Upper Airway Research Articles

Effectiveness Of Oropharyngeal Exercises For Obstructive Sleep Apnea In Sedentary 45-Year-Old Adult: A Case Report

Background: Obstructive sleep apnea (OSA) is a common condition characterized by repeated episodes of airway obstruction during sleep. Traditional treatments include CPAP and lifestyle modifications. This case report explores the effectiveness of Oropharyngeal exercises in a sedentary 45-year-old adult with OSA. Case Presentation: A 45-year-old sedentary male with moderate OSA underwent a regimen of Oropharyngeal exercises over a 12-week period. Intervention: The patient performed daily Oropharyngeal exercises designed to strengthen the upper airway muscles. Outcome Measures: Improvement was assessed using the Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and subjective sleep quality. Results: After 12 weeks, there was a significant reduction in AHI, improvement in ESS scores, and enhanced subjective sleep quality. Conclusion: Oropharyngeal exercises may be a viable adjunctive treatment for OSA, particularly in sedentary individuals. Further research with larger samples is needed to confirm these findings

Clinical Efficacy of Probiotics for Allergic Rhinitis: Results of an Exploratory Randomized Controlled Trial

Background: Allergic Rhinitis (AR) is an atopic disease affecting the upper airways of predisposed subjects exposed to aeroallergens. This study evaluates the effects of a mix of specific probiotics (L. acidophilus PBS066, L. rhamnosus LRH020, B. breve BB077, and B. longum subsp. longum BLG240) on symptoms and fecal microbiota modulation in subjects with AR. Methods: Probiotic effects were evaluated at the beginning (T0), at four and eight weeks of treatment (T1 and T2, respectively), and after four weeks of follow-up from the end of treatment (T3) (n = 19) compared to the placebo group (n = 22). AR symptoms and quality of life were evaluated by the mini rhinitis quality of life questionnaire (MiniRQLQ) at each time point. Allergic immune response and fecal microbiota compositions were assessed at T0, T2, and T3. The study was registered on Clinical-Trial.gov (NCT05344352). Results: The probiotic group showed significant improvement in the MiniRQLQ score at T1, T2, and T3 vs. T0 (p < 0.01, p < 0.05, p < 0.01, respectively). At T2, the probiotic group showed an increase in Dorea, which can be negatively associated with allergic diseases, and Fusicatenibacter, an intestinal bacterial genus with anti-inflammatory properties (p-value FDR-corrected = 0.0074 and 0.013, respectively). Conversely, at T3 the placebo group showed an increase in Bacteroides and Ruminococcaceae unassigned, (p-value FDR-corrected = 0.033 and 0.023, respectively) which can be associated with allergies, while the probiotic group showed a significative increase in the Prevotella/Bacteroides ratio (p-value FDR-corrected = 0.023). Conclusions: This probiotic formulation improves symptoms and quality of life in subjects with AR, promoting a shift towards anti-inflammatory and anti-allergic bacterial species in the intestinal microbiota.

Polysomnographic Phenotype of Positional Obstructive Sleep Apnea

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction, leading to disrupted sleep and various health complications. Positional OSA (POSA) refers to patients whose OSA severity is significantly influenced by body position, especially when lying supine. This study aimed to evaluate the polysomnographic characteristics of POSA and non-positional OSA (non-POSA) and to assess their clinical implications.Methods: This retrospective study included patients diagnosed with OSA who underwent type 1 polysomnography. Patients were categorized into POSA and non-POSA groups based on whether their apnea-hypopnea index (AHI) in the supine position was at least twice as high as that in the lateral position. We collected and analyzed clinical and polysomnographic parameters, including AHI, oxygen desaturation index, arousal index, nadir peripheral oxygen saturation (SpO<sub>2</sub>), and sleep position proportions. These were compared across different OSA severity levels—mild, moderate, and severe—to assess differences between the POSA and non-POSA groups.Results: In total, 500 patients with OSA were analyzed, of whom 63.4% were classified as having POSA. Patients with POSA exhibited milder disease severity than those without, with an average AHI of 23.3±15.3/h versus 43.9±27.9/h, respectively, and a higher nadir SpO<sub>2</sub> of 82.8%±6.6% versus 77.1%±9.8%. POSA was more common in patients with mild OSA (76.5%) and moderate OSA (72.8%), while severe OSA cases were predominantly non-POSA (POSA was 47.4%). Moreover, patients with POSA spent significantly more sleep time in the lateral position (43.8%±22.7%) than non-POSA patients (27.2%±28.2%).Conclusion: Patients with POSA generally exhibited milder disease and more favorable polysomnographic profiles than non-POSA patients. POSA is prevalent in mild-to-moderate OSA, and identifying it via polysomnography may inform tailored treatment strategies.

Intranasal Scope Negotiation Trajectories for Flexible Nasopharyngolaryngoscopy

Background and Objectives: Flexible nasopharyngolaryngoscopy (F-NPLS) is a routine procedure performed in office settings. We compared two different intranasal scope navigation techniques used during F-NPLS, evaluating patient comfort and practitioner satisfaction.Methods: This is a prospective, randomized, parallel-group controlled study. Patients undergoing F-NPLS to evaluate the upper airway were enrolled and randomized into two study groups. Patients in group A underwent intranasal scope negotiation following a trajectory below the middle turbinate; for group B, a trajectory along the inferior turbinate was used. The primary outcome evaluated was the successful, unhindered negotiation of the scope on the first attempt. Secondary outcomes included patient-perceived pain, incidents of mucosal trauma and bleeding, and the frequency and necessity of repeat scopy.Results: In total, 111 patients were randomized into group A (n=53) and group B (n=58). Baseline characteristics, such as age and sex, were similar in both groups. There was no statistically significant difference between the groups with respect to the primary outcome (group A: 52.8% vs. group B: 55.2%, p=0.8). The frequency of F-NPLS without episodes of mucosal trauma was significantly higher in group B (group A: 56.9% vs. group B: 35.9%, p=0.004). Mucosal ecchymosis was a common finding in group A (group A: 41.5% vs. group B: 13.8%, p=0.03), while nasal bleeding was more frequently observed in group B, although the difference was not statistically significant (group A: 29.3% vs. group B: 22.6%, p=0.42).Conclusion: The present study demonstrated that the success rate of unhindered F-NPLS was comparable between the two trajectories. However, patients experienced moderate to severe pain during repeat scopy compared to the initial F-NPLS attempt.

Review of Tracheotomy Auxiliary Device Patents

Background: Tracheotomy is a surgical technique in which the trachea in the front of the neck is cut to construct an artificial airway. Bypassing blockage or lesions in the upper airway, this opening permits oxygen provision and carbon dioxide exhalation straight through the trachea. A more profound comprehension of the pathophysiologic role of the airway has made tracheotomy a crucial component of treatment for several illnesses. Medical devices used both during and after a tracheotomy are known as auxiliary devices for tracheotomies. These devices, which include dilators, cannulas, plugging devices for cannulas, and immobilization devices, ensure the procedure is completed safely and the patient recovers quickly. Objective: This paper aims to identify the key issues, summarize the many tracheotomy auxiliary device constructions in recent years, and serve as a resource for researchers working on related topics. Methods: Assess and evaluate the benefits and drawbacks of the tracheotomy auxiliary devices covered by the patents filed in the last several years and identify areas for development. Results: This patent research examines the shortcomings of current tracheotomy auxiliary devices and speculates about future directions for their advancement. Conclusion: Although they are challenging to use, the tracheotomy auxiliary devices now in use provide good stability and dependability. Enhancing the mechanical structure of tracheotomy auxiliary devices and strengthening clinical trials for various patient populations and intricate surgical settings are essential improvements. Furthermore, pertinent patents for auxiliary equipment used in tracheotomies have not yet been created.

Predicting complete concentric collapse at the palatal level during drug-induced sleep endoscopy: an analysis of 1761 cases.

Drug-induced sleep endoscopy (DISE) helps select patients with obstructive sleep apnea (OSA) for surgery by identifying upper airway collapse patterns. This study aimed to predict the probability of complete concentric collapse at the palatal level (CCCp) during DISE based on patient characteristics, specifically body mass index (BMI). We retrospectively reviewed records of OSA patients who underwent DISE from January 2018 to July 2023. Logistic regression with receiver operating characteristic (ROC) analysis and classification and regression tree (CART) analysis were used to assess the diagnostic efficiency of BMI and other predictors for CCCp. A consecutive series of 1761 eligible patients was included for analysis. CCCp was observed in 22.3% of cases. The CCCp group had significantly higher BMI, neck circumference, apnea-hypopnea index (AHI) and height as well as increase in partial and complete collapse at oropharyngeal level. The ROC analysis for predicting CCCp for a BMI cut-off was similar for males and females 29.4kg/m² and 29.5kg/m², with an area under the curve (AUC) of 0.65 and 0.73, respectively. Adding predictors like tonsils, AHI, height and neck circumference improved the model's performance. Although confirming an association between increasing BMI and presence of CCCp, we were unable to define an accurate BMI cut-off value for predicting CCCp. The multifactorial nature of this collapse pattern challenges BMI's efficacy as a sole predictor. Our findings underscore the continued importance of DISE in evaluating CCCp and other collapse patterns for clinical decision-making in patients considered for hypoglossal nerve stimulation therapy.

Granzyme K+CD8+ T cells interact with fibroblasts to promote neutrophilic inflammation in nasal polyps

Sophisticated interactions between stromal and immune cells play crucial roles in various biological and pathological processes. In chronic rhinosinusitis with nasal polyps (CRSwNP), the upper airway inflammation in many patients is driven by TH2, ILC2, and eosinophils, thus being treated with glucocorticoids and anti-type 2 inflammation biologics. The resistance to these therapies is often associated with neutrophilic inflammation, which has also been widely identified in CRSwNP, but the underlying mechanisms remain unclear. Using single-cell analysis, spatial transcriptomics, and T-cell receptor sequencing, we identify an increased presence of granzyme K+(GZMK+) CD8+ T cells in NPs, which possess a phenotype distinct from the cytotoxic GZMB+ effector CD8+ T subset. GZMK+CD8+ T cells are found to express CXCR4 and interact with CXCL12-secreting fibroblasts, inducing the latter to produce neutrophil chemoattractants in a manner uniquely mediated by GZMK but not other granzymes. This GZMK+CD8+ T cell-fibroblast crosstalk is also observed in other inflammatory diseases. Furthermore, GZMK+CD8+ T cells exhibit a selective expansion of clones that recognize Epstein-Barr virus. Here, we show that GZMK marks a phenotypically distinct subset of effector CD8+ T cells that promote neutrophilic inflammation.

Interrater reliability of different scoring systems for drug-induced sleep endoscopy

PurposeTo explore the interobserver reliability of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) of two classification systems.MethodsDISE examinations were recorded digitally for all patients and were evaluated independently by five examiners blinded to all patient data. Areas of obstruction were rated using VOTE (velum, oropharynx lateral wall, tongue base, epiglottis) classification and PTLTbE (palate, tonsils, lateral pharyngeal wall, tongue base, epiglottis) classification. Additionally, palatal coupling was assessed during the jaw thrust maneuver. Interobserver reliability was evaluated with Fleiss’ kappa for categorical data and linearly weighted kappa for ordinal data.ResultsIn total, 123 patients were included in this study, 92 males and 31 females, with a mean (SD) age of 50.7 (12.1) years and a body mass index (BMI) of 28.3 (5.0) kg/m2. The mean apnea-hypopnea index was 22.2 (18) per hour, and the Epworth Sleepiness Scale was 7.3 (2.3). In our cohort, the interobserver reliability for the VOTE classification ranged from 0.32 to 0.59 and for the PTLTbE classification from 0.23 to 0.49 over all assessed levels, indicating fair to moderate interobserver reliability. The weighted kappa for palatal coupling was 0.37. In the VOTE classification, the level with the best agreement was the velum, while in PTLTbE, the best agreement was observed for tonsillar obstruction.ConclusionThe interrater agreement was fair to moderate for both classifications, with no clear superiority for one classification. The large variability shows the need to objectively quantify upper airway collapse during DISE and natural sleep endoscopy.

Cholinergic modulation of upper airway control: maturational changes and mechanisms at cellular and synaptic levels.

Respiration is governed by a central rhythm and pattern generator, which has the preBötzinger complex as the inspiratory oscillator initiating the coordinated activity of several respiratory muscles, including the diaphragm, intercostals, and upper airway muscles. The diaphragm is the main inspiratory pump muscle driving inflow, while dilator upper airway muscles, such as tongue muscles, reduce airway resistance during inspiration. Breathing exhibits a marked state-dependent pattern attributed to changes in neuromodulatory tone in respiratory-related brain regions, including decreases in noradrenaline and serotonin and increases in acetylcholine levels during rapid eye movement (REM) sleep. Here, we discuss respiratory modulation by acetylcholine acting on its metabotropic muscarinic receptors, focusing on the regulation of upper airway muscle activity during sleep and wakefulness and its changing effects with postnatal maturation. We focus on experimental data examining muscarinic receptor distribution patterns, the ion channels they modulate, and how these distribution patterns change with postnatal maturation. We also consider experimental data highlighting cholinergic cellular and synaptic effects on hypoglossal motoneurons and preBötzinger Complex neurons, and how that might explain changes in the effects of cholinergic modulation with development. Overall, this discussion is critical to comprehend the postnatal maturation in the cholinergic modulation of the respiratory control system leading to opposing effects of muscarinic receptors on upper airway muscle activity in neonate (excitatory) and adult (inhibitory) preparations. The changes in cholinergic pathways associated with dysfunctional upper airway patency control will also be discussed in the context of pathologies, such as sleep-disordered breathing.

Optical coherence tomography to identify upper airway obstruction sites in an apneic patient

Optical coherence tomography to identify upper airway obstruction sites in an apneic patient

Current aspects of differential diagnosis and treatment of cough

Cough is a common and important respiratory symptom that can cause significant complications for patients and be a diagnostic challenge for physicians. An organized approach to the evaluation of cough begins with classifying it as acute, subacute, or chronic based on duration and time of onset. Acute cough (up to 3 weeks) is most often one of the main symptoms of acute respiratory viral infections and acute bronchitis. Subacute cough, lasting from 3 to 8 weeks, is usually postinfectious postviral in origin. Common causes of chronic cough lasting more than 8 weeks with a normal chest X-ray are cough variant of bronchial asthma, chronic obstructive pulmonary disease, upper airway cough syndrome / postnasal drip syndrome, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux, and medications (primarily angiotensin-converting enzyme inhibitors). The spectrum of possible causes of cough is diverse, however, respiratory pathology comes to the forefront in the differential diagnostic search. Successful treatment of cough is an important task in clinical practice. Given the possible multicomponent nature of cough, the presence of catarrhal-respiratory and broncho-obstructive syndromes in the clinical picture along with bronchitis syndrome, combination drugs become the drug of choice. In conclusion, the possibilities of a combined (bromhexine + guaifenesin + salbutamol) expectorant against cough, its effectiveness and safety are considered.

Comprehensive analysis of orofacial motor skills in children with obstructive sleep apnea.

The neuromuscular activity has a critical role in the permeability of the upper airways. The present study aimed to conduct a detailed and comparative investigation of the orofacial musculature and motor skills of children with obstructive sleep apnea (OSA). Children aged 7 to 12 years with OSA (OSA group, n = 12) and without OSA (Control group, n = 12) were compared. Orofacial appearance/posture and motor skills were assessed using the orofacial myofunctional evaluation protocol with scores. Bite force, tongue pressure measurements, and surface electromyography of swallowing were also performed. Compared to the control group, the OSA group obtained lower scores in appearance/posture, mobility, and orofacial functions (P < 0.0001), and lower values of bite force (P = 0.019) and tongue strength in protrusion (P = 0.008) and deglutition (P = 0.004). The OSA group also displayed lower values of maximum speed (P = 0.003) and peak activity (P = 0.0005) during spontaneous swallowing and higher relative energy expenditure (integral) of the muscles in the water swallowing task (50 mL) (P ≤ 0.01). Notably, the effect size ranged from moderate to large for all groups differences. The children with OSA showed impairments in orofacial musculature and motor skills, as evidenced by reduced muscle recruitment capacity and coordination in applying pressure/force and performing orofacial movements and functions. This study contributes to the understanding of non-anatomical factors associated with OSA in children and to the development of therapeutic strategies.

Bolted in the nasopharynx: case report of an unusual foreign body in a child

Bolted in the nasopharynx: case report of an unusual foreign body in a child

Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?

Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence. Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2-6months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis.Adherence data was downloaded from the UAS device. 327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (β = 3.7, CI [1.3, 7.4], p = 0.038) and increased age (β = 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence. UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.

Neutrophils in nasal polyps exhibit transcriptional adaptation and proinflammatory roles that depend on local polyp milieu.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory upper airway disease, divided into eosinophilic CRSwNP (eCRSwNP) and noneosinophilic CRSwNP (neCRSwNP) according to eosinophilic levels. Neutrophils are major effector cells in CRSwNP, but their roles in different inflammatory environments remain largely unclear. We performed an integrated transcriptome analysis of polyp-infiltrating neutrophils from patients with CRSwNP, using healthy donor blood as a control. Additional experiments, including flow cytometry and in vitro epithelial cell and fibroblast culture, were performed to evaluate the phenotypic feature and functional role of neutrophils in CRSwNP. Single-cell RNA-sequencing analysis demonstrated that neutrophils could be classified into 5 functional subsets, with GBP5+ neutrophils occurring mainly in neCRSwNP and a high proportion of CXCL8+ neutrophils in both subendotypes. GBP5+ neutrophils exhibited significant IFN-I pathway activity in neCRSwNP. CXCL8+ neutrophils displayed increased neutrophil activation scores and mainly secreted oncostatin M (OSM), which facilitates communication with other cells. In vitro experiments showed that OSM enhanced IL-13- or IL-17-mediated immune responses in nasal epithelial cells and fibroblasts. Our findings indicate that neutrophils display transcriptional plasticity and activation when exposed to polyp tissue, contributing to CRSwNP pathogenesis by releasing OSM, which interacts with epithelial cells and fibroblasts depending on the inflammatory environment.

TMEM16A Antagonism: Therapeutic Potential with Desensitization of β-agonist Responsiveness in Asthma.

The efficacy of β-agonists in asthma is severely limited by β-adrenoceptor desensitization which results in poorly managed symptoms and refractory bronchoconstriction. Thus, there is a need to identify novel therapeutic pathways and to clarify the relationship between novel therapeutics and functional β-adrenoceptor responsiveness. We have previously demonstrated that acute antagonism of the calcium activated chloride channel, transmembrane member 16A (TMEM16A), relaxes airway smooth muscle (ASM). We sought to determine the efficacy and role of TMEM16A antagonism in the context of desensitization β - adrenoceptor responsiveness. For these studies, we exposed murine tracheal rings on wire myography and precision cut lung slices to contractile mediators in the presence or absence of TMEM16A antagonists and β-agonists with or without prior β-adrenoceptor desensitization. Contractile studies were also performed with human tracheal and bronchial ASM. Finally, the ability of TMEM16A antagonism to prevent desensitization of β2-adrenoceptor-induced cyclic AMP synthesis was measured in human ASM cells. From these studies we demonstrate that acute TMEM16A antagonism is effective in relaxing β-agonist desensitized ASM in central and peripheral murine ASM and human ASM. Furthermore, we demonstrate that chronic pretreatment with TMEM16A antagonists prevents functional desensitization of β-agonist responsiveness in mouse and human upper airways and prevents desensitization of β-agonist-mediated cyclic AMP production in human ASM cells. Taken together, the present study demonstrates a favorable therapeutic profile of TMEM16A antagonism for airway smooth muscle relaxation despite functional desensitization of β-agonist responsiveness which may be a novel therapeutic approach in the face of β-adrenoceptor tachyphylaxis.

Comparative effectiveness of pre-epiglottic baton plates and mandibular distraction in infants with Robin sequence.

Mandibular distraction osteogenesis (MDO) and pre-epiglottic baton plates (PEBP) are both effective for early management of upper airway obstruction (UAO) in infants with Robin sequence (RS), but have not been directly compared. The purpose of this study was to compare early airway, feeding and growth outcomes between these treatments. This is a bicentric retrospective cohort study from 2015-2021 including infants with RS treated with MDO or PEBP before 6 months-of-age with pre- and post-treatment sleep studies and follow-up at least through age 1-year. The primary outcome was immediate post-intervention UAO, measured as obstructive apnea-hypopnea index (oAHI) or obstructive apnea index (oAI), as available. Latest follow-up sleep studies, feeding and growth characteristics were also assessed. 114 subjects were included: MDO, n=31 and PEBP, n=83. Pre-treatment UAO was similar between groups (p=0.61). PEBP was initiated at a younger age (median [IQR] 31 [14,53] vs. 41 [28,84] days-of-life, p<0.05). Significant reduction of oAHI/oAI was achieved in both groups, but greater with MDO (98%) compared to PEBP (94%, p<0.05). PEBP demonstrated better early feeding and growth outcomes compared to MDO, with fewer surgical feeding tubes (p<0.001) and more rapid early growth (p=0.038). When stratified by pre-intervention UAO, infants starting with moderate UAO experienced similar airway outcomes with both treatments (p=0.11), while those with severe UAO had greater resolution with MDO (p<0.001). Both treatments effectively relieve moderate UAO in infants with RS, but MDO is more effective for infants with severe respiratory compromise.

French consensus on the care pathway for children with suspected or diagnosed type 1 obstructive sleep disorder

Obstructive sleep-disordered breathing (OSDB) is the consequence of an anatomical and/or functional reduction in upper airway size during sleep. Young patients can also be affected. TROS type1 (TROS1 ) is most often found in young, non-obese children with no associated comorbidities, presenting with an otorhinolaryngological (ENT) obstacle, generally an enlargement of lymphoid tissue (tonsils and/or adenoids). The aim of this article was to outline the consensus. A collaborative work, realized on the request of the French Society of Sleep Research and Medicine, to provide recommendations for the management of obstructive sleep apnea syndrome type1 (OSA1 ) in children was published in 2023. This work brought together various experts in pediatric sleep disorders breathings (SDB). A sleep study for OSA1 is not mandatory when at least two nighttime symptoms are noted. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. The ENT specialist is the mainstay of initial care, but works as part of a multidisciplinary team that includes pediatricians, general practitioners, orthodontists and linguo-oro-maxillo-facial rehabilitation specialists. Whatever the treatment, follow-up must be continuous and multidisciplinary; it is essential to ensure the effectiveness of the treatments implemented, the absence of SDB recurrence and the recovery of nasal breathing.

Reporte de caso: Síndrome de Kartagener completo diagnosticado en la edad adulta

We present the case of a 48-year-old patient with a clinical picture of recurrent upper airway infections of the chronic sinusitis type and acute otitis media, in addition to clinical diagnoses of pneumonia in childhood that required hospital admission for intravenous antibiotic therapy. In addition, the patient had tried to become pregnant several years ago without success. She consulted the pulmonologist for this condition, reaching a diagnosis of bilateral bronchiectasis, chronic sinusitis and situs inversus, diagnosis of complete Kartagener syndrome. The diagnosis, treatment and prognosis of the disease are discussed.

Craniofacial anatomical determinants of pediatric sleep-disordered breathing: A comprehensive review.

This narrative review aims to elucidate the anatomical features of sleep-disordered breathing (SDB) in children. By identifying key structures and intervening proactively, we seek to alter craniofacial growth patterns and improve functional outcomes for SDB children. The literature on pediatric sleep-disordered breathing (PSDB), pediatric obstructive sleep apnea (OSA), anatomical predispositions, and the relationship between skeletal deformity and PSDB was examined using PubMed and Google Scholar databases, covering studies from 2006 to 2024. Forty relevant articles were reviewed, focusing on craniofacial characteristics associated with PSDB. The etiology of PSDB is multifactorial, with adenoid and palatal tonsil enlargement being the most common cause. While adenotonsillectomy is recommended as the primary treatment, residual SDB may result in craniofacial skeletal deformities contributing to upper airway constriction. Typical craniofacial phenotypes of SDB include excessive vertical growth and constriction of the maxilla, a retruded mandible, and posterior rotation, known as a Class II hyperdivergent pattern. Conversely, Class III with an underdeveloped maxilla shows a relatively lower risk for SDB due to reduced nasal cavity and nasopharyngeal airway volumes. Transverse maxillary constriction with a high, deep palatal vault is a significant risk factor. Additionally, nasal obstruction and low tongue posture, with or without a short lingual frenulum, are identified as craniofacial risk factors for SDB development in children. Early diagnosis and intervention are critical in managing PSDB. Dentists, through screening and early treatment, can significantly influence craniofacial growth and health outcomes. A multidisciplinary approach is essential for effective management, improving the quality of life and long-term health of affected children.