Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis

Buck, Lloyd M.; Dalci, Oyku; Darendeliler, M. Ali; Papageorgiou, Spyridon N.; Papadopoulou, Alexandra K.

doi:10.1093/ejo/cjw048

Cited by 46 publications

(60 citation statements)

References 70 publications

(75 reference statements)

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“…NCV was reported in four SRs by means of acoustic rhinometry (AR), or CBCT . Gordon and colleagues reported a statistically significant increase in the NCV after ME, both in basal condition (0.06 cm 3 in the control group and 0.65 cm 3 in the treated group) and after the use of decongestants (0.03 cm 3 in the control group and 1.44 cm 3 in the treated group) .…”

Section: Resultsmentioning

confidence: 99%

“…Afterwards, 16 manuscripts were included for full‐text reading, of which eight studies were excluded according to the pre‐determined exclusion criteria (for the list of full‐text excluded and reason for the exclusion see Table ) and the most common exclusion criterion was the absence of a systematic search strategy. Finally, eight SRs were included in the current overview . The selection process is given in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the reported increase was significantly greater than that observed in control group due to normal growth and it was stable for at least 11 months after ME. In the MA by Buck and colleagues, NCV was measured before and after treatment, showing a significant increase in 1218.3 mm 3 . In the same study, also NCV pre‐ and post‐retention (8 months) was measured, showing a stable increase from baseline (1143.9 mm 3 ) .…”

Section: Resultsmentioning

confidence: 99%

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Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta‐analyses

Bucci

Montanaro

Rongo

et al. 2019

J of Oral Rehabilitation

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Summary Background Constricted maxilla is frequently associated with reduced nasal airway dimensions. Wheatear skeletal maxillary expansion (ME) is effective on the dimension of the upper airways is still a debated issue. Objectives This overview aimed to report the evidence provided by systematic reviews (SRs) on the effect of ME on the upper airways and to assess the methodological quality of the included SRs. Methods Six electronic databases have been explored up to November 2017. After title and abstract screening, SRs addressing the effects of fixed palatal expanders on the dimension and function of the nasal airways were included. The methodological quality of the included SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Review (AMSTAR‐2). Results Eight SRs were included. The methodological quality of most of the included SRs ranged between low and critically low. One SR was rated of high quality. A significant increase in nasal linear dimensions was reported both in the short and long term, but supported by low‐/critically low‐quality SRs. The significant increase in nasal cavity volume was the only outcome supported by a high‐quality SR Controversial results were found with regards to nasal function. Conclusion Whenever a constricted maxilla is present general dentists, paediatricians and ENTs should be familiar with the potential improvement provided by ME. However, due to the low/critically low quality of SRs supporting these results, ME cannot be indicated only for upper airways enhancement, but should be supported by an orthodontic indication.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta‐analyses

Bucci

Montanaro

Rongo

et al. 2019

J of Oral Rehabilitation

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“…Orthodontists use RME in children to correct maxillary transverse deficiency by splitting the midpalatal suture of narrow maxillary arch. Evidence has shown that RME increases nasal cavity volume and decreases nasal resistance . Our results show that although RME is less effective in reducing AHI, it is one of the most effective interventions to improve lowest SaO 2 .…”

Section: Discussionmentioning

confidence: 53%

“…Evidence has shown that RME increases nasal cavity volume and decreases nasal resistance. 60,61 Our results show that although RME is less effective in reducing AHI, it is one of the most effective interventions to improve lowest SaO 2 . RME is significantly more effective than steroids + LTRAs, steroids, and placebo medications to improve lowest SaO 2 based on low to very low quality of evidence.…”

Section: Discussionmentioning

confidence: 73%

Management of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis

Lin

et al. 2019

Int J Paed Dentistry

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Background Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. Aim Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta‐analysis. Design Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea‐hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2). Frequentist approach to network meta‐analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. Results Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta‐analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO2. No comparisons showed statistical significance in reducing ODI. Conclusions Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.

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

Fagundes

Flores-Mir

2021

Pediatric Pulmonology

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The significant contribution of dental professionals to the management of selected adult obstructive sleep apnea (OSA) cases is understood. Among children, it has also been suggested that dental professionals may also help screen and manage this morbidity in selected cases. It has also been noted that our understanding of pediatric OSA lags significantly behind adult OSA. During the screening process for potential pediatric OSA cases, dental professionals may be quite helpful as specific craniofacial abnormalities have been previously associated with pediatric OSA, including Class II malocclusion, vertical facial growth and maxillary transversal deficiency. As dental professionals assess children more frequently than physicians, they can help screen sleep‐disordered breathing signs and symptoms using validated questionnaires. In more advanced cases, orthodontists may be leading contributors to the management of selected cases where a craniofacial involvement is suspected. Rapid maxillary expansion and mandibular or maxillary anterior repositioning devices have been proposed as managing alternatives. So far, there is no substantial evidence if these approaches can be adopted to treat OSA fully or if the reported OSA signs and symptoms improvements observed in a selected group of patients are stable long‐term. Nevertheless, dentists and orthodontists' integration into a transdisciplinary team should be encouraged to play a significant role. This review discusses dentists or orthodontists' potential contribution to screen and manage selective pediatric OSA patients as part of a transdisciplinary team.

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Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis

Abstract: Australian Society of Orthodontics Foundation for Research and Education Inc.

Cited by 46 publications

References 70 publications

Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta‐analyses

Effects of maxillary expansion on the upper airways: Evidence from systematic reviews and meta‐analyses

Management of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis

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

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