Multidisciplinary Approach in a 12-Year-Old Patient Affected by Severe Obstructive Sleep Apnea: a Case-Report

Abstract

A 12-year-old boy shows a restless sleep and snoring episodes declaring himself tired during the day and the school lessons. On clinical examination the patient presents a second-class profile, a retrusive jaw with a small chin and an open nasolabial angle. From the intraoral examination a tonsillar hypertrophy is denoted. The patient is sent by the ear, nose, and throat specialist (ENT) and subsequently subjected to a polysomnography (PSG). The ENT decides to subject him to a tonsillectomy and the subsequent PSG shows an improvement in the obstructive sleep apnea syndrome (OSAS) pathology with an apnea-hypopnea index (AHI) improved from 25.5 episodes/hr to 3.4 episodes/hr. Subsequently a orthodontic treatment with twin-block was start to further reduce the apnea episodes. The last PSG highlights the success of the treatment further lowering the AHI to 0.7 episodes/hr. This case report shows how a multidisciplinary approach to OSAS is fundamental also in the young patient and that the orthodontist carried out in this area a fundamental task both in diagnosis and treatment.

Combined Surgical and Orthodontic Treatments in Children with OSA: A Systematic Review

“…The included studies were categorized into one randomized controlled trial (RCT) [ 27 ], two non-randomized controlled trials (NRCTs) [ 22 , 26 ], two observational case–control studies [ 24 , 25 ] and five case reports [ 18 , 19 , 20 , 21 , 23 ]. The sample sizes ranged from one to 80 subjects.…”

“…The mean age of participants before starting treatment ranged from 3 to 12 years. In three case reports [ 19 , 23 , 25 ], the participants were female. In the other studies, males made up a higher proportion than females.…”

“…In the other studies, males made up a higher proportion than females. The mean BMI varied between 15.75 and 22.4, however, only five studies reported the BMI [ 19 , 22 , 23 , 25 , 26 ]. To diagnose and evaluate the severity of OSA, eight studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 ] employed PSG and two [ 18 , 26 ] used home sleep studies (HSTs).…”

“…Two types of orthodontic treatment were carried out: RME or MA. However, only two case reports used MA as an orthodontic treatment [ 19 , 20 ]. Concerning the order of treatment, five studies [ 19 , 20 , 23 , 24 , 25 ] performed AT before orthodontic treatment, one case report [ 21 ] performed both treatments at the same time, one study [ 18 ] completed the orthodontic treatment before AT and three trials [ 22 , 26 , 27 ] compared both in different groups: AT followed by RME and RME followed by AT.…”

Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort

“…Given the growing recognition of orofacial characteristics as important developmental factors of sleep disorders, as well as their therapeutic implications in some disorders (such as OSAS, snoring and bruxism), dentists are nowadays more conscious of sleep disorders, with a potential role in the diagnostic and therapeutic process [ 22 , 23 , 24 , 25 , 26 ].…”