Rapid maxillary expansion before and after adenotonsillectomy in children with obstructive sleep apnea

Abstract

Adenotonsillectomy is not always successful in controlling obstructive sleep apnea (OSA) in children, and orthodontic treatment may be a helpful adjunction and sometime an important alternative. A total of 80 nonoverweight children (37 girls) with a high and narrow hard palate, based on an indepth orthodontic evaluation, were subdivided into two groups based on presence/absence of chronic adenotonsillar inflammatory problems as determined by full otolaryngological examination, with recruitment of 40 children in each group. Patients with evidence of chronic inflammation were treated with adenotonsillectomy first (group II), while all other children had rapid maxillary expension (RME) first (group I). In all children, clinical interviews and clinical evaluations, frontal and lateral cephalometry, and polysomnography were performed at entry. Four months after end of treatment, the initial evaluation was repeated in all children. Children incompletely treated were offered to cross-over to the other treatment venue. At entry, there was no significant difference between the monitored respiratory polygraphic variables between the two groups. At the 4-month follow-up, 15 subjects treated with RME were considered as cured compared to 6 patients after adenotonsillectomy, and absence of improvement was observed in 8 children with RME and 16 with adenotonsillectomy. After cross-over to the other treatment, involving 42 subjects due to 17 drop-outs between treatment 1 and 2,, three children were still having residual sleep disordered breathing at the 12-month follow-up, while normal breathing during sleep was observed in all others. With appropriate clinical investigation, prepubertal children with OSA and narrow maxilla may have better treatment outcome when treated with orthodontics than with adenotonsillectomy; and polygraphic and even better polysomnographic documentation of clinical impression is always needed posttreatment.