Pierre Robin Research Articles

Comparison of the Effectiveness of Orthodontic Treatment with Adenotonsillectomy Procedures in Children with Obstructive Sleep Apnea (OSA)

Background: Obstructive Sleep Apnea Syndrome (OSA) is a syndrome of total or partial obstruction of the airways, leading to significant disturbances with varying clinical impact. In children, the main cause is thought to be overgrowth (hypertrophy) of the tonsils and adenoids, as well as structural abnormalities in Pierre Robin and Down Syndrome. The airway structures are significantly narrowed in children with head-face bone abnormalities or craniofacial anomalies, causing them to experience airway obstruction even in the absence of adenoid hypertrophy. The incidence of OSA in children needs to be observed as well as rising risk factors such as obesity. Pediatric obstructive sleep apnea (OSA) is typically treated with an adenotonsillectomy and the use of orthodontic procedures including rapid maxillary expansion and mandibular advancement devices. Each approach has different treatment advantages. Systematic reviews and meta-analysis of OSA treatments have been reported, however there have been relatively few comparisons of various treatments. In a systematic review of the evidence for the efficacy of AT and orthodontic treatment, Templier et al. concluded that combined AT orthodontic treatment (RME and/or MAD) was more effective than either therapy alone for treating OSA in pediatric patients. Objective: To systemically analyze the literature on the effectiveness of orthodontic treatment with adenotonsillectomy surgery in children with obstructive sleep apnea (OSA) and to identify differences in the two treatments’ effectiveness. Conclusion and implications: The effectiveness of adenotonsillectomy, orthodontic treatment, and orthodontic treatment combined with adenotonsillectomy was assessed in children with mild OSA and mandibular retrognathia. That study, which needed a large sample size (352 children) and had a high dropout rate, revealed that combine orthodontic adenotonsillectomy (RME and/or MAD treatment) was more effective when given simultaneously than when given individually for treating OSA in pediatric patients. To date, the effectiveness of these two treatments cannot currently be compared due to a lack of strong evidence. If the treatment outcomes were unsatisfactory at 7 months after the initial treatment, subjects could receive further treatment following assessment by a stomatologist and ear, nose, and throat (ENT) specialist. Limitations: Of the 10 publications included in this review, 8 were randomized controlled trials, the remaining 2 non-randomized research journals were vulnerable to many biases that impair the certainty of the evidence gained, especially by confounding factors and the lack of control groups.

Epidemiology of Rare Craniofacial Anomalies: Retrospective Western Australian Population Data Linkage Study

To describe birth prevalence of rare craniofacial anomalies and associations with antenatal and perinatal factors. All live and stillbirths in Western Australia between 1980 and 2010 were identified from the Western Australian Birth Registrations and the Midwives Notification System (also provides information on antenatal and perinatal factors). Rare craniofacial anomalies (craniosynostosis, craniofacial microsomia, and others [Pierre Robin, Van der Woude, and Treacher Collins syndrome]) were ascertained from the Western Australian Register of Developmental Anomalies and linked to other data sources. Trends in prevalence, adjusted for sex and Indigenous status, were investigated by Poisson regression and presented as annual percent change (APC). Strengths of association of related factors were assessed using multivariable log-binomial regression adjusted for sex, Indigenous status, birth year, socioeconomic disadvantage, and remoteness and reported as risk ratios with 95% CIs. There was a temporal increase in prevalence of metopic synostosis (APC 5.59 [2.32-8.96]) and craniofacial microsomia (Goldenhar syndrome) (APC 4.43 [1.94-6.98]). Rare craniofacial anomalies were more likely among infants born preterm, as twins or greater-order multiples, with growth restriction, to older parents, to mothers undertaking fertility treatments, and with pre-existing medical conditions, specifically epilepsy, diabetes, or hypothyroidism. Prenatal identification of rare craniofacial anomalies was uncommon (0.6%). Our findings indicate a steady increase over time in prevalence of metopic synostosis and craniofacial microsomia (Goldenhar syndrome). Possible associations of fertility treatments and pre-existing maternal medical conditions with rare craniofacial anomalies require further investigation.

Distribution and risk factors of cleft lip and palate on patients from a sample of Damascus hospitals - A case-control study

ObjectiveThis case-control study was conducted to determine the distribution of cleft lip and/or palate, its association with family history, syndromes and serous otitis media (SOM), and its relation with several risk factors. MethodsThe case group comprised of 133 children born with cleft lip and/or palate, and the control was 133 non-cleft children born full-term. Data was collected including age, gender, origin and risk factors for cleft lip and palate from patients’ files, interviewing supervising doctors, and the patient. Data was then filled out into Excel and underwent statistical analysis using the Goodness of Fit Test and Chi-Square to determine the significance of the results. ResultsCleft lip and/or palate (CL/P) was slightly higher among males (51.9%). Combined cleft lip and palate (CLP) was the most common presentation (42.1%). Cleft lips (CL) were mostly complete cleft (51,5%) incomplete cleft comprised (41.1%), In the sample 35.4% of the cases were bilateral, 32.3% were right unilateral, 28.3% were left unilateral and 4% were median cleft. Cleft palate (CP) was mostly complete (46.6%) there were incomplete clefts (40%), and the remainder were submucosal (13.4%). Isolated CL and combined CLP were higher in males (51.6%, 62.5% respectively). Both isolated CP and Tessier anomaly were more common in females (64.7% and 58.3% respectively). consanguineous marriages accounted for 36.1% of cases. 21.8% of the sample had a first-degree relative and 24.8% had a second degree relative born with CL/P. There were only 7 cases (0.05%) of syndromic CL/P: Down's (4), Pierre Robin's (2), and Van der Woude Syndrome (1). A relationship was found between CL/P and the risk factors: taking anticonvulsants (without specifying the drug) (p = 0.025, OR = 10.73 C.I. 95%), taking retinoic acid (p-value = 0.049, OR = 4.75 C.I. 95%), not consuming folic acid (p-value = 0.00, OR = 28.23 C.I. 95%), and smoking cigarettes (p-value = 0.046, OR = 2.00 C.I. 95%). There was no relationship with maternal alcohol consumption or maternal diabetes (p-values = 0.652 and 0.210, respectively). SOM was present in 63.2% of patients with CL/P and were mostly isolated CP. ConclusionCL/P was only slightly higher among males. The most common condition was CLP. There was higher incidence of CL/P among second-degree relatives than first degree. Down's, Pierre Robin's, and Van der Woude Syndromes may be associated with CL/P. Taking anticonvulsants, taking retinoic acid, not consuming folic acid, and smoking cigarettes all have a role in the incidence of CL/P. More than half of the sample had an associated SOM.

Parental Experiences in the Management of Children with Syndromic Craniofacial Diagnoses in Malaysia

INTRODUCTION: Patients with syndromic craniofacial diagnoses (SCD) require coordinated overall management and remain a parental challenge. This study assessed the parental experience and psychological outcome, as well as the evaluation of professional and community support, received in Malaysia. MATERIAL AND METHODS: The Craniofacial Experiences Questionnaire (CFEQ) was used to assess parents of SCD children registered with the Combined Oro-Craniomaxillofacial Clinic in University Malaya Medical Centre, Kuala Lumpur. RESULTS: Thirty parents participated in this study with their children’s age ranged from 2 months to 14 years old diagnosed with Apert, Crouzon, and Pfeiffer syndromes, as well as other SCD such as Goldenhar, Pierre Robin, and Nager. The majority of parents felt anxious whenever their child underwent an operation despite having positive perceptions of the outcome. Most respondents did not see the condition as handicap although 6.7% of parents were embarrassed by their child’s appearance. The majority of the respondents were worried about the financial implication, had to be occasionally absent from work due to their child’s regular appointments, and felt depressed while only a quarter of respondents socialised less and struggled to meet parenting needs. Most respondents received positive comments, were treated with respect, and obtained adequate support from both health professionals and the community with regards to their childcare. CONCLUSIONS: Although most parents were concerned about their children’s condition, only minimal social stigmatisation was noted. Parents were satisfied with the emotional and physical support received from healthcare professionals and the community. Understanding parental experience may contribute to the improvement of multidisciplinary syndromic craniofacial management.

Pierre Robin and breathing: What to do and when?

Robin sequence is characterized by mandibular retrognathia, airway obstruction, and glossoptosis; 80%-90% also have a cleft palate. Various treatment approaches exist, and although controlled studies are rare, objective assessment of treatment outcomes that address the leading clinical issues, namely obstructive sleep apnea and failure to thrive, are essential. Sleep-disordered breathing may be detected using cardiorespiratory polygraphy or polysomnography. Pulse oximetry alone may miss infants with frequent obstructive apneas, yet no intermittent hypoxia. Among conservative treatment options, the Tubingen Palatal Plate with a velar extension shifting the tongue base forward is the only approach that corrects the underlying anatomy and that has undergone appropriate evaluation. Of the surgical treatment options, which are not necessarily the first line of therapy, mandibular distraction osteogenesis (MDO) is effective and has been most extensively adopted. Notwithstanding, it is puzzling that MDO is frequently used in some countries, yet hardly ever in others, despite similar tracheostomy rates. Thus, prospective multicenter studies with side-by-side comparisons aimed at identifying an optimal treatment paradigm for this potentially life-threatening condition are urgently needed.

ANESTHETIC CONCERNS AND AIRWAY MANAGEMENT OF A 12-YEAR-OLD CHILD BORN WITH CRANIOFACIAL CLEFT: A CASE REPORT

Children born with craniofacial anomalies are usually associated with syndromes such as Treacher Collins, Pierre Robin, Klippel–Feil, craniosynostosis, and its related disorders. These children present with difficult challenges for the anesthesiologist, one being the difficult mask ventilation and intubation. With the recent advances in modern craniofacial surgeries, these facial defects can be corrected to a large extent and thus, a person can lead a normal life. It is important to understand the development and characteristics of the more common anomalies and the challenges associated with them so that we can plan safe anesthesia for these patients. Here, we describe the successful anesthetic management of a 12-year-old child with left Tessier type 12 naso-orbital cleft with a cleft lip and high arched palate. The child was posted for corrective surgery of the facial cleft.

ACUTE BRADYCARDIA AND ATELECTASIS AFTER ENDOTRACHEAL INTUBATION IN CLEFT CHILD: A CASE REPORT AND REVIEW OF ANESTHESIA MANAGEMENT IN CLEFT LIP AND PALATE PATIENTS

The most common craniofacial anomalies in children are cleft lip and palate with an incidence of 1:800 live births. Associated anomalies are common in patients with both cleft lip and palate (28%). Most commonly these anomalies affect the vertebral column or limb (33%) and the cardiovascular system (24%). Almost 150 syndromes are associated with cleft deformities and well known are Pierre Robin’s, Goldenhar, and Treacher Collins syndrome. On an average, 5–10% of these patients have congenital heart disease (CHD) such as ventricular septal defect, atrial septal defect, and cyanotic CHD. Until now, there are no clear guidelines regarding the timing of cleft surgery, especially if the child is having airway problems. In this article, we report an unusual case of a 6-month-old female child with weight of 6.5 kg with no medical history, who underwent surgical repair of congenital cleft lip in general anesthesia, leading to sudden collapse.

Predicting Adverse Perioperative Events in Patients Undergoing Primary Cleft Palate Repair.

This study aimed to identify risk factors for adverse perioperative events (APEs) after cleft palatoplasty to develop an individualized risk assessment tool. Retrospective cohort. Tertiary institutional. Patients younger than 2 years with cleft palate. Primary Furlow palatoplasty between 2008 and 2011. Adverse perioperative event, defined as laryngo- or bronchospasm, accidental extubation, reintubation, obstruction, hypoxia, or unplanned intensive care unit admission. Three hundred patients averaging 12.3 months old were included. Cleft distribution included submucous, 1%; Veau 1, 17.3%; Veau 2, 38.3%; Veau 3, 30.3%; and Veau 4, 13.0%. Pierre Robin (n = 43) was the most prevalent syndrome/anomaly. Eighty-three percent of patients received reversal of neuromuscular blockade, and total morphine equivalent narcotic dose averaged 0.19 mg/kg. Sixty-nine patients (23.0%) had an APE, most commonly hypoventilation (10%) and airway obstruction (8%). Other APEs included reintubation (4.7%) and laryngobronchospasm (3.3%). APE was associated with multiple intubation attempts (odds ratio [OR] = 6.6, P = .001), structural or functional airway anomaly (OR = 4.5, P < .001), operation >160 minutes (OR = 2.2, P = .04), narcotic dose >0.3 mg/kg (OR = 2.3, P = .03), inexperienced provider (OR = 2.1, P = .02), and no paralytic reversal administration (OR = 2.0, P = .049); weight between 9 and 13 kg was protective (OR = 0.5, P = .04). Patients were risk-stratified according to individual profiles as low, average, high, or extreme risk (APE 2.5%-91.7%) with excellent risk discrimination (C-statistic = 0.79). APE incidence was 23.0% after palatoplasty, with a 37-fold higher incidence in extreme-risk patients. Individualized risk assessment tools may enhance perioperative clinical decision making to mitigate complications.

Co-Occurrence of Natal Teeth With Rapidly Involuting Congenital Hemangioma: A Case Report

We present in this report a case of an infant girl who was born with natal teeth along with an ulcerated rapidly involuting congenital hemangioma (RICH) on her thigh. RICH is a benign vascular tumor that is more common than other congenital hemangioma subtypes. Natal teeth are a birth anomaly that occurs in isolated form or in association with different syndromes like Ellis-van Creveld, Pierre Robin, Soto and Hallerman-Streiff. We have performed an intensive literature search to determine if there is a link between natal teeth and RICH, but no article has described any association thus far. It remains unclear whether this is a mere coincidence or whether there are common genetic factors that play a role in benign tumor growth and eruption of premature teeth. Further reports on the co-occurrence may shed light on possible common risk factors contributing to natal teeth and congenital hemangioma. J Med Cases. 2016;7(4):120-122 doi: http://dx.doi.org/10.14740/jmc2433w

Isolated versus Pierre Robin Sequence Cleft Palates: Are They Different?

To determine if there are any differences in size between isolated cleft palates (CPs) and those associated with Pierre Robin (PR) sequence. Prospective case series. Tertiary care hospital. From 1993 to 2011, nonsyndromic isolated CP and PR sequence cases were classified as severe if the patients had respiratory or feeding difficulties. While patients were under general anesthesia, seven anatomical cleft parameters were prospectively measured in the operating room at the time of palatoplasty. Fifty-seven patients without the PR sequence and 36 patients with the PR sequence were enrolled. Within the PR group, 61% of cases were mild and 39% were severe. A larger soft palate width was found to be statistically significant in a comparison of the severe PR cases with the isolated clefts (P < .005) and mild PR (P < .05), respectively. For the hard palate width, a statistically significant difference was found in a comparison of the narrower isolated cleft cases with the mild PR (P < .05) and the severe PR cases (P < .05), respectively. A shorter cleft length was found to be statistically significant in isolated clefts versus both the clefts of the mild PR (P < .05) and the severe PR cases (P < .05). The patients with PR sequence presented statistically significant different cleft characteristics. The increased width of the cleft at the soft palate level showed the greatest correlation with increased airway and feeding problems.

Aberrant subclavian artery origin in tetralogy of Fallot with pulmonary stenosis is associated with chromosomal or genetic abnormality

We determined the relationship between aortic arch anatomy in tetralogy of Fallot with pulmonary stenosis and chromosomal or genetic abnormality, by performing analysis of 257 consecutive patients undergoing surgical repair from January, 2003 to March, 2011. Chromosomal or genetic abnormality was identified in 49 of the 257 (19%) patients. These included trisomy 21 (n = 14); chromosome 22q11.2 deletion (n = 16); other chromosomal abnormalities (n = 9); CHARGE (n = 2); Pierre Robin (n = 2); and Kabuki, Alagille, Holt-Oram, Kaufman McKusick, Goldenhar, and PHACE (n = 1 each). Aortic anatomy was classified as left arch with normal branching, right arch with mirror image branching, left arch with aberrant right subclavian artery, or right arch with aberrant left subclavian artery. Associated syndromes occurred in 33 of 203 (16%) patients with left arch and normal branching (odds ratio 1); three of 36 (8%) patients with right arch and mirror image branching (odds ratio 0.4, 95% confidence interval 0.1-1.6); seven of eight (88%) patients with left arch and aberrant right subclavian artery (odds ratio 36, 95% confidence interval 4-302); and six of 10 (60%) patients with right arch and aberrant left subclavian artery (odds ratio 8, 95% confidence interval 2-26). Syndromes were present in 13 of 18 (72%) patients with either right or left aberrant subclavian artery (odds ratio 15, 95% confidence interval 4-45). Syndromes in patients with an aberrant subclavian artery included trisomy 21 (n = 4); chromosome 22q11.2 deletion (n = 5); and Holt-Oram, PHACE, CHARGE, and chromosome 18p deletion (n = 1 each). Aberrant right or left subclavian artery in tetralogy of Fallot with pulmonary stenosis is associated with an increased incidence of chromosomal or genetic abnormality, whereas right aortic arch with mirror image branching is not. The assessment of aortic arch anatomy at prenatal diagnosis can assist counselling.

Pierre Robin Sequence児の呼吸管理方法の検討

Pierre Robin Sequence児の呼吸管理方法の検討

Audiometrische Daten subjektiver und objektiver Hörprüfungen bei Kindern mit orofazialen Spaltbildungen - eine prospektive Längsschnittuntersuchung

The hearing status of children with orofacial clefts was analysed using objective hearing tests over an average of 38.7 months following soft palate closure. We investigated the influence of: timing of closure, type of cleft, importance of grommets insertion and concomitant craniofacial syndromes such as Pierre Robin (PRS). 70 children were selected for prospective audiometric testing twice yearly. The average age at surgical closure was 8.3 months. More than half had PRS, but their hearing levels were not significantly different from those who did not. Neither did cleft type or timing of closure seem to have any influence. The portion of children with a hearing level better than 30 dB increased after repair from 38.6% to 81.4%--significant at 0.001 and remained stable more than 24 months later. In the group of children with concomitant grommets insertion, it was also found that also more than 80% achieved longstanding normal hearing. There is no long lasting hearing loss which has any relevance to speech. The only intervention of any consequence is insertion of pressure equalising/tympanostomy tubes (grommets) in cases of primary palatal clefts when hearing is substantially impaired at the time of soft palate closure.

The Aerodigestive Clinic: Multidisciplinary Management of Pediatric Dysphagia

Abstract The purposes of this article are (a) to explore the relationship between pediatric upper airway obstruction and dysphagia and (b) to highlight the benefits of using a multidisciplinary approach when assessing infants and children with upper respiratory and swallowing disorders. The functions of breathing and swallowing are tightly coordinated in infants and young children, and pediatric upper airway disorders can often adversely affect the swallowing mechanism and may even predispose the individual to aspiration. Some of the more common causes of pediatric airway obstruction seen in this setting are laryngomalacia, vocal fold paralysis, laryngeal cleft, and Pierre Robin's sequence. In the setting of all of these disorders, associations may also exist with gastroesophageal reflux (GER) and laryngopharyngeal reflux, and this topic is also reviewed. In the multidisciplinary assessment of young children with aerodigestive disorders, fiberoptic flexible endoscopic evaluation of swallowing has gained traction as a useful test for simultaneous evaluation of pediatric upper airway obstruction and dysphagia and has provided complimentary information to the more traditional pediatric videofluoroscopic swallowing evaluation. A representative case study is provided that illustrates the relationship between pediatric upper airway obstruction and dysphagia and demonstrates the effectiveness of a multidisciplinary approach.

Complete and isolated congenital aglossia: case report and treatment of sequelae using rapid prototyping models

Aglossia is a rare anomaly caused by failed embryogenesis of the lateral lingual swellings and tuberculum impar from the fourth to eighth gestational weeks. Most cases of aglossia and hypoglossia reported in the literature were associated with limb deformities, cleft palate, deafness, situs inversus, and several syndromes, such as Moebius, Pierre Robin, and Hanhart. This report describes the case of a 14-year-old girl with complete aglossia. As the tongue plays an important role in facial growth, this patient had dentofacial deformities that affected the mandible in particular. She also had severe malocclusion and agenesis of permanent mandibular incisors. Thyroid dysfunction, recently associated with aglossia, was not observed. The use of rapid prototyping models of the jaws as an aid to osteogenic distraction of the mandibular symphysis is also described.

Associated malformations in patients with anorectal anomalies

Patients with congenital anorectal malformations (ARM) often have other associated congenital defects. The reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalences at birth of associated malformations in patients of a geographically defined population with ARM which were collected between 1979 and 2003 in 334, 262 consecutive births. Of the 174 patients with ARM during the study period, 49.4% had associated malformations. Patients with associated malformations were further classified into groups with nonsyndromic multiple congenital anomalies; chromosomal abnormalities; nonchromosomal syndromes including Townes–Brocks, Walker–Warburg, Ivemark, Fetal alcohol, Klippel–Feil, Pallister–Hall, Facio-auriculo-vertebral spectrum, deletion 22q11.2; sequences, including OEIS, Pierre Robin and sirenomelia; and associations including VATER and MURCS. Malformations of the urogenital system (81.1%) and of the skeletal system (45.5%) were the most common other congenital anomalies occurring with ARM in multiply malformed patients without recognized entities, followed by malformations of the cardiovascular system, the digestive system, and the central nervous system. Weight, length, and head circumference of children with ARM and multiple associated malformations were lower than in controls, as was the weight of the placenta. Prenatal detection by fetal ultrasonographic examination was rarely made in isolated ARM. However, even in multiple associated malformations, prenatal detection by fetal ultrasonographic examination had a low sensitivity, 36%. In conclusion the overall prevalence of malformations, which was close to 1 in two infants, emphasizes the need for a thorough investigation of patients with ARM. A routine screening for other malformations may be considered in patients with ARM, and genetic counseling seems warranted in most of these complicated cases.

Anaesthesia for cleft palate surgery

Cleft lip and palate repair are common surgical procedures in paediatric centres. With careful attention to detail (e.g. watching for tube kinking and endobronchial intubation with gag insertion) anaesthesia should be relatively straightforward in most cases. Associated problems such as Pierre Robin or Treacher Collins can make airway management very difficult. These associated syndromes are mostly seen with isolated cleft palate. Postoperatively, close monitoring of airway patency is required. If this is likely to be a problem, a nasopharyngeal tube can be inserted for the first 24–48 hours. This can be done best in theatre by the surgeon using a cut short endotracheal tube. If necessary, this may be done carefully in recovery or on the ward by an experienced doctor. Airway monitoring should involve direct nursing observation and saturation monitoring while breathing air. This should take place in an high-dependency unit setting for the first 24 hours after palate surgery.

The Genetic Basis of the Pierre Robin Sequence

The Pierre Robin Sequence (PRS) is subgroup of the cleft palate population. As with the etiology of cleft lip or palate, the etiology of PRS is generally unknown. Some factors are suggestive of a genetic basis for PRS. The purpose of this study was to compare genetic information on PRS available in the literature and in a cytogenetic database to facilitate focused genetic studies of PRS. After searching Medline for "pierre robin and genetics," the Mendelian Cytogenetics Network database for "robin" and "pierre robin," and two reviews from the Human Cytogenetics Database for "cleft palate" and "micrognathia," a comparison of the data and a search in Online Mendelian Inheritance in Man (OMIM) Gene Map was performed to identify relevant candidate genes. The findings revealed consistency to a certain degree to loci 2q24.1-33.3, 4q32-qter, 11q21-23.1, and 17q21-24.3. A search in the OMIM Gene Map provided many candidate genes for PRS in these regions. The GAD67 on 2q31, the PVRL1 on 11q23-q24, and the SOX9 gene on 17q24.3-q25.1 are suggested to be of particular importance. Candidate loci and a few potential candidate genes for PRS are proposed from the present study. This may enable researchers to focus their effort in the studies of PRS.

OSAS in children

Background: Major risk factors for obstructive sleep apnea syndrome (OSAS) in children include adenotonsillar hypertrophy, neuromuscular disease and syndromes such as Down’s or Pierre–Robin’s syndrome; there is currently no consensus concerning diagnosis and therapy. Methods: The study analyses 40 children, aged 2 through 14 years, with macroscopic tonsillar hypertrophy (without recurrent tonsillitis but with OSAS) underwent adenotonsillectomy. Parents were invited to indicate the intensity of their children’s symptomatology using a subjective evaluation scale, each patient underwent cephalometric analysis and polysomnography (PSG) before and after surgery. Results: The subjective scale of symptoms passed from 3.01 before treatment to 0.42 after treatment, rhinomanometry, passed from 3.456 to 0.896 p after 1 month the surgical operation ( P<0.05). The polysomnography showed a resolution of the number of obstructive events in 37 patients and a reduction in 3 patients and RDI index fell from a mean of 26.9–2.6 after therapy. The average of oxygen saturation changed from 79% before treatment to 95% after therapy. Conclusions: Adenotonsillectomy plays a major role in the treatment of OSAS.

OSAS in children

Background: Major risk factors for obstructive sleep apnea syndrome (OSAS) in children include adenotonsillar hypertrophy, neuromuscular disease and syndromes such as Downxx's or Pierre–Robin's syndrome; there is currently no consensus concerning diagnosis and therapy. Methods: The study analyses 40 children, aged 2–14 years, with macroscopic tonsillar hypertrophy (without recurrent tonsillitis but with OSAS) that underwent adenotonsillectomy. Parents were invited to indicate the intensity of their children's symptomatology using a subjective evaluation scale; each patient underwent cephalometric analysis and polysomnography before and after surgery. Results: The subjective scale of symptoms passed from 3.01 before treatment to 0.42 after treatment, rhinomanometry, passed from 3.456 to 0.896 p after 1 month of surgical operation (p<0.05). The polysomnography showed a resolution of the number of obstructive events in 37 patients and a reduction in three patients and RDI index fell from a mean of 26.9–2.6 after therapy. The average oxygen saturation changed from 79% before treatment to 95% after therapy. Conclusions: Adenotonsillectomy plays a major role in the treatment of OSAS.