Clinical application of orofacial myofunctional therapy combined with muscle functionnal appliance in postoperative rehabilitation of children with OSA

Abstract

Objective:To explore the clinical significance of orofacial myofunctional therapy combined with muscle functional appliance in postoperative rehabilitation of children with OSA. Methods:Sixty children were diagnosed as moderate-to-severe OSA with AHI≥5 and underwent adenoid and/or tonsillar surgery. Children were divided into two groups based on whether they were willing to receive orofacial myofunctional therapy and muscle functional appliance after surgery. Lateral cephalogram and portable polysomnography were performed, and the pediatric OSA-18 scale was filled under the guidance of medical staff. The treatment group received combined treatment with orofacial myofunctional therapy and muscle functional appliance. Results:①General condition and subjective symptoms: The total score of OSA-18 in the treatment group was 65.15±11.25 preoperatively and 49.83±7.09 1-month postoperatively, while the score in the control group was 64.69±10.23 preoperatively and 48.07±6.87 1-month postoperatively. The results showed that postoperative sleep, physical symptoms, emotional status, daytime lethargy and energy status of patients, and their influence on their guardians were significantly improved in both groups（P<0.01）. The improvement of sleep disturbance, physical condition, daytime lethargy, the influence on their guardians were greater in the treatment group than in the control group 6-month and 12-month post-operatively（P<0.05）. These findings suggested that oral and facial muscle functional training combined with muscle functional appliance can provide greater improvement in general condition and subjective symptoms in the treatment group. ②PSG: Postoperative AHI and OAI were significantly decreased in both groups, while LSaO2 was significantly increased （P<0.01）, indicating that sleep respiratory function was significantly improved in both groups after treatment. Patients in treatment group showed greater AHI reduction and LSaO2 improvement 6-month and 12-month postoperatively（P<0.01）, indicating that oral and facial muscle functional training combined with muscle functional appliance can provide greater improvement in airway obstruction symptoms and sleep respiration. ③Radiological changes: SNB Angle was increased（P<0.05） and ANB Angle was decreased significantly（P<0.05）, while SPP-SPPW, U-MPW and TB-TPPW increased significantly in airway measurement 6-month and 12-month postoperatively （P<0.01）, indicating that after combined treatment with oral muscle functional training and muscle functional appliance, the mandible was moved forward and rotated clockwise. Conclusion:The combined treatment with oral muscle functional training and muscle functional appliance is more effective in improving oral breathing, upper airway sagittal structure and sleep breathing, and can correct oral habits of children. The long-term effect needs further investigation.