed, and extracted the quality of the publications. A meta-analysis was performed to compare AHI values before and after the treatment with RME. Results: Six studies reported outcomes for 102 children with a narrow maxillary arch suffering from OSAS with a mean age of 6.7 ± 1.3. AHI improved from a M ± SD of 7.5 ± 3.2/h to 2.5 ± 2.6/h. A higher AHI change in patients with no tonsils (83.4%) and small tonsils (97.7%) was detected when compared to children with large tonsils (56.4%). Data was analyzed based on a follow-up duration of ≤3 year in 79 children and >3 years in 23 children. Conclusion: Reduction in the AHI was detected in all 102 children with OSAS that underwent RME treatment, with or without an adenotonsillectomy. Additionally, a larger reduction in the AHI was observed in children with small tonsils or no tonsils. A general improvement on the daytime and nighttime symptoms of OSAS after RME therapy was noted in all the studies, demonstrating the efficacy of this therapy.

Catering Work Profession and Medico-Oral Health: A Study on 603 Subjects

“…This aspect is directly linked with what is mentioned in the introduction section, since it is observed that overweight is one of the predisposing factors of OSAS, and it is a common aspect in catering workers. Diagnosis and treatment of OSAS is very relevant for the health of the population [ 13 , 15 ]. Dentists should detect signs and symptoms of obstructive sleep apnea syndrome.…”

“…Similar findings were illustrated by Marty et al 2017 [ 36 ] stating that custom-fitted MAD improved respiratory and somnolence parameters, with response rates similar to those published in the literature with other devices. Moreover, Quinzi et al conducted a meta-analysis on 102 children affected by obstructive sleep apnea syndrome and concluded that on a mean follow-up duration of ≤3 years, a decrease of 66.1% of apnea-hypopnea index was detected in the sample after rapid maxillary expansion treatment [ 13 ].…”

“…Thus, the screening of symptoms of this particular disorder (e.g., daytime fatigue or snoring) is important in the catering workers profession [ 2 ]. In fact, the accumulation of visceral fat in obese patients is a key risk factor for OSAS [ 4 , 8 , 13 ]. The diagnosis and treatment of this disease is often neglected, either by the lack of knowledge of dentists and physicians or by non-adherence of patients to treatment.…”

“…However, diagnosing and treating is of fundamental importance and involves multiple specialties cooperating with each other [ 14 , 15 ]. The treatments can range from weight loss to maxillomandibular advancement and palatal expansion [ 13 , 15 ].…”

Acceleration Techniques for Teeth Movements in Extractive Orthodontic Therapy

“…There is a 4-5-month window during which the bone physiology changes, where the trabecular bone loses density and selectively offers less resistance to OTM. In AOO (Accelerated Osteogenic Orthodontics), non-activated teeth provide a relative anchorage for activated teeth that move faster (Figure 3) [33,65,66]. Several studies have been conducted to investigate the efficacy of this strategy.…”