Efficacy of Rapid Maxillary Expansion in the Treatment of Obstructive Sleep Apnea Syndrome: A Systematic Review With Meta-analysis

Vale, Francisco; Albergaria, Mariana; Carrilho, Eunice; Francisco, Inês; Guimarães, Adriana Coutinho de Azevedo; Caramelo, Francisco; Maló, Luísa

doi:10.1016/j.jebdp.2017.02.001

Cited by 67 publications

(35 citation statements)

References 23 publications

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“…27,28 A recent systematic review evaluated the effect of tooth-borne RME on treatment of patients with obstructive sleep apnea. 29 The results of the meta-analysis showed that RME was an effective tool for normalization of apnea-hypopnea index (AHI) and improvement of obstructive sleep apnea syndrome in children. The present study demonstrated that both bone-and tooth-borne expanders appeared to be viable options for increasing the volume of the nasal cavity, as well as the nasopharynx.…”

Section: Discussionmentioning

confidence: 99%

Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion

Kavand

Lagravère

Kula

et al. 2019

The Angle Orthodontist

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Objectives: To compare changes in upper airway volume after maxillary expansion with bone- and tooth-borne appliances in adolescents and to evaluate the dentoskeletal effects of each expansion modality. Materials and Methods: This retrospective study included 36 adolescents who had bilateral maxillary crossbite and received bone-borne maxillary expansion (average age: 14.7 years) or tooth-borne maxillary expansion (average age: 14.4 years). Subjects had two cone beam computed tomography images acquired, one before expansion (T1) and a second after a 3-month retention period (T2). Images were oriented, and three-dimensional airway volume and dentoskeletal expansion were measured. Analysis of variance was used to test for differences between the two expansion methods for pretreatment, posttreatment, and prepost changes. Paired t-tests were used to test for significance of prepost changes within each method. Results: Both groups showed significant increase only in nasal cavity and nasopharynx volume (P < .05), but not oropharynx and maxillary sinus volumes. Intermolar and maxillary width increased significantly in both groups (P < .05); however, the buccal inclination of maxillary molars increased significantly only in the tooth-borne group (P < .05). There was no significant difference between tooth- and bone-borne expansion groups, except for the significantly larger increase in buccal inclination of the maxillary right first molar after tooth-borne expansion. Conclusions: In adolescents, both tooth- and bone-borne RME resulted in an increase in nasal cavity and nasopharynx volume, as well as expansion in maxillary intermolar and skeletal widths. However, only tooth-borne expanders caused significant buccal tipping of maxillary molars.

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Section: Discussionmentioning

confidence: 99%

Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion

Kavand

Lagravère

Kula

et al. 2019

The Angle Orthodontist

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“…The electrophysiological observations have demonstrated that the expiratory activity dominates in SWS [40]. The expiratory air flow in SWS can press against the sensory posterior palate and maxillary sinuses, and elicit the neurovascular regulation in head, as having been demonstrated that the palate may cause snoring and obstructive sleep apnea [43], while the maxillary expansion may treat the obstructive sleep apnea [44]. Besides, such expiratory neurovascular regulation in head in SWS can further be relayed up to eye, as evidenced by that many vascular diseases of eyes are associated with the obstructive sleep apnea [47] [48], in which the inspiration can still affect the eye similarly as in normal subjects while the expiration is affected somewhat from pressing the posterior palate and maxillary sinuses due to the physical obstacle.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that the palate may cause snoring and obstructive sleep apnea [43], while the maxillary expansion can treat the obstructive sleep apnea [44], demonstrating the presence of pressure from the expiratory air flow in SWS onto the posterior palate and maxillary sinuses. To analogize the yawns to SWS, their common expiratory activity would certainly be accounted into consideration.…”

Section: The Parallel Expiratory Driving Neurovascular Regulation In mentioning

confidence: 99%

One Neglected Yawning Function like Slow Wave Sleep: The Hypothetic Neurovascular Regulation from Mouth to Eye Driven by Expiration

Cai¹

2018

OALib

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In this article, it is considered that the mechanism of yawning function is correlative to sleep. It was revealed from the electrophysiological studies that the slow wave sleep (SWS) was characterized as decrease in excitation from inspiratory motoneurons more than from expiration, manifesting the expiratory activity dominating in SWS. To analogize yawning to SWS, herein it is only considered the expiration during yawning, pressing the sensory posterior palate and maxillary sinuses with air flow, so that yawns similarly regulate the vascular circulations from mouth to eye as SWS, as evidenced by the closure of eyelid in sleep and the association of ophthalmic diseases with obstructive sleep apnea. Besides, it is pointed out that the yawning expiration of high muscular tone elicits the muscular constriction at the back of neck, potentiating the expiratory press in mouth stronger than that of SWS. Accordingly, it is hypothesized that the yawning resembles the SWS to play the neurovascular regulation in head driven by expiration. It is speculated that the initiative mouth opening in yawns may have functions other than that considered here. It is expected that this new and neglected function of yawning with expiratory neurovascular regulation in head may add more to understand the complex functions of yawns.

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“…[55][56][57][58] The surgically assisted expansion of the maxilla is a less invasive procedure and presents promising results in well selected patients. 59 The maxillomandibular advancement surgery has a success rate close to 90% in cases where it is possible to achieve at least 10 mm of maxillary advancement, associated with the anticlockwise rotation of the mandible. 60 It is important to mention that the cure rate (AHI ≤5 events / hour) of this procedure is around 40% and the literature data refers to patients with a BMI lower than 35 kg/m 2 .…”

Section: Upper Airway Stimulationmentioning

confidence: 99%

Obstructive Sleep Apnea Surgical Options: A Phenotypical Approach

Thuler¹,

Yui²,

Vanier³

et al. 2019

International Journal of Head and Neck Surgery

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As a consequence of being a multifactorial disease, multiple mechanisms are involved in OSA pathophysiology, including not only anatomical causes but also causes related to the muscular response during sleep and its effect on pharyngeal wall resistance, both predisposing the upper airway to collapse.The scientific evidence for OSA surgical treatment suggests that it must be indicated in well-selected cases, mostly in patients presenting anatomical causes, either by tissue hypertrophy or by craniofacial deformities.Electrical stimulation of the hypoglossal nerve presents promising results, reinforcing the role of the muscular response in OSA pathophysiology. The greatest challenge in choosing the best surgical treatment option is to define the predominant factor in each candidate, concept called phenotype, which explains the existence of numerous surgical options, presented in a comprehensive way in this paper.

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Efficacy of Rapid Maxillary Expansion in the Treatment of Obstructive Sleep Apnea Syndrome: A Systematic Review With Meta-analysis

Cited by 67 publications

References 23 publications

Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion

Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion

One Neglected Yawning Function like Slow Wave Sleep: The Hypothetic Neurovascular Regulation from Mouth to Eye Driven by Expiration

Obstructive Sleep Apnea Surgical Options: A Phenotypical Approach

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