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Cossa IA, Santos PS, Vitali FC, Santana CM, Bolan M, Cardoso M. Are sleep disorders associated with traumatic dental injuries in school children? A cross-sectional study. Aust Dent J 2024. [PMID: 38838027 DOI: 10.1111/adj.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND To evaluate whether the prevalence of traumatic dental injuries (TDIs) in permanent anterior teeth among school children is associated with sleep behaviours and disorders. METHODS A cross-sectional study was carried out with a representative sample of schoolchildren aged 8 to 10 years (n = 1402) from Florianopolis, Brazil. Clinical examinations for TDIs were performed according to the classification proposed by Andreasen. Parents/caregivers completed a questionnaire addressing sociodemographic characteristics and sleep behaviours/disorders (sleep duration, insomnia, sleep rhythmic movement, snoring, and signs of sleep apnoea). Descriptive analysis and Poisson regression were performed. RESULTS The prevalence of TDIs was 10.9%. Insomnia was observed in 3.0% of the children, snoring in 42.8%, sleep rhythmic movement in 27.9%, and signs of obstructive sleep apnoea in 33.6% of the schoolchildren. Most children (75.2%) slept less than eight hours a day. The prevalence of TDIs was higher among schoolchildren with an increased overjet (PR: 1.65; 95% CI: 1.15-2.35; P < 0.01), after adjusting for monthly family income, caregiver's schooling, and sleep behaviours. The prevalence of TDIs was not associated with sleep behaviours/disorders. CONCLUSIONS Parent-reported sleep disorders such as insomnia, sleep rhythmic movement, snoring and signs of sleep apnoea were not associated with the prevalence of TDIs in schoolchildren. © 2024 Australian Dental Association.
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Affiliation(s)
- I A Cossa
- Postgraduate Program of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - P S Santos
- Postgraduate Program of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - F C Vitali
- Postgraduate Program of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - C M Santana
- Department of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - M Bolan
- Department of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - M Cardoso
- Department of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil
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2
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Becking BE, Verweij JP, Jonkman REG, van Merkesteyn JPR, Van den Akker-Van Marle ME. Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population. Sleep Med 2024; 119:19-26. [PMID: 38636211 DOI: 10.1016/j.sleep.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/18/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Pediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. METHODS The translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4-18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. RESULTS The factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. CONCLUSIONS Cultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.
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Affiliation(s)
- Bibi E Becking
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Jop P Verweij
- Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, the Netherlands.
| | | | - J P Richard van Merkesteyn
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Center, P.O Box 9600, 2300 RC, Leiden, the Netherlands.
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Finke H, Drews A, Engel C, Koos B. Craniofacial risk factors for obstructive sleep apnea-systematic review and meta-analysis. J Sleep Res 2024; 33:e14004. [PMID: 37485571 DOI: 10.1111/jsr.14004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
Obstructive sleep apnea (OSA) is caused by temporary partial or complete constriction of the upper airway during sleep which leads to reduced blood oxygen and cardiovascular risks. Main symptoms vary between adults and children leading to misdiagnosis or delayed patient identification. To improve early diagnosis, lateral cephalograms can provide craniofacial measurements associated with a higher risk of OSA. In order to identify the most relevant craniofacial measurements, a systematic literature review with meta-analysis was conducted combining the terms 'orthodontic*', 'craniofacial', 'cephalometr*', 'cephalogram', 'OSA*', 'UARS', 'SDB', 'sleep disordered breathing', 'sleep apnea' and 'sleep apnoea'. Of 3016 publications, 19 were included in the systematic review and meta-analysis, 15 with adult patients and four with children. A total of 16 measurements (six angles, 10 distances) were compared, nine showed a possible influence in patients with OSA compared to controls: NSBa angle (-0.28°), ANB angle (+0.33°), ML-NSL angle (+0.34°), Me-Go-Ar angle (+0.33°), SN distance (-0.70 mm), N-ANS distance (-0.36 mm), MP-H distance (+1.18 mm), uvula length (+1.07 mm) and thickness (+0.96 mm). Posterior airway measurements were not sufficiently described or comparably measured to be statistically analysed. There is some evidence for altered craniofacial anatomy in patients with OSA compared to controls. Lateral cephalograms should be screened for these aspects routinely to improve early diagnosis of OSA and craniofacial orthopaedics should complement the interdisciplinary treatment plan for young patients with OSA.
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Affiliation(s)
- Hannah Finke
- Department of Orthodontics, University Hospital, Tübingen, Germany
| | - Anne Drews
- Department of Orthodontics, University Hospital, Tübingen, Germany
| | - Corinna Engel
- Center for Pediatric Clinical Studies, University Children's Hospital, Tübingen, Germany
| | - Bernd Koos
- Department of Orthodontics, University Hospital, Tübingen, Germany
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Zhao T, Yang Z, Ngan P, Luo P, Zhang J, Hua F, He H. Association between adenotonsillar hypertrophy and dentofacial characteristics of children seeking for orthodontic treatment: A cross-sectional study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 125:101751. [PMID: 38145836 DOI: 10.1016/j.jormas.2023.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/23/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare the dentofacial characteristics of children with and without adenoid and/or tonsillar hypertrophy. METHODS A consecutive sample of orthodontic patients aged 6-12 that took pre-treatment lateral cephalograms were included in this study. Those with history of previous orthodontic treatment, adenoidectomy or tonsillectomy, or craniofacial anomalies were excluded. The diagnosis of adenoid and tonsillar hypertrophy was based on Fujioka's and Baroni's methods, according to which the subjects were divided into four groups: the adenoid hypertrophy only (AHO) group; tonsillar hypertrophy only (THO) group; combined adenoid and tonsillar hypertrophy (AH+TH) group; and no adenoid or tonsillar hypertrophy (NH) group. Cephalograms were used for skeletal and dental measurement. Data were analyzed using one-way ANOVA, LSD post-hoc tests and Chi-square test. RESULTS A total of 598 patients were included. Compared with the NH group, the THO group had significantly larger SNB angle (P < 0.001), as well as significantly smaller ANB angle (P<0.001) and Wits value (P = 0.001). The U1-L1 angle of AHO group was significantly smaller than that in the NH group (P = 0.035). The proportion of adenoid hypertrophy in Class II patients was significantly higher than that in Class III patients (P = 0.001). The proportion of tonsillar hypertrophy in Class III patients was significantly higher than that in Class I patients (P < 0.001) and Class II patients (P < 0.001). CONCLUSION Over 80 % of children seeking orthodontic treatment had either adenoid or tonsillar hypertrophy. Children with adenoid hypertrophy tend to have skeletal Class II malocclusion, while those with tonsillar hypertrophy tend to have skeletal Class III malocclusion.
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Affiliation(s)
- Tingting Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zheng Yang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WV, United States of America
| | - Ping Luo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jun Zhang
- Department of Oral Radiology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Hong He
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Dentofacial Development and Sleep Medicine, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Kadkhodayan S, Almeida FT, Lai H, Pacheco-Pereira C. Uncovering the Hidden: A Study on Incidental Findings on CBCT Scans Leading to External Referrals. Int Dent J 2023:S0020-6539(23)00979-6. [PMID: 38142160 DOI: 10.1016/j.identj.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/10/2023] [Accepted: 11/26/2023] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVES This project aims to determine the prevalence of cone-beam computed tomography (CBCT) findings requiring referral. Additionally, the goal is to establish a reference standard protocol for incidental findings, outlining indications for further investigation and management protocol. METHODS Patients records from the Advanced Imaging Centre at the School of Dentistry, University of Alberta, underwent systematic examination to identify CBCT incidental findings. Radiographic findings requiring referral were categorised into 8 anatomic zones. Analysis assessed prevalence and a management protocol was developed for significant findings. Inferential analyses were conducted to determine the frequency and prevalence of specific findings requiring further investigation. RESULTS A total of 1260 CBCT interpretive reports were analysed. The most prevalent radiographic findings outside the areas of interest were found in the cervical vertebrae (18%), followed by the sinuses (15%), temporomandibular joints (8%), jaw lesions (7%), airway (5%), teeth (5%), soft tissue calcifications (5%), and other (1%). CONCLUSIONS Findings most commonly requiring external referral included carotid atheroma (2.7%), cervical vertebrae osteoarthritis (0.97%), jaw lesions (0.86%), adenoid and/or tonsillar hypertrophy (0.86%), and paranasal sinus pathology (0.73%). Increased medicolegal awareness and practitioner knowledge contribute to the rising number of CBCT-identified radiographic findings outside the area of concern. The study addresses the debate on reporting all CBCT/radiographic findings by exploring their prevalence and providing protocols. These guidelines assist dentists in identification, decision-making, and referral processes.
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Affiliation(s)
| | - Fabiana T Almeida
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hollis Lai
- School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Cordray H, Mahendran GN, Tey CS, Nemeth J, Raol N. The Impact of Ankyloglossia Beyond Breastfeeding: A Scoping Review of Potential Symptoms. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:3048-3063. [PMID: 37606583 DOI: 10.1044/2023_ajslp-23-00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the spectrum of pediatric quality-of-life sequelae associated with ankyloglossia that may affect children who do not undergo tongue-tie release (frenotomy) during infancy. DATA SOURCES This study contains data from PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar (1961-January 2023). REVIEW METHOD The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews reporting guidelines. Experimental and observational studies were eligible if they reported baseline outcomes associated with ankyloglossia in children above a year of age. Two reviewers independently screened studies, extracted data, and assessed quality. Low-quality studies were excluded. CONCLUSIONS Twenty-six of 1,568 screened studies (> 1,228 patients) were included. Six studies were high quality and 20 were medium quality. Studies identified various symptoms that may be partially attributable to ankyloglossia after infancy, including speech/articulation difficulties, eating difficulties, dysphagia, sleep-disordered breathing symptoms, dental malocclusion, and social embarrassment such as oral hygiene issues. Multiple comparative studies found associations between ankyloglossia and risk factors for obstructive sleep apnea; a randomized controlled trial found that frenotomy may attenuate apnea severity. Ankyloglossia may also promote dental crowding. IMPLICATIONS FOR PRACTICE Ankyloglossia may be associated with myriad effects on children's quality of life that extend beyond breastfeeding, but current data regarding the impact are inconclusive. This review provides a map of symptoms that providers may want to evaluate as we continue to debate the decision to proceed with frenotomy or nonsurgical therapies in children with ankyloglossia. A continuing need exists for controlled efficacy research on frenotomy for symptoms in older children and on possible longitudinal benefits of early frenotomy for maxillofacial development. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23900199.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
| | | | - Ching Siong Tey
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Psychology, University of Georgia, Athens
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Egleston Hospital, GA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Manrikyan GE, Vardanyan IF, Markaryan MM, Manrikyan ME, Badeyan EH, Manukyan AH, Gevorgyan MA, Khachatryan SG. Association between the Obstructive Sleep Apnea and Cephalometric Parameters in Teenagers. J Clin Med 2023; 12:6851. [PMID: 37959316 PMCID: PMC10650301 DOI: 10.3390/jcm12216851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND OSA is a common problem in children and adolescents. Angle class II malocclusion, a tendency toward the vertical type of growth, causes a decrease in the volume of the oral air space, increasing the risk of OSAS. The aim of this study was to evaluate the relationship between cephalometric and OSA parameters, to develop collaborative approaches between orthodontists and somnologists in the treatment of adolescents with OSA. METHODS We analyzed data from 41 adolescents with OSA. Their mean age was 15.8 ± 1.08 years. Orthodontic and polysomnographic examinations of patients were conducted. Statistical analysis was performed in SPSS 19.0.0. RESULTS Most often in patients with distal occlusion, a violation of the harmony in the development of the dental system was observed. The sagittal incisive fissure, characteristic of a distal occlusion, was absent due to the palatal inclination of the upper incisors in 25 (60.98%) patients. The SNB was 79.4 ± 3.1°, indicating a distal position of the mandible relative to the anterior cranial base. The SNA exceeded the normal value, which is one of the prerequisites for mandibular retrognathia. The ANB angle was 4.3 ± 1.9°. Tonsillar hypertrophy affected 6 patients, 21 had adenoid hypertrophy, and 3 had both of them. Movements of the masticatory muscles during sleep were recorded in 22.0% of patients. CONCLUSION To improve the quality of diagnosis and treatment of OSA, a multidisciplinary approach is needed that will correct the processes of child growth and development.
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Affiliation(s)
- Gayane E. Manrikyan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Izabella F. Vardanyan
- Department of Pediatric Dentistry and Orthodontics, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (I.F.V.); (M.E.M.)
| | - Marina M. Markaryan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Mikayel E. Manrikyan
- Department of Pediatric Dentistry and Orthodontics, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (I.F.V.); (M.E.M.)
| | - Elen H. Badeyan
- Department of Pediatric Dentistry and Orthodontics, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (I.F.V.); (M.E.M.)
| | - Anna H. Manukyan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Mariana A. Gevorgyan
- Department of Therapeutic Dentistry, Yerevan State Medical University (YSMU), Koryun Str. 2, Yerevan 0002, Armenia; (M.M.M.)
| | - Samson G. Khachatryan
- “Somnus” Neurological Clinic, Department of Neurology and Neurosurgery, National Institute of Health, Yerevan 0051, Armenia;
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Bierley K, Antonarakis GS. Lateral cephalometric characteristics in individuals with Down Syndrome compared to non-syndromic controls: A meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101407. [PMID: 36738889 DOI: 10.1016/j.jormas.2023.101407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of the present meta-analysis was to provide a complete synthesis of all studies involving lateral cephalometric measurements in populations with Down Syndrome (DS). METHODS A literature search was carried out using six electronic databases to identify studies comparing cephalometric characteristics between populations with DS and control (healthy) populations. Studies were selected according to the research objectives, and predefined inclusion and exclusion criteria. Only the cephalometric measurements included in three or more studies selected were analyzed. The random-effects meta-analysis model was used for data analysis, and all analyses were carried out using RevMan5 software. RESULTS From an initial 871 articles identified through the literature search, ten cross-sectional studies were finally selected based on the inclusion and exclusion criteria. Ten cephalometric measurements underwent meta-analysis, five linear and five angular measurements. Concerning the five linear measurements, namely S-N, ANS-PNS, Go-Gn, Ar-Go, and N-ANS, all were significantly smaller in the DS group with the exception of Go-Gn. Of the five angular measurements, only three were statistically different between the DS and control groups. SNB and ANB angles were smaller in individuals with DS, whereas the basilar angle was larger. Subgroup analysis was also carried out based on age, and it was found that the gonial angle was significantly smaller before puberty, in individuals with DS. No differences between groups were found for the SNA angle. CONCLUSION There are significant cephalometric differences between individuals with and without DS. Individuals with DS have a shorter anterior cranial base, maxillary length, upper anterior facial height and mandibular height. The ANB and SNB angles were also smaller in those with DS, but the SNA angle showed no differences. These findings may indicate that the Class III malocclusion commonly found in individuals with DS does not seem to be due to mandibular prognathism. CLINICAL RELEVANCE Lateral cephalometric measurements in individuals with DS show significant differences from individuals without DS. Practitioners need to be aware of this and monitor growth from an early age in these children.
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Affiliation(s)
- Kara Bierley
- Division of orthodontics, University clinics of dental medicine, University of Geneva, 1 rue Michel-Servet, 1211 Genève 4, Swizerland.
| | - Gregory S Antonarakis
- Division of orthodontics, University clinics of dental medicine, University of Geneva, 1 rue Michel-Servet, 1211 Genève 4, Swizerland
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Alsaeed S, Huynh N, Wensley D, Lee K, Hamoda MM, Ayers E, Sutherland K, Almeida FR. Orthodontic and Facial Characteristics of Craniofacial Syndromic Children with Obstructive Sleep Apnea. Diagnostics (Basel) 2023; 13:2213. [PMID: 37443607 DOI: 10.3390/diagnostics13132213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction: Obstructive sleep apnea (OSA) is a disorder in which ventilation becomes disrupted due to a complete or partial upper airway obstruction Altered craniofacial morphology is one of the most important anatomical factors associated with obstructive sleep apnea (OSA). Studies have assessed craniofacial features in the non-syndromic pediatric population. The aim of this study was to analyze the orthodontic and facial characteristic of craniofacial syndromic children referred for polysomnography (PSG) and to assess the correlation with the apnea-hypopnea index (AHI). Methods: In the current cross-sectional study, consecutive syndromic patients referred for PSG were invited to participate. A systematic clinical examination including extra- and intra-oral orthodontic examination was performed by calibrated orthodontists. Standardized frontal and profile photographs with reference points were taken and analyzed using ImageJ® software to study the craniofacial morphology. PSG data were analyzed for correlation with craniofacial features. STROBE guidelines were strictly adopted during the research presentation. Results: The sample included 52 syndromic patients (50% females, mean age 9.38 ± 3.36 years) diagnosed with 17 different syndromes, of which 24 patients had craniofacial photography analysis carried out. Most of the sample (40%) had severe OSA, while only 5.8% had no OSA. Down's syndrome (DS) was the most common syndrome (40%) followed by Goldenhar syndrome (5%), Pierre Robin Sequence (5%), and other syndromes. The severity of AHI was significantly correlated with decreased midfacial height. increased thyromental angle and cervicomental angle, decreased mandibular angle, and decreased upper facial height. All patients with DS were diagnosed with OSA (57% severe OSA), and their ODI was significantly correlated with increased intercanthal distance. Obesity was not correlated to the severity of AHI for syndromic patients. Conclusions: Decreased midfacial height and obtuse thyromental angle were correlated with increased AHI for syndromic patients. Increased intercanthal distance of DS patients could be a major predictor of OSA severity. Obesity does not seem to play a major role in the severity of OSA for syndromic patients. Further studies with larger samples are necessary to confirm these findings.
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Affiliation(s)
- Suliman Alsaeed
- Preventive Dental Sciences Department, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- Ministry of the National Guard-Health Affairs, Riyadh 11426, Saudi Arabia
| | - Nelly Huynh
- Faculty of Dental Medicine, Université de Montréal, Montreal, QC 2001, Canada
| | - David Wensley
- Faculty of Medicine, University of British Columbia, Vancouver, BC 2312, Canada
| | - Kevin Lee
- Faculty of Dentistry, University of British Columbia, Vancouver, BC 2199, Canada
| | - Mona M Hamoda
- Faculty of Dentistry, University of British Columbia, Vancouver, BC 2199, Canada
| | - Evan Ayers
- Faculty of Dentistry, University of British Columbia, Vancouver, BC 2199, Canada
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Fernanda R Almeida
- Faculty of Dentistry, University of British Columbia, Vancouver, BC 2199, Canada
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10
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Messaoudi Y, Kiliaridis S, Antonarakis GS. Craniofacial Cephalometric Characteristics and Open Bite Deformity in Individuals with Amelogenesis Imperfecta-A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12113826. [PMID: 37298021 DOI: 10.3390/jcm12113826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Individuals with amelogenesis imperfecta (AI) often present with malocclusions, especially a dental or skeletal anterior open bite (AOB). OBJECTIVES To evaluate the craniofacial characteristics in individuals with AI. MATERIAL AND METHODS A systematic literature search was conducted with the PubMed, Web of Science, Embase and Google Scholar databases to identify studies relating to the cephalometric characteristics of individuals with AI, without any language or publication date restrictions. The grey literature was searched using Google Scholar, Opengrey and Worldcat. Only studies with a suitable control group for comparison were included. Data extraction and a risk of bias assessment were carried out. A meta-analysis was performed using the random effects model for cephalometric variables that were evaluated in at least three studies. RESULTS The initial literature search yielded 1857 articles. Following the removal of duplicates and a screening of the records, seven articles were included in the qualitative synthesis, representing a total of 242 individuals with AI. Four studies were included in the quantitative synthesis. The meta-analysis results showed that individuals with AI present a smaller SNB angle and larger ANB angle than those of control groups in the sagittal plane. In the vertical plane, those with AI present a smaller overbite and larger intermaxillary angle than those without AI. No statistically significant differences were found for the SNA angle when comparing the two groups. CONCLUSIONS Individuals with AI seem to present with more vertical craniofacial growth, leading to an increased intermaxillary angle and decreased overbite. This possibly leads to a more retrognathic mandible with a larger ANB angle due to an anticipated posterior mandibular rotation.
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Affiliation(s)
- Yassine Messaoudi
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, 1 rue Michel-Servet, 1205 Geneva, Switzerland
| | - Stavros Kiliaridis
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, 1 rue Michel-Servet, 1205 Geneva, Switzerland
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3010 Bern, Switzerland
| | - Gregory S Antonarakis
- Division of Orthodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, 1 rue Michel-Servet, 1205 Geneva, Switzerland
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Calvo-Henriquez C, Tucciarone M, Lechien JR, Maniaci A, Graham E, Maza-Solano J, Metwaly O, Martinez-Capoccioni G, Mariño-Sanchez F, Plaza G, Martin-Martin C. Turbinate surgery in pediatric patients: A worldwide survey. ACTA OTORRINOLARINGOLOGICA (ENGLISH EDITION) 2023; 74:93-100. [PMID: 37005043 DOI: 10.1016/j.otoeng.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/04/2022] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Impaired nasal breathing is a common condition among pediatric patients, being rhinitis the most common cause. In recent years, turbinate surgery, mainly turbinate radiofrequency ablation (TRA), has increased in popularity amongst pediatric otolaryngologists and rhinologists as a safe and useful technique to address turbinate hypertrophy in pediatric patients. The present paper is designed with the aim of assessing the current worldwide clinical practice regarding turbinate surgery in pediatric patients. METHODS The questionnaire was developed based on previous researches, by a group of 12 experts from the rhinology and pediatric otolaryngology research group belonging to the Young Otolaryngologists of the International Federation of Otorhinolaryngological societies (YO-IFOS). The survey was then translated to 7 languages and sent to 25 scientific otolaryngologic societies around the globe. RESULTS 15 scientific societies agreed to distribute the survey to their members. There were 678 responses from 51 countries. From them, 65% reported to usually perform turbinate surgery in pediatric patients. There was a statistically significant increased likelihood of performing turbinate surgery for those practicing rhinology, sleep medicine, and/or pediatric otolaryngology compared to other subspecialties. The main indication to perform turbinate surgery was nasal obstruction (93.20%); followed by sleep disordered breathing (53.28%), chronic rhinosinusitis (28.70%) and facial growth alterations (22.30%). CONCLUSIONS There is no general consensus on the indications and ideal technique for turbinate reduction in children. This dissension arises mainly from the lack of scientific evidence. The points with highest agreement (>75%) between respondents is the use of nasal steroids prior to surgery; reintroducing nasal steroids in allergic patients; and performing turbinate surgery as day-case surgery.
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12
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Caruso S, Lisciotto E, Caruso S, Marino A, Fiasca F, Buttarazzi M, Sarzi Amadè D, Evangelisti M, Mattei A, Gatto R. Effects of Rapid Maxillary Expander and Delaire Mask Treatment on Airway Sagittal Dimensions in Pediatric Patients Affected by Class III Malocclusion and Obstructive Sleep Apnea Syndrome. Life (Basel) 2023; 13:life13030673. [PMID: 36983829 PMCID: PMC10056418 DOI: 10.3390/life13030673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that is very common in pediatric patients. In the literature, there are very few studies concerning the association between OSAS and class III malocclusion in children. The use of a rapid maxillary expander (RME) in association with the Delaire mask is a common treatment protocol for class III malocclusion. The aim of this work was to evaluate the cephalometric variations of upper airway dimensions and OSA-related clinical conditions after orthodontic treatment with an RME and the Delaire mask, as recorded in pediatric patients with a class III malocclusion who were affected by OSAS. In this preliminary study, 14 pediatric patients with mixed dentition, aged between 6 and 10 years, were selected. All patients were treated with an RME and the Delaire mask. Pre- and post-treatment cephalometric radiographs were traced, analyzed, and compared. The results demonstrated a significant increase in the upper airway linear measurements and the nasopharyngeal and oropharyngeal dimensions (p ≤ 0.05). This increase creates an improvement in airway patency and in OSAS-related clinical conditions. The use of the RME in association with the Delaire mask can be effective in the treatment of pediatric patients with a class III malocclusion who are affected by OSAS.
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Affiliation(s)
- Sara Caruso
- Department MeSVA, University of L’Aquila, 67100 L’Aquila, Italy
| | - Emanuela Lisciotto
- Department MeSVA, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence:
| | - Silvia Caruso
- Department MeSVA, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandra Marino
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant’Andrea Hospital, Sapienza University of Rome, 00185 Roma, Italy
| | - Fabiana Fiasca
- Department MeSVA, University of L’Aquila, 67100 L’Aquila, Italy
| | | | - David Sarzi Amadè
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant’Andrea Hospital, Sapienza University of Rome, 00185 Roma, Italy
| | - Melania Evangelisti
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant’Andrea Hospital, Sapienza University of Rome, 00185 Roma, Italy
| | | | - Roberto Gatto
- Department MeSVA, University of L’Aquila, 67100 L’Aquila, Italy
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13
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Ersu R, Chen ML, Ehsan Z, Ishman SL, Redline S, Narang I. Persistent obstructive sleep apnoea in children: treatment options and management considerations. THE LANCET. RESPIRATORY MEDICINE 2023; 11:283-296. [PMID: 36162413 DOI: 10.1016/s2213-2600(22)00262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 10/14/2022]
Abstract
Unresolved obstructive sleep apnoea (OSA) after an adenotonsillectomy, henceforth referred to as persistent OSA, is increasingly recognised in children (2-18 years). Although associated with obesity, underlying medical complexity, and craniofacial disorders, persistent OSA also occurs in otherwise healthy children. Inadequate treatment of persistent OSA can lead to long-term adverse health outcomes beyond childhood. Positive airway pressure, used as a one-size-fits-all primary management strategy for persistent childhood OSA, is highly efficacious but has unacceptably low adherence rates. A pressing need exists for a broader, more effective management approach for persistent OSA in children. In this Personal View, we discuss the use and the need for evaluation of current and novel therapeutics, the role of shared decision-making models that consider patient preferences, and the importance of considering the social determinants of health in research and clinical practice. A multipronged, comprehensive approach to persistent OSA might achieve better clinical outcomes in childhood and promote health equity for all children.
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Affiliation(s)
- Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Maida L Chen
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Missouri, Kansas City, KS, USA
| | - Stacey L Ishman
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Indra Narang
- Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
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Automated Evaluation of Upper Airway Obstruction Based on Deep Learning. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8231425. [PMID: 36852295 PMCID: PMC9966825 DOI: 10.1155/2023/8231425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/31/2022] [Accepted: 01/25/2023] [Indexed: 02/20/2023]
Abstract
Objectives This study is aimed at developing a screening tool that could evaluate the upper airway obstruction on lateral cephalograms based on deep learning. Methods We developed a novel and practical convolutional neural network model to automatically evaluate upper airway obstruction based on ResNet backbone using the lateral cephalogram. A total of 1219 X-ray images were collected for model training and testing. Results In comparison with VGG16, our model showed a better performance with sensitivity of 0.86, specificity of 0.89, PPV of 0.90, NPV of 0.85, and F1-score of 0.88, respectively. The heat maps of cephalograms showed a deeper understanding of features learned by deep learning model. Conclusion This study demonstrated that deep learning could learn effective features from cephalograms and automated evaluate upper airway obstruction according to X-ray images. Clinical Relevance. A novel and practical deep convolutional neural network model has been established to relieve dentists' workload of screening and improve accuracy in upper airway obstruction.
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15
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Liu Y, Zhao T, Ngan P, Qin D, Hua F, He H. The dental and craniofacial characteristics among children with obstructive sleep apnoea: a systematic review and meta-analysis. Eur J Orthod 2023; 45:346-355. [PMID: 36763565 DOI: 10.1093/ejo/cjac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Paediatric obstructive sleep apnoea (OSA) is a sleep breathing disorder which may have dramatic effects on childhood behaviour, neurodevelopment, metabolism, and overall health in children. Malocclusion and craniofacial morphology may be related to paediatric OSA, and therefore provide information for clinicians to recognize, evaluate and treat patients with this sleeping disorder. OBJECTIVE The aim of this systematic review was to summarize evidence regarding the association between paediatric OSA and children's dental and craniofacial characteristics. SEARCH METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to 1 June 2022. SELECTION CRITERIA Cross-sectional studies, comparing dental or craniofacial characteristics using clinical dental examinations or radiographic findings between OSA children (less than 18 year, diagnosed with overnight polysomnography) and healthy children, were included. DATA COLLECTION AND ANALYSIS The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used to assess the quality of included studies. RevMan software was used for performing the Meta-analyses. RESULTS Sixteen studies were included. Meta-analyses showed that the overjet (MD = 0.86, 95% CI: 0.20 to 1.51; P = 0.01), the saggital skeletal jaw discrepancy (ANB; MD = 1.78, 95% CI: 1.04 to 2.52; P < 0.00001) and mandibular plane angle (FH-MP; MD = 3.65, 95% CI: 2.45 to 4.85; P < 0.00001) were greater in OSA-affected children. In contrast, the upper molar arch width (upper first deciduous molar width; MD = -1.86, 95% CI: -3.52 to -0.20; P = 0.03), (Upper second deciduous molar width; MD = -1.06, 95% CI: -1.88 to -0.24; P = 0.01), SNB (MD = -2.10, 95% CI: -3.11 to -1.09; P < 0.0001), and maxillary length (ANS-PNS; MD = -1.62, 95% CI: -2.66 to -0.58; P = 0.002) were smaller in the OSA group. CONCLUSIONS This review shows that OSA-affected children tend to present with mandibular retroposition or retrognathia, increased mandibular plane angle and excess anterior overjet. However, these findings need to be viewed with caution as the corresponding differences may not be significant clinically. REGISTRATION PROSPERO (CRD42020162274).
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Affiliation(s)
- Yanxiaoxue Liu
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Tingting Zhao
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, School of Dentistry, Morgantown, WV, USA
| | - Danchen Qin
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hong He
- Hubei-MOST KLOS and KLOBM, School and Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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16
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Arroyo Buenestado A, Ribas-Pérez D. Early Childhood Caries and Sleep Disorders. J Clin Med 2023; 12:jcm12041378. [PMID: 36835914 PMCID: PMC9967236 DOI: 10.3390/jcm12041378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Obstructive sleep-disordered breathing (oSDB) comprises a set of breathing disturbances when the individual is asleep due to partial or complete upper airway obstruction. Modifying or risk factors are the anatomy, the size and shape of the airway, muscle tone, central nervous system responses to hypoxia, etc. In children, this is associated with poor school performance and reduced memory and learning abilities. In addition, increased levels of blood and lung pressure and cardiac alterations have been reported in children with sleep disturbances. On the other hand, Early Childhood Caries (ECC) is defined as the presence of one or more decayed primary teeth (cavities) of children under the age of 5. This study aimed to establish the possible relationship between sleep disorders and ECC by means of validated surveys and determined whether the results obtained coincide with the available literature. Our results found that up to 24.5% of children with a high risk of caries present regular nasal congestion, while this finding is only present among 6% of children with a low risk of caries (p = 0.041). The dmft index remains significantly linked to this occasional congestion, but the association depends on the patient's level of risk (p = 0.008); increasing with a high increasing risk of caries. As a conclusion, the risk of early childhood caries could correlate to a specific sleep change such as occasional snoring.
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Affiliation(s)
| | - David Ribas-Pérez
- Department of Pediatric Dentistry, University of Seville, 41004 Sevilla, Spain
- Correspondence:
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17
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Bucci R, Rongo R, Zunino B, Michelotti A, Bucci P, Alessandri-Bonetti G, Incerti-Parenti S, D'Antò V. Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2023; 67:101730. [PMID: 36525781 DOI: 10.1016/j.smrv.2022.101730] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Orthodontic treatment is suggested in growing individuals to correct transverse maxillary deficiency and mandibular retrusion. Since, as a secondary effect, these orthodontic procedures may improve pediatric obstructive sleep apnea (OSA), this systematic review assessed their effects on apnea-hypopnea index (AHI) and oxygen saturation (SaO2). Twenty-five (25) manuscripts were included for qualitative synthesis, 19 were selected for quantitative synthesis. Five interventions were analyzed: rapid maxillary expansion (RME, 15 studies), mandibular advancement (MAA, five studies), myofunctional therapy (MT, four studies), and RME combined with MAA (one study). RME produced a significant AHI reduction and minimum SaO2 increase immediately after active treatment, at six and 12 months from baseline. A significant AHI reduction was also observed six and 12 months after the beginning of MAA treatment. MT showed positive effects, with different protocols. In this systematic review and meta-analysis of data from mainly uncontrolled studies, interceptive orthodontic treatments showed overall favorable effects on respiratory outcomes in pediatric OSA. However, due to the low to very low level of the body evidence, this treatment cannot be suggested as elective for OSA treatment. An orthodontic indication is needed to support this therapy and a careful monitoring is required to ensure positive improvement in OSA parameters.
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Affiliation(s)
- Rosaria Bucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
| | - Roberto Rongo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
| | - Benedetta Zunino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
| | - Paolo Bucci
- Department of Public Health, Section of Hygiene, University of Naples Federico II, Naples, Italy
| | - Giulio Alessandri-Bonetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics and Sleep Dentistry, University of Bologna, Bologna, Italy.
| | - Serena Incerti-Parenti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics and Sleep Dentistry, University of Bologna, Bologna, Italy
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
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18
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Wang H, Xu W, Zhao A, Sun D, Li Y, Han D. Clinical Characteristics Combined with Craniofacial Photographic Analysis in Children with Obstructive Sleep Apnea. Nat Sci Sleep 2023; 15:115-125. [PMID: 36945230 PMCID: PMC10024909 DOI: 10.2147/nss.s400745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/20/2023] [Indexed: 03/23/2023] Open
Abstract
Purpose Distinguishing obstructive sleep apnea (OSA) in a high-risk population remains challenging. This study aimed to investigate clinical features to identify children with OSA combined with craniofacial photographic analysis. Methods One hundred and forty-five children (30 controls, 62 with primary snoring, and 53 with OSA) were included. Differences in general demographic characteristics and surface facial morphology among the groups were compared. Risk factors and prediction models for determining the presence of OSA (obstructive sleep apnea-hypopnea index>1) were developed using logistic regression analysis. Results The BMI (z-score), tonsil hypertrophy, and lower face width (adjusted age, gender, and BMI z-score) were showed significantly different in children with OSA compared with primary snoring and controls (adjusted p<0.05). The screening model based on clinical features and photography measurements correctly classified 79.3% of the children with 64.2% sensitivity and 89.1% specificity. The area under the curve of the model was 81.0 (95% CI, 73.5-98.4%). Conclusion A screening model based on clinical features and photography measurements would be helpful in clinical decision-making for children with highly suspected OSA if polysomnography remains inaccessible in resource-stretched healthcare systems.
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Affiliation(s)
- Huijun Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China
| | - Wen Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China
| | - Anqi Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China
| | - Dance Sun
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China
| | - Yanru Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China
| | - Demin Han
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Demin Han; Yanru Li, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang, Dongcheng District, Beijing, People’s Republic of China, Email ;
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Hsueh WY, Kang KT, Yao CCJ, Chen YJ, Weng WC, Lee PL, Chang CW, Hsu WC. Measurements of craniofacial morphology using photogrammetry in children with sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2022; 162:111287. [PMID: 36029654 DOI: 10.1016/j.ijporl.2022.111287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/20/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess the craniofacial morphology in children with sleep-disordered breathing (SDB) using nonradiation and readily accessible photogrammetry technique. METHODS Included children aged 3-18 years with SDB-related symptoms from April 2019 to February 2020 in a tertiary center. All participants underwent craniofacial photogrammetry and overnight polysomnography (PSG). Participants were stratified into 2 groups (obstructive sleep apnea [OSA] group: apnea-hypopnea index [AHI] ≥ 1 and non-OSA group: AHI <1). Craniofacial photogrammetry was performed to derive variables of craniofacial features in standardized frontal and profile views. The 2 groups were propensity score matched based on age, sex, and body mass index (BMI) percentiles. Associations between craniofacial feature variables and OSA (AHI ≥1) likelihood were examined using logistic regression test. intraclass correlation coefficient (ICC) was used to evaluate the intrarater and interrater reliability. RESULTS In total, 58 children were enrolled for the analysis after matching. All 3 variables representing the mandibular plane angle in the profile view were increased in the OSA group (mego-tn: 34.85 ± 5.99 vs 31.65 ± 5.96°, odds ratio [OR]: 1.10, 95% CI:1.02 to 1.18, P = .01; tn-gogn: 28.65 ± 6.38 vs 25.91 ± 5.38°, OR: 1.08, 95% CI:1.02 to 1.15, P = .012; and gome-tsup: 26.71 ± 6.13 vs 22.20 ± 5.89°, OR: 1.13, 95% CI:1.04 to 1.23, P = .003). CONCLUSIONS Craniofacial photogrammetry revealed increased mandibular inclination in children with OSA. A steep mandibular plane with craniofacial photogrammetry is considered a potential predictor of pediatric OSA. Further investigation with a large sample size is required to clarify the validity of photogrammetry in evaluating pediatric OSA.
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Affiliation(s)
- Wan-Yi Hsueh
- Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yunn-Jy Chen
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Wei Chang
- Division of Endodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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20
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Calvo-Henriquez C, Tucciarone M, Lechien JR, Maniaci A, Graham E, Maza-Solano J, Metwaly O, Martinez-Capoccioni G, Mariño-Sanchez F, Plaza G, Martin-Martin C. Turbinate surgery in pediatric patients: A worldwide survey. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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Conrad LA, Nandalike K, Rani S, Rastogi D. Associations between sleep, obesity, and asthma in urban minority children. J Clin Sleep Med 2022; 18:2377-2385. [PMID: 35801341 PMCID: PMC9516592 DOI: 10.5664/jcsm.10114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although obesity, asthma, and sleep-disordered breathing are interrelated, there is limited understanding of the independent contributions of body-mass index and pulmonary function on polysomnography in children with asthma. METHODS We conducted a retrospective chart review on 448 7- to 18-year-old children with asthma who had undergone polysomnography testing between 1/2007-12/2011 to elucidate the association between spirometry variables, body-mass index, and polysomnography parameters, adjusting for asthma and antiallergic medications. RESULTS Obese children had poorer sleep architecture and more severe gas exchange abnormalities compared to healthy weight children. Multivariate analysis revealed an independent association of body-mass index with sleep efficiency, with more light and less deep sleep in both obese and healthy-weight children, and with baseline oxygen saturation and oxygen nadir in obese children. In obese children, forced vital capacity was independently associated with less deep sleep (time in N3 sleep) as well as with oxygen nadir, while among healthy-weight children, forced expiratory volume directly correlated but forced vital capacity inversely correlated with deep sleep. In obese children, inhaled corticosteroid was associated with baseline oxygen saturation, and montelukast was associated with lower end-tidal carbon dioxide. In healthy-weight children, inhaled corticosteroid was associated with arousal awakening index, and montelukast was associated with light sleep. Antiallergic medications were not independently associated with polysomnography parameters. CONCLUSIONS Pulmonary function, body-mass index, and asthma medications have independent and differing influences on sleep architecture and gas exchange polysomnography parameters in obese and healthy-weight children with asthma. Asthma medications are associated with improved gas exchange in obese children and improved sleep architecture in healthy-weight children with asthma. CITATION Conrad LA, Nandalike K, Rani S, Rastogi D. Associations between sleep, obesity, and asthma in urban minority children. J Clin Sleep Med. 2022;18(10):2377-2385.
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Affiliation(s)
- Laura A. Conrad
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Kiran Nandalike
- Department of Pediatrics, UC Davis Medical Center, Sacramento, California
| | - Seema Rani
- St. Christopher’s Hospital for Children, Drexel University, Philadelphia, Pennsylvania
| | - Deepa Rastogi
- Children’s National Medical Center, GWU School of Medicine and Health Sciences, Washington, District of Columbia
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22
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Xu Q, Wang X, Liu P, Qin L, Chen H, Chen W, Guo J. Correlation of cephalometric variables with obstructive sleep apnea severity among children: a hierarchical regression analysis. Cranio 2022:1-8. [PMID: 36018797 DOI: 10.1080/08869634.2022.2106073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To evaluate the correlation between cephalometric parameters and apnea-hypopnea index (AHI) after controlling gender, body mass index (BMI), and adenoid size in children with obstructive sleep apnea (OSA). METHODS Sixty-four children with OSA (40 males, 24 females, 8.72 ± 0.899 years) were chosen by simple random sampling for a cross-sectional study from January 2018 to March 2022. They were diagnosed with OSA, assessed by Obstructive Sleep Apnea-18 questionnaire and home polysomnography and underwent lateral cephalograms. RESULTS Hierarchical regression analysis indicated that cephalometric parameters (except adenoid size) were associated with OSA severity, explaining 18.1% of the AHI variance. Among cephalometric measurements, AHI was positively associated with H-RGn and N-Go-Me angle (p < 0.05) and negatively associated with NP (p < 0.05). CONCLUSION The sagittal diameter of the oropharynx, lower gonial angle, and hyoid position are significant AHI predictors in children with OSA, independent of demographic characteristics and adenoid size.
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Affiliation(s)
- Qiuping Xu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, SD, China
| | - Xiaoya Wang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, SD, China
| | - Panpan Liu
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, SD, China
| | - Luo Qin
- Savaid Stomatology School, Hangzhou Medical College/Ningbo Stomatology Hospital, XJ, China
| | - Hui Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, SD, China
| | - Wenqian Chen
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, SD, China
| | - Jing Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, SD, China
- Savaid Stomatology School, Hangzhou Medical College/Ningbo Stomatology Hospital, XJ, China
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A Comparative Assessment of the Upper Pharyngeal Airway Dimensions among Different Anteroposterior Skeletal Patterns in 7–14-Year-Old Children: A Cephalometric Study. CHILDREN 2022; 9:children9081163. [PMID: 36010053 PMCID: PMC9406918 DOI: 10.3390/children9081163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/30/2022] [Accepted: 07/30/2022] [Indexed: 11/16/2022]
Abstract
Background: The pharyngeal airway is a crucial part of the respiratory system’s function. Assessing the pharyngeal airway dimensions in different skeletal types is important in the orthodontic treatment of growing patients. The aim of this study was to compare the upper pharyngeal airway dimensions of 7–14-year-old children with different skeletal types. Methods: Three-hundred-sixty-one lateral cephalometric radiographs were grouped based on their skeletal patterns determined by the ANB angle as skeletal type I (n = 123), type II (n = 121), and type III (n = 117). The radiographs were divided into 4 groups: 7/8 YO (7–8 years old), 9/10 YO, 11/12 YO, and 13/14 YO. The cephalometric measurements comprised SNA, SNB, ANB, Ad1-PNS, Ad2-PNS, McUP, and McLP. An ANOVA was used to compare the group results. Results: Significant differences in Ad1-PNS, Ad2-PNS, McUP, and McLP in skeletal types II and III were found between age groups. Most upper pharyngeal airway dimensions in skeletal types II and III children were significantly wider in the 13/14 YO group than in the other age groups. Conclusion: The upper pharyngeal airway dimensions increased age-dependently in 7–14-year-old children, especially in skeletal types II and III. The upper pharyngeal airway dimensions could serve as a guide in differentiating the different skeletal classes in clinical settings.
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Fagundes NCF, Flores-Mir C. Pediatric obstructive sleep apnea-Dental professionals can play a crucial role. Pediatr Pulmonol 2022; 57:1860-1868. [PMID: 33501761 DOI: 10.1002/ppul.25291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/15/2022]
Abstract
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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Affiliation(s)
| | - Carlos Flores-Mir
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Canada
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25
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Craniofacial Morphologic Predictors for Passive Myofunctional Therapy of Pediatric Obstructive Sleep Apnea Using an Oral Appliance with a Tongue Bead. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9071073. [PMID: 35884057 PMCID: PMC9319715 DOI: 10.3390/children9071073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022]
Abstract
We conducted this retrospective study to identify potential clinical, polysomnographic, and cephalometric predictors for the treatment outcomes of a tongue-beaded oral appliance (OA) in children with obstructive sleep apnea syndrome (OSAS). In total, 63 patients—50 boys and 13 girls ranging in age from 4 to 16 years—underwent OA treatment nightly for at least 6 months. A baseline digital lateral cephalometric radiograph was obtained for each patient. Multivariate logistic regression analysis was performed to examine predictors for the treatment outcome based on the clinical and cephalometric measurements. Overall, 28 patients responded to the treatment (post-treatment improvement > 50% or apnea−hypopnea index (AHI) < 1/h), and 35 did not (post-treatment improvement < 50% and AHI ≥ 1/h). Significantly larger cranial base angle (SNBa), smaller lower gonial angle (LGo Angle), and shorter length of anterior cranial base (SN) were found in responders. Smaller lower gonial angle (LGo Angle) and smaller anterior cranial base (SN) predict a favorable outcome for pediatric OSAS using a tongue-beaded OA. This finding will equip practitioners with additional insights when selecting suitable candidates for OA therapy in pediatric patients.
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Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2022; 18:1865-1875. [PMID: 35074045 PMCID: PMC9243277 DOI: 10.5664/jcsm.9904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This review aimed to evaluate the association between craniofacial features in children and adolescents with pediatric obstructive sleep apnea (OSA). METHODS Seven databases were searched to fulfill our research objectives. Clinical studies that included participants younger than 18 years with fully diagnosed OSA or without OSA and that evaluated skeletal, soft craniofacial features, or dental arch morphology were considered for this review. The risk of bias and certainty of evidence were assessed. A meta-analysis was performed when low methodological and clinical heterogeneity were detected. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA-2020) guidelines. RESULTS Nine studies were identified at the end of the selection process, from which 5 did not report differences. Four studies reported differences between craniofacial features when OSA was compared to an asymptomatic control group. Mandibular retrognathia, reduced anteroposterior linear dimensions of the bony nasopharynx (decreased pharyngeal diameters at the levels of the adenoids), longer facial profile, and a narrower intercanine width were described among children with OSA. A meta-analysis was performed considering the studies with a similar methodological approach, and no differences were observed in all the considered cephalometric angles (SNA, SNB, ANB, NSBa, U1-L1, U1-SN). All the included studies were considered at low risk of bias even though some limitations were noted. CONCLUSIONS Due to the very low to moderate level of certainty, neither an association nor a lack thereof between craniofacial morphology and pediatric OSA can be supported by these data. CITATION Fagundes NCF, Gianoni-Capenakas S, Heo G, Flores-Mir C. Craniofacial features in children with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2022;18(7):1865-1875.
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Affiliation(s)
| | - Silvia Gianoni-Capenakas
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Giseon Heo
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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27
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Coban G, Buyuk SK. Sleep disordered breathing and oral health-related quality of life in children with different skeletal malocclusions. Cranio 2022:1-8. [PMID: 35622899 DOI: 10.1080/08869634.2022.2080960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the relationship among different skeletal malocclusion patterns, sleep-disordered breathing (SDB) and children's oral health-related quality of life (OHRQoL). METHODS Two hundred-five patients were divided into three groups, considering skeletal malocclusion. Parents completed the Pediatric Sleep Questionnaire (PSQ) on behalf of the patients, who completed the 14-question version of the Oral Health Impact Profile (OHIP-14). RESULTS SDB was observed in 10.7% of children. The overall prevalence of snoring, difficulty breathing during sleeping, mouth breathing, and dry mouth on awakening was 8.78%, 7.31%, 36.09%, and 37.07%, respectively. However, there was no significant difference in OHIP-14 parameters among the skeletal groups. A positive correlation was found between OHIP-14 and PSQ and was significant in Class I and III. CONCLUSION Although there was no significant difference, SDB risk and sleep quality were found as most to least problematic, in the following sequential order: Class II > Class III > Class I.
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Affiliation(s)
- Gokhan Coban
- Department of Orthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - S Kutalmış Buyuk
- Department of Orthodontics, Faculty of Dentistry, Ordu University, Ordu, Turkey
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28
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Bariani RCB, Bigliazzi R, Badreddine FR, Yamamoto LH, Tufik S, Moreira G, Fujita RR. A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S162-S170. [PMID: 35780010 PMCID: PMC9801059 DOI: 10.1016/j.bjorl.2022.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/22/2022] [Accepted: 04/25/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The present prospective clinical study aimed to investigate the effects of rapid maxillary expansion on the airway, correlating airway volumes obtained on multi-slice computed tomography and polysomnography assessment of oxygen saturation and apnea/hypopnea index. METHODS Twenty-four patients (11 with obstructive sleep apnea and 13 with residual snoring, mean age 10.0 (1.8), were enrolled in the study. Each patient underwent multislice computed tomography and nocturnal polysomnography before rapid maxillary expansion and after removal of maxillary expansion after six months. Airway regions were segmented, and volumes were computed. RESULTS The increase in oropharyngeal volume was significant in both groups. Oxygen saturation and apnea/hypopnea index were not statistically significant. No correlation was found between total airway volume, oxygen saturation, and apnea/hypopnea index changes between the time points examined. CONCLUSIONS This study showed that when rapid maxillary expansion is performed in individuals with sleep-disordered breathing, there were statistically significant differences in oropharyngeal volume between pre- and post-rapid maxillary expansion, but there was no correlation between oxygen saturation values and oropharyngeal volume increase. LEVEL OF EVIDENCE The article is classified as Evidence Level 3 (Three).
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Affiliation(s)
- Rita Catia Brás Bariani
- Universidade Federal de São Paulo (Unifesp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil,Corresponding author.
| | | | - Fauze Ramez Badreddine
- Universidade Federal de São Paulo (Unifesp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Lucia Hatsue Yamamoto
- Universidade Federal de São Paulo (Unifesp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo (Unifesp), Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Gustavo Moreira
- Universidade Federal de São Paulo (Unifesp), Departamento de Psicobiologia, São Paulo, SP, Brazil
| | - Reginaldo Raimundo Fujita
- Universidade Federal de São Paulo (Unifesp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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29
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Niu X, Moland J, Pedersen TK, Bilgrau AE, Cattaneo PM, Glerup M, Stoustrup P. Restricted upper airway dimensions in patients with dentofacial deformity from juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:32. [PMID: 35477405 PMCID: PMC9044879 DOI: 10.1186/s12969-022-00691-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This retrospective, cross-sectional study aimed to assess the pharyngeal airway dimensions of patients with juvenile idiopathic arthritis (JIA) and moderate/severe JIA-related dentofacial deformity (mandibular retrognathia/micrognathia), and compare the results with JIA patients with a normal mandibular appearance and a group of non-JIA patients. METHODS Seventy-eight patients were retrospectively included in a 1:1:1 manner as specified below. All patients had previously been treated at the Section of Orthodontics, Aarhus University, Denmark. All had a pretreatment cone beam computed tomography (CBCT). Group 1 (JIA+); 26 JIA patients with severe arthritis-related dentofacial deformity and mandibular retrognathia/micrognathia. Group 2 (JIA-); 26 JIA patients with normal mandibular morphology/position. Group 3 (Controls); 26 non-JIA subjects. Dentofacial morphology and upper airway dimensions, excluding the nasal cavity, were assessed in a validated three-dimensional (3D) fashion. Assessment of dentofacial deformity comprised six morphometric measures. Assessment of airway dimensions comprised nine measures. RESULTS Five morphometric measures of dentofacial deformity were significantly deviating in the JIA+ group compared with the JIA- and control groups: Posterior mandibular height, anterior facial height, mandibular inclination, mandibular occlusal inclination, and mandibular sagittal position. Five of the airway measurements showed significant inter-group differences: JIA+ had a significantly smaller nasopharyngeal airway dimension (ad2-PNS), a smaller velopharyngeal volume, a smaller minimal cross-sectional area and a smaller minimal hydraulic diameter than JIA- and controls. No significant differences in upper airway dimensions were seen between JIA- and controls. CONCLUSION JIA patients with severe arthritis-related dentofacial deformity and mandibular micrognathia had significantly restricted upper airway dimensions compared with JIA patients without dentofacial deformity and controls. The restrictions of upper airway dimension seen in the JIA+ group herein were previously associated with sleep-disordered breathing in the non-JIA background population. Further studies are needed to elucidate the role of dentofacial deformity and restricted airways in the development of sleep-disordered breathing in JIA.
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Affiliation(s)
- Xiaowen Niu
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Julianne Moland
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Thomas Klit Pedersen
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Ellern Bilgrau
- grid.5117.20000 0001 0742 471XDepartment of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Paolo M. Cattaneo
- grid.7048.b0000 0001 1956 2722Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia, Formerly, Section of Orthodontics, Aarhus University, Denmark, Aarhus, Denmark
| | - Mia Glerup
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Stoustrup
- Section of Orthodontics, Aarhus University, Aarhus, Denmark.
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A 3D CBCT Analysis of Airway and Cephalometric Values in Patients Diagnosed with Juvenile Idiopathic Arthritis Compared to a Control Group. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: The temporomandibular joint (TMJ) is affected in 30–45% of juvenile idiopathic arthritis (JIA) patients, with all JIA subtypes at risk for TMJ involvement. JIA patients with TMJ involvement may present with altered craniofacial morphology, including micrognathia, mandibular retrognathia, a hyperdivergent mandibular plane angle, and skeletal anterior open bite. These features are also commonly present and associated with non-JIA pediatric patients with obstructive sleep apnea (OSA). Materials and Methods: The study was comprised of a group of 32 JIA patients and a group of 32 healthy control subjects. CBCT images were taken for all patients and were imported into Dolphin Imaging software. The Dolphin Imaging was used to measure the upper airway volumes and the most constricted cross-sectional areas of each patient. Cephalometric images were rendered from the CBCT data for each patient, and the following cephalometric values were identified: SNA angle, SNB angle, ANB angle, anterior facial height (AFH), posterior facial height (PFH), mandibular plane angle (SN-MP), FMA (FH-MP), overjet (OJ), and overbite (OB). Airway volumes, the most constricted cross-sectional area values, and cephalometric values were compared between the JIA and control groups. Results: For airway values, statistically significant differences were seen in the nasopharynx airway volume (p = 0.004), total upper airway volume (p = 0.013), and the most constricted cross-sectional area (p = 0.026). The oropharynx airway volume was not statistically significant (p = 0.051). For cephalometric values, only the posterior facial height showed a statistically significant difference (p = 0.024). Conclusions: There was a significant difference in airway dimensions in the JIA patients as compared to the control patients. In addition, the posterior facial dimensions seem to be affected in JIA patients. The ODDs ratio analysis further corroborated the findings that were significant.
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Improved diagnostic accuracy for pediatric obstructive sleep apnea using an out-of-center sleep test. Auris Nasus Larynx 2022; 49:980-985. [DOI: 10.1016/j.anl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/20/2022]
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Alansari RA. The role of orthodontics in management of obstructive sleep apnea. Saudi Dent J 2022; 34:194-201. [PMID: 35935723 PMCID: PMC9346943 DOI: 10.1016/j.sdentj.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Dental sleep medicine is the field of dental practice that deals with the management of sleep-related breathing disorders, which includes obstructive sleep apnea (OSA) in adults and children. Depending on the developmental age of the patient and the cause of the apnea dental treatment options may vary. For adult patients, treatment modalities may include oral appliance therapy (OAT), orthognathic surgery and surgical or miniscrew supported palatal expansion. While for children, treatment may include non-surgical maxillary expansion and orthodontic functional appliances. Many physicians and dentists are unaware of the role dentistry, particularly orthodontics, may play in the interdisciplinary management of these disorders. This review article is an attempt to compile evidence-based relevant information on the role of orthodontists/sleep dentists in the screening, diagnosis, and management of sleep apnea. Oral sleep appliance mechanisms of action, selective efficacy, and the medical physiological outcomes are discussed. The purpose of this review is to provide a comprehensive understanding of how orthodontists and sleep physicians can work in tandem to maximize the benefits and minimize the side effects while treating patients with OSA.
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Fernández-Barriales M, Lafuente-Ibáñez de Mendoza I, Alonso-Fernández Pacheco JJ, Aguirre-Urizar JM. Rapid maxillary expansion versus watchful waiting in pediatric OSA: a systematic review. Sleep Med Rev 2022; 62:101609. [DOI: 10.1016/j.smrv.2022.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
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Fernandes Fagundes NC, Carlyle T, Dalci O, Darendeliler MA, Kornerup I, Major PW, Montpetit A, Pliska BT, Quo S, Heo G, Flores Mir C. Use of facial stereophotogrammetry as a screening tool for pediatric obstructive sleep apnea by dental specialists. J Clin Sleep Med 2022; 18:57-66. [PMID: 34170240 PMCID: PMC8807899 DOI: 10.5664/jcsm.9490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To evaluate facial 3-dimensional (3D) stereophotogrammetry's effectiveness as a screening tool for pediatric obstructive sleep apnea (OSA) when used by dental specialists. METHODS One hundred forty-four participants aged 2-17 years, including children fully diagnosed with pediatric OSA through nocturnal polysomnography or at high-risk or low-risk of pediatric OSA, participated in this study. 3D stereophotogrammetry, Craniofacial Index, and Pediatric Sleep Questionnaire were obtained from all participants. Ten dental specialists with interest in pediatric sleep breathing disorders classified OSA severity twice, once based only on 3D stereophotogrammetry and then based on 3D stereophotogrammetry, Craniofacial Index, and Pediatric Sleep Questionnaire. Intrarater and interrater reliability and diagnostic accuracy of pediatric OSA classification were calculated. A cluster analysis was performed to identify potential homogeneous pediatric OSA groups based on their craniofacial features classified through the Craniofacial Index . RESULTS Intrarater and interrater agreement suggested a poor reproducibility when only 3D facial stereophotogrammetry was used and when all tools were assessed simultaneously. Sensitivity and specificity varied among clinicians, indicating a low screening ability for both 3D facial stereophotogrammetry, ranging from 0.36-0.90 and 0.10-0.70 and all tools ranging from 0.53-1.0 and 0.01-0.49, respectively. A high arched palate and reversed or increased overjet contributed to explaining how participating dental clinicians classified pediatric OSA. CONCLUSIONS 3D stereophotogrammetry-based facial analysis does not seem predictive for pediatric OSA screening, alone or combined with the Pediatric Sleep Questionnaire and Craniofacial Index when used by dental specialists interested in sleep-disordered breathing. Some craniofacial traits, more specifically significant sagittal overjet discrepancies and an arched palate, seem to influence participating dental specialists' classification. CITATION Fernandes Fagundes NC, Carlyle T, Dalci O, et al. Use of facial stereophotogrammetry as a screening tool for pediatric obstructive sleep apnea by dental specialists. J Clin Sleep Med. 2022;18(1):57-66.
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Affiliation(s)
| | - Terry Carlyle
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Oyku Dalci
- Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, New South Wales, Australia
| | - M. Ali Darendeliler
- Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney South West Area Health Service, Sydney, New South Wales, Australia
| | - Ida Kornerup
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W. Major
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrée Montpetit
- Department of Oral Health–Orthodontics Section, Faculty of Dental Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Benjamin T. Pliska
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stacey Quo
- Division of Orthodontics, School of Dentistry, University of California San Francisco, San Francisco, California
| | - Giseon Heo
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Address correspondence to: Carlos Flores Mir, DDS, DSc, 5-528 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G Canada; Tel: (780) 492-7409; Fax: (780) 492-7536;
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Bozzini MF, Di Francesco RC, Soster LA. Clinical and anatomical characteristics associated with obstructive sleep apnea severity in children. Clinics (Sao Paulo) 2022; 77:100131. [PMID: 36334493 PMCID: PMC9636441 DOI: 10.1016/j.clinsp.2022.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/13/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the clinical and anatomical characteristics associated with obstructive sleep apnea severity in children with adenotonsillar hypertrophy. METHODS The authors conducted a cross-sectional multidisciplinary survey and selected 58 Brazilian children (4‒9 years old) with adenotonsillar hypertrophy, parental complaints of snoring, mouth-breathing, and witnessed apnea episodes. The authors excluded children with known genetic, craniofacial, neurological, or psychiatric conditions. Children with a parafunctional habit or early dental loss and those receiving orthodontic treatment were not selected. All children underwent polysomnography, and three were excluded because they showed an apnea-hypopnea index lower than one or minimal oxygen saturation higher than 92%. The sample consisted of 55 children classified into mild (33 children) and moderate/severe (22 children) obstructive sleep apnea groups. Detailed clinical and anatomical evaluations were performed, and anthropometric, otorhinolaryngological, and orthodontic variables were analyzed. Sleep disorder symptoms were assessed using the Sleep Disturbance Scale for Children questionnaire. All children also underwent teleradiography exams and Rickett's and Jarabak's cephalometric analyses. RESULTS The mild and moderate/severe obstructive sleep apnea groups showed no significant differences in clinical criteria. Facial depth angle, based on Ricketts cephalometric analysis, was significantly different between the groups (p = 0.010), but this measurement by itself does not express the child's growth pattern, as it is established by the arithmetic mean of the differences between the obtained angles and the normal values of five cephalometric measurements. CONCLUSIONS The clinical criteria and craniofacial characteristics evaluated did not influence the disease severity.
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Affiliation(s)
| | | | - Letícia A Soster
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Hadaegh Y, Uludag H, Dederich D, El-Bialy TH. The effect of low intensity pulsed ultrasound on mandibular condylar growth in young adult rats. Bone Rep 2021; 15:101122. [PMID: 34527791 PMCID: PMC8433121 DOI: 10.1016/j.bonr.2021.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
There is a need for more effective methods to enhance mandibular growth in young adults with mandibular deficiency. Previous studies suggest that low intensity pulsed ultrasound (LIPUS) can enhance mandibular growth in growing individuals. This study aimed to evaluate the potential growth changes of the mandible following 4-week LIPUS application in young adult rats. Nineteen ≈120-day-old female rats were allocated to experimental (n = 10) and control (n = 9) groups. The animals in the experimental group were treated with LIPUS to their temporomandibular joints (TMJs) bilaterally, 20 min each day for 28 consecutive days. Animals were then euthanized; gross morphological evaluation was performed on 2D photographs and 3D virtual models of hemi-mandibles, and microstructural assessment was done for the mandibular condyle (MC). Evaluation of mineralization and microarchitecture properties of subchondral cancellous bone was performed by micro-computed tomography (μCT) scanning. Qualitative and histomorphometric analysis was done on condylar cartilage and subchondral bone following Alcian Blue/PAS and Goldner's Trichrome staining. Vital flourochrome (calcein green) labeling was also utilized to determine the amount of endochondral bone growth. Gross morphological evaluations showed a slight statistically non-significant increase especially in the main condylar growth direction in the LIPUS group. Moreover, 3D evaluation depicted an enhanced periosteal bone apposition at the site of LIPUS application. Microstructural analysis revealed that LIPUS stimulates both chondrogenesis and osteogenesis and enhances endochondral bone formation in young adult rat MC. Furthermore, the effect of LIPUS on osteogenic cells of subchondral cancellous bone was notable. To conclude, LIPUS can enhance young adult rats' MC residual growth potential.
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Affiliation(s)
- Yasamin Hadaegh
- School of Dentistry, University of Alberta, Edmonton, Canada
| | - Hasan Uludag
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Canada
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Calvo-Henriquez C, Mariño-Sánchez F, Lechien JR, Maldonado-Alvarado B, Maniaci A, Maza-Solano J, Martínez-Capoccioni G, Neves JC, Martin-Martin C. Radiofrequency ablation turbinoplasty improves the sense of smell in pediatric patients: A prospective study. Int J Pediatr Otorhinolaryngol 2021; 150:110935. [PMID: 34649156 DOI: 10.1016/j.ijporl.2021.110935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The olfactory sense is of paramount importance for the adequate development of a child. Olfactory loss in children might have different origins. One of the most common is conductive, when nasal obstruction prevents odorants from reaching the olfactory epithelium. Rhinitis and turbinate enlargement have been proven to diminish the sense of smell in pediatric patients. A common treatment for resistant rhinitis in these patients is turbinate radiofrequency ablation (TRA). However, despite an increasing research effort in this field, there are no studies instrumentally assessing olfaction in children undergoing turbinate surgery to date. This study was designed with the aim of assessing changes in olfaction through validated instrumental tools in pediatric patients undergoing TRA for the first time. METHODS A prospective uncontrolled intervention clinical trial design was conducted. Two cohorts of children ranging 4-15 years old were consecutively selected from a third level referral Hospital and subjected to the universal sniff test (U-Sniff), alcohol sniff test (AST), and sniffin sticks threshold test (SST) before and 1, 3 and 6 months after surgery. Cohort A consisted of children solely undergoing TRA. Cohort B consisted of children on whom adenoidectomy and TRA had been performed. Additionally, a cohort of Spanish healthy controls, paired by sex and age, were asked to perform the U-Sniff. RESULTS A total of 81 participants with a mean age of 10.31 ± 2.56 years were included. Fifty-three patients underwent TRA exclusively and 28 were subjected to associated adenoidectomy. Despite a tendency toward improvement in the U-sniff scores, there were no statistically significant differences after surgery. However, statistically significant differences were obtained for threshold tasks measured with SST and AST, revealing differences at 1, 3 and 6 months after surgery compared to preoperative scores. CONCLUSIONS In summary, this research demonstrated adequate levels in the sense of smell regarding identification tasks, but decreased olfactory threshold scores in pediatric patients suffering from TE. TRA, alone or with adenoidectomy, improved smell threshold scores, but had no significant effect on identification tasks.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Franklin Mariño-Sánchez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Foch Hospital, University of Paris Saclay, Paris, France
| | - Byron Maldonado-Alvarado
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonino Maniaci
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, ENT Department of University of Catania, Catania, Italy
| | - Juan Maza-Solano
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Rhinology and Skull Base Surgery Unit, Otolaryngology Department, Hospital Virgen de la Macarena, Seville, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Carlos Neves
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; MyFace Clinics and Academy, Lisbon, Portugal
| | - Carlos Martin-Martin
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Pérez-Rodríguez LM, Diéguez-Pérez M, Millón-Cruz A, Arcos-Palomino I. Airways cephalometric norms from a sample of Caucasian Children. J Clin Exp Dent 2021; 13:e941-e947. [PMID: 34603624 PMCID: PMC8464393 DOI: 10.4317/jced.58105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/24/2021] [Indexed: 11/05/2022] Open
Abstract
Background The diagnosis of the respiratory pattern and the analysis of airway dimension using lateral cephalometric radiographs include the study of the adenoid region, free air space of the nasopharynx and oropharynx, soft palate and posterior part of the tongue. The objective of this study is to identify the airways cephalometric norms from a sample of Caucasian children, in relation to gender, age and type of malocclusion.
Material and Methods A total of 480 patients of both sexes were included in the study, the age ranged between 6-12 years. The radiographic records were analyzed using the Nemoceph® 11.3.0 software and the diagnosis of skeletal class was performed using the Steiner analysis. The cephalometric measurements used for the study were PNS-AD1, AD1-Ba, PNS-Ba, Ptm-Ba, PNS-H and the upper and lower airways according to McNamara analysis. The comparative analysis was performed using only upper and lower airways variables.
Results The mean values for each variable in the total sample were 23.2 mm (PNS-Ad1), 24.7 mm (Ad1-Ba), 47.6 mm (PNS-Ba), 45.7 mm (Ptm-Ba), 30.0 mm (PNS-H), 9.3 mm (upper airway) and 11.5 mm (lower airway). According to gender, all variables were greater in the boys group except for the lower airway. In relation to age, the mean values increased with age except for the lower airway and the AD1-Ba variables. In patients with skeletal Class I greater dimensions of the upper and lower airways were observed.
Conclusions In this Caucasian sample, it has been observed a tendency of minor airway dimensions in patients with skeletal Class II, lower age range female gender. It has been observed only significant differences between age and skeletal class for lower airways variable and, in relation to upper airways variable the results were significant in relation to age. Key words:Child development, Diagnostic XRay, Cephalometry, Respiratory system diagnostic imaging.
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Affiliation(s)
- Luis-Miguel Pérez-Rodríguez
- DDS, MSc, PhD. School of Dentistry. Universidad Europea de Madrid. Campus de Universidad Europea de Madrid. Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid
| | - Montserrat Diéguez-Pérez
- DDS, MSc, PhD. School of Dentistry. Universidad Europea de Madrid. Campus de Universidad Europea de Madrid. Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid
| | - Alejandrina Millón-Cruz
- MD, PhD. Department of Oral and Maxillofacial Surgery. Hospital Universitario Príncipe de Asturias. Carretera Alcalá-Meco s/n 28805, Madrid
| | - Ignasi Arcos-Palomino
- DDS, MSc, PhD. School of Dentistry. Universidad Europea de Madrid. Campus de Universidad Europea de Madrid. Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid
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Fernandes Fagundes NC, d'Apuzzo F, Perillo L, Puigdollers A, Gozal D, Graf D, Heo G, Flores-Mir C. Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions. J Clin Sleep Med 2021; 17:1627-1634. [PMID: 33745506 DOI: 10.5664/jcsm.9262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES To analyze differences in mandibular cortical width (MCW) among children diagnosed with obstructive sleep apnea (OSA) or at high- or low-risk for OSA. METHODS A total of 161 children were assessed: 60 children with polysomnographically diagnosed OSA, 56 children presenting symptoms suggestive of high-risk for OSA, and 45 children at low risk for OSA. Children at high- and low-risk for OSA were evaluated through the Pediatric Sleep Questionnaire. MCW was calculated using ImageJ software from panoramic radiograph images available from all participants. Differences between MCW measurements in the 3 groups were evaluated using analysis of covariance and Bonferroni post-hoc tests, with age as a covariate. The association between MCW and specific cephalometric variables was assessed through regression analysis. RESULTS The participants' mean age was 9.6 ± 3.1 years (59% male and 41% female). The mean body mass index z-score was 0.62 ± 1.3. The polysomnographically diagnosed OSA group presented smaller MCW than the group at low-risk for OSA (mean difference = -0.385 mm, P = .001), but no difference with the group at high-risk for OSA (polysomnographically diagnosed OSA vs high-risk OSA: P = .085). In addition, the MCW in the group at high-risk for the OSA was significantly smaller than the group at low-risk for the OSA (mean difference = -0.301 mm, P = .014). The cephalometric variables (Sella-Nasion-A point angle (SNA) and Frankfort - Mandibular Plane angle (FMA)) explained only 8% of the variance in MCW. CONCLUSIONS Reductions in MCW appear to be present among children with OSA or those at high-risk for OSA, suggesting potential interactions between mandibular bone development and/or homeostasis and pediatric OSA. CITATION Fernandes Fagundes NC, d'Apuzzo F, Perillo L, et al. Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions. J Clin Sleep Med. 2021;17(8):1627-1634.
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Affiliation(s)
| | - Fabrizia d'Apuzzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andreu Puigdollers
- Department of Orthodontics and Craniofacial Orthopedics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri
| | - Daniel Graf
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Giseon Heo
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Zhao T, Zhou J, Yan J, Cao L, Cao Y, Hua F, He H. Automated Adenoid Hypertrophy Assessment with Lateral Cephalometry in Children Based on Artificial Intelligence. Diagnostics (Basel) 2021; 11:1386. [PMID: 34441320 PMCID: PMC8394806 DOI: 10.3390/diagnostics11081386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Adenoid hypertrophy may lead to pediatric obstructive sleep apnea and mouth breathing. The routine screening of adenoid hypertrophy in dental practice is helpful for preventing relevant craniofacial and systemic consequences. The purpose of this study was to develop an automated assessment tool for adenoid hypertrophy based on artificial intelligence. A clinical dataset containing 581 lateral cephalograms was used to train the convolutional neural network (CNN). According to Fujioka's method for adenoid hypertrophy assessment, the regions of interest were defined with four keypoint landmarks. The adenoid ratio based on the four landmarks was used for adenoid hypertrophy assessment. Another dataset consisting of 160 patients' lateral cephalograms were used for evaluating the performance of the network. Diagnostic performance was evaluated with statistical analysis. The developed system exhibited high sensitivity (0.906, 95% confidence interval [CI]: 0.750-0.980), specificity (0.938, 95% CI: 0.881-0.973) and accuracy (0.919, 95% CI: 0.877-0.961) for adenoid hypertrophy assessment. The area under the receiver operating characteristic curve was 0.987 (95% CI: 0.974-1.000). These results indicated the proposed assessment system is able to assess AH accurately. The CNN-incorporated system showed high accuracy and stability in the detection of adenoid hypertrophy from children' lateral cephalograms, implying the feasibility of automated adenoid hypertrophy screening utilizing a deep neural network model.
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Affiliation(s)
- Tingting Zhao
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
| | - Jiawei Zhou
- School of Physics and Technology, Wuhan University, Wuhan 430079, China;
| | - Jiarong Yan
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
| | - Lingyun Cao
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
| | - Yi Cao
- School of Electronic Information, Wuhan University, Wuhan 430079, China;
| | - Fang Hua
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
- Center for Evidence-Based Stomatology, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Hong He
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; (T.Z.); (J.Y.); (L.C.)
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A New Method for Anterior Boundary Demarcation of the Nasopharynx in Three-Dimensional Analysis. J Craniofac Surg 2021; 33:400-403. [PMID: 34320585 DOI: 10.1097/scs.0000000000008033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Three-dimensional (3D) measurements of the upper airway have been extensively applied and researched, but the division of the airway is carried out in various ways, especially when demarcating the anterior boundary of the nasopharynx. The present study was to propose a new method based on the anatomical definition for the anterior boundary demarcation of the nasopharynx used in three-dimensional analysis. Twenty computed tomography scans (age 9.5 ± 2.5 years, 11 males, and 9 females) of head and neck were randomly selected and transferred to Materialism's interactive medical image control system 19.0 for segmentation of the nasopharynx. Precise localization of the reference points that determining the nasopharyngeal anterior and inferior boundaries was managed by recording their coordinates in the interface of the software. The area of the anterior and the inferior boundaries, and the volume of the nasopharynx were measured and repeated with a 2-week interval for the consistency test. Both the interobserver reliability as well as the intra-observer reliability were very high (intraclass correlation coefficients, 0.985-0.997). Paired t test showed no significant difference between the first and the second examinations. This new simple method proposed for demarcation of the nasopharyngeal anterior boundary was based on the innate anatomical boundary, which was statistically reliable, technically convenient, and clinically reasonable.
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Gu M, Lin Y, McGrath CPJ, Hägg U, Wong RWK, Yang Y. Evaluation of the upper airway dimensions following Herbst appliance treatment in adolescents: A retrospective study. APOS TRENDS IN ORTHODONTICS 2020. [DOI: 10.25259/apos_83_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
This retrospective study investigated dimensional changes in the upper airway following Herbst appliance therapy in adolescents with Class II malocclusion and compared those changes with growth data.
Materials and Methods:
Lateral cephalograms from 44 Herbst-treated adolescents (23 boys, mean age = 13.3 ± 1.1 years, and 21 girls, mean age = 12.6 ± 1.1 years) were analyzed for the changes in the upper airway and craniofacial variables. Longitudinal cephalometric data of 34 untreated adolescents (15 boys, mean age = 12.6 ± 0.3 years, and 19 girls, mean age = 12.9 ± 0.4 years) were used as growth data for comparison.
Results:
Following treatment, significant changes were noted in most of the variables. Boys displayed greater downward movement of the hyoid bone than girls did (P = 0.021). Compared with the growth data, a greater increase in retroglossal oropharyngeal depth and hypopharyngeal depth was observed in boys and girls, respectively. Both displayed a decrease in the inclination of the soft palate and a smaller change in nasopharyngeal depth.
Conclusion:
Herbst appliance therapy enlarges the upper airway dimensions at two dissimilar sites in girls (oropharynx) and boys (hypopharynx). Boys display a greater increase in anterior and posterior facial heights than girls do, potentially accounting for the site dissimilarities. Moreover, a Herbst appliance improves the inclination of the soft palate and restricts the growth of the nasopharynx in both boys and girls.
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Affiliation(s)
- Min Gu
- Department of Paediatric Dentistry and Orthodontics, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Yifan Lin
- Department of Paediatric Dentistry and Orthodontics, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Colman Patrick Joseph McGrath
- Department of Public Health, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Urban Hägg
- Department of Paediatric Dentistry and Orthodontics, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Ricky Wing Kit Wong
- Department of Dentistry and Maxillofacial Surgery Cleft Center (Craniofacial Orthodontics), United Christian Hospital, Hong Kong, China,
| | - Yanqi Yang
- Department of Paediatric Dentistry and Orthodontics, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
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Kirkham EM, Hoi K, Melendez JB, Henderson LM, Leis AM, Puglia MP, Chervin RD. Propofol versus dexmedetomidine during drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea. Sleep Breath 2020; 25:757-765. [PMID: 32876805 DOI: 10.1007/s11325-020-02179-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To test for differences in DISE findings in children sedated with propofol versus dexmedetomidine. We hypothesized that the frequency of ≥ 50% obstruction would be higher for the propofol than dexmedetomidine group at the dynamic levels of the airway (velum, lateral walls, tongue base, and supraglottis) but not at the more static adenoid level. METHODS A single-center retrospective review was performed on children age 1-18 years with a diagnosis of sleep disordered breathing or obstructive sleep apnea (OSA) who underwent DISE from July 2014 to Feb 2019 scored by the Chan-Parikh scale sedated with either propofol or dexmedetomidine (with or without ketamine). Logistic regression was used to test for a difference in the odds of ≥ 50% obstruction (Chan-Parikh score ≥ 2) at each airway level with the use of dexmedetomidine vs. propofol, adjusted for age, sex, previous tonsillectomy, surgeon, positional OSA, and ketamine co-administration. RESULTS Of 117 subjects, 57% were sedated with propofol and 43% with dexmedetomidine. Subjects were 60% male, 66% Caucasian, 31% obese, 38% syndromic, and on average 6.5 years old. Thirty-three percent had severe OSA and 41% had previous tonsillectomy. There was no statistically significant difference in the odds of ≥ 50% obstruction between the two anesthetic groups at any level of the airway with or without adjustment for potential confounders. CONCLUSION We did not find a significant difference in the degree of upper airway obstruction on DISE in children sedated with propofol versus dexmedetomidine. Prospective, randomized studies would be an important next step to confirm these findings.
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Affiliation(s)
- Erin M Kirkham
- Department of Otolaryngology: Head & Neck Surgery, Mott Children's Hospital, University of Michigan Medical Center, 1540 E. Hospital Dr. CW 5-702, SPC 4241, Ann Arbor, MI, 48109, USA.
| | - Karen Hoi
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan B Melendez
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren M Henderson
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Aleda M Leis
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael P Puglia
- Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
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Boyd KL. A century of adenotonsillectomy's failure to fully resolve sleep-disordered breathing: mild malocclusions are maybe not so mild? J Clin Sleep Med 2020; 16:1229-1230. [PMID: 32807292 PMCID: PMC7446097 DOI: 10.5664/jcsm.8656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Boyd KL. A century of adenotonsillectomy’s failure to fully resolve sleep-disordered breathing: mild malocclusions are maybe not so mild? J Clin Sleep Med. 2020;16(8):1229–1230.
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Affiliation(s)
- Kevin L Boyd
- Department of Dentistry and Sleep Medicine, Lurie Children's Hospital, Chicago, Illinois
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Remy F, Bonnaure P, Moisdon P, Burgart P, Godio-Raboutet Y, Thollon L, Guyot L. Preliminary results on the impact of simultaneous palatal expansion and mandibular advancement on the respiratory status recorded during sleep in OSAS children. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:235-240. [PMID: 32777308 DOI: 10.1016/j.jormas.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The study aimed to evaluate the evolution of the respiratory status during sleep of OSAS children treated with a custom-made device combining maxillary expansion and mandibular advancement. MATERIAL AND METHODS Sleep studies were performed before and after the treatment for 103 children presenting an initial OSAS and Class II malocclusion. Sleep questionnaires were also addressed to parents several years after the end of the treatment to evaluate its long-term effects. RESULTS After nine months of treatment, the sleep breathing quality significantly improved: the Apnea/Hypopnea Index systematically decreased ≤5. According to the sleep questionnaires results, 84% of the patients did not show any loud or troubled breathing several years after the end of the treatment. DISCUSSION Simultaneous maxillary expansion and mandibular advancement induced an increase of the oral space in the three spatial dimensions, helping in the significant improvement of the OSAS symptoms, with long-terms effects on the sleep breathing quality.
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Affiliation(s)
- F Remy
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France; YooMed, Montpellier, France.
| | | | | | | | | | - L Thollon
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - L Guyot
- Department of Oral-Maxillofacial, Plastic and Reconstructive Surgery, A.P.-H.M., North University Hospital, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
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Hsu WC, Kang KT, Yao CCJ, Chou CH, Weng WC, Lee PL, Chen YJ. Evaluation of Upper Airway in Children with Obstructive Sleep Apnea Using Cone-Beam Computed Tomography. Laryngoscope 2020; 131:680-685. [PMID: 33070361 DOI: 10.1002/lary.28863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cone-beam computed tomography (CBCT) offers three-dimensional structures in assessing upper airway of patients. This study aims to compare the cone-beam computerized tomography scan measurements between children with obstructive sleep apnea (OSA) and primary snoring. STUDY DESIGN Case-control study. METHODS This prospective study was conducted in a tertiary referral center. Thirty-six children with moderate-to-severe OSA (with apnea-hypopnea index [AHI] > 5 events/hour) and 36 age-, gender-, and obesity-matched children with primary snoring (AHI <1) were enrolled. The measurements in CBCT parameters were compared between children with moderate-to-severe OSA and primary snorers by conditional logistic regression model. RESULTS A total of 72 children (mean age, 7.9 ± 2.8 years; 64% male) were included. Children with moderate-to-severe OSA had a significantly smaller nasopharyngeal (2900 ± 1400 vs. 3800 ± 1800 mm3 , P = .017) and oropharyngeal airway volume (5600 ± 2700 vs. 7400 ± 4000 mm3 , P = .026) than those with primary snoring. Children with moderate-to-severe OSA, as compared to primary snorers, also had a significantly smaller minimal airway area in nasopharynx (77.4 ± 37.7 vs. 107.7 ± 52.0 mm2 , P = .006) and oropharynx (66.6 ± 61.9 vs. 101.6 ± 65.8 mm2 , P = .023). Moreover, the airway length was not significantly different between children with moderate-to-severe OSA and primary snoring. CONCLUSIONS The three-dimensional CBCT airway analysis could be used as a useful tool to evaluate upper airway in children with OSA. LEVEL OF EVIDENCE 3 Laryngoscope, 131:680-685, 2021.
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Affiliation(s)
- Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chung-Chen Jane Yao
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Han Chou
- Department of Otolaryngology, National Taiwan University Hospital Yun-Lin branch, Yunlin County, Taiwan
| | - Wen-Chin Weng
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yunn-Jy Chen
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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47
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Duman S, Vural H. Evaluation of the relationship between malocclusions and sleep-disordered breathing in children. Cranio 2020; 40:295-302. [PMID: 32538314 DOI: 10.1080/08869634.2020.1779508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the relationship between dental/skeletal malocclusions and sleep-disordered breathing (SDB) in the early diagnosis and treatment of sleep disorders in children. METHODS Patients were evaluated by pedodontists to identify dental, skeletal, and functional malocclusion (n = 240; <15 years). In order to determine the sleep and daytime behavior of the patients, pediatric sleep questionnaires (PSQ) were applied. Per results of the PSQ, patients with a mean of ≥ 0.33 were defined as the high-risk group. RESULTS A total of 25.8% children were in the high-risk group, with the most convex profile, high-angle growth direction, and mandibular retrognathy. The prevalence of habitual snoring, mouth breathing, and dry mouth was 48.4%, 64.5%, and 87.2% among all high-risk children, respectively. CONCLUSION Convex profile, high-angle growth direction, and retrognathic mandible were determined as risk factors for SDB. The prevalence of dry mouth, mouth breathing, and snoring was higher in the high-risk group.
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Affiliation(s)
- Sacide Duman
- Department of Pediatric Dentistry, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Handan Vural
- Department of Pediatric Dentistry, Faculty of Dentistry, Inonu University, Malatya, Turkey
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48
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Zheng W, Zhang X, Dong J, He J. Facial morphological characteristics of mouth breathers vs. nasal breathers: A systematic review and meta-analysis of lateral cephalometric data. Exp Ther Med 2020; 19:3738-3750. [PMID: 32346438 PMCID: PMC7185155 DOI: 10.3892/etm.2020.8611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022] Open
Abstract
The present systematic review and meta-analysis was performed to assess the association between mouth breathing and facial morphological characteristics in children and adolescents. PubMed, Medline, Scopus and Google Scholar databases were searched for cross-sectional case-control studies published between 1st January 1980 and 1st April 2019. Studies comparing cephalometric data of mouth breathers and nasal breathers were included, while studies on adults were excluded. Meta-analysis was performed regarding 11 angular and 4 linear measurements. A total of 19 studies were included in the systematic review and data from 18 studies were extracted for the meta-analysis. The results indicated statistically significant decreases in Sella-Nasion-Point A (SNA) angle [mean difference (MD)=-1.33; 95% CI -2.03 to -0.63; P=0.0002] and Sella-Nasion-Point B (SNB) angle of mouth breathers as compared to nasal breathers (MD=-1.33; 95% CI -2.18 to -0.49; P=0.002). There was no difference in Point A-Nasion-Point B (ANB) angle between the two groups (MD=0.25; 95% CI -0.26 to 0.75; P=0.34). Mouth breathers demonstrated an increased mandibular plane angle, total and lower anterior facial height and decreased posterior facial height. Within the limitations of the study, the results indicated that mouth breathers tended to have a retrognathic maxilla and mandible, vertical growth pattern with high mandibular plane angle, downward and backward rotation of the mandible and an increase in total and lower anterior facial height and decrease in posterior facial height. Further high-quality studies are required to strengthen the evidence on this subject.
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Affiliation(s)
- Weiying Zheng
- Department of Stomatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Xi Zhang
- Department of Stomatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Jiazeng Dong
- Department of Stomatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Jianming He
- Department of Stomatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
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Vázquez-Casas I, Sans-Capdevila O, Moncunill-Mira J, Rivera-Baró A. Prevalence of sleep-related breathing disorders in children with malocclusion. J Clin Exp Dent 2020; 12:e555-e560. [PMID: 32665814 PMCID: PMC7335603 DOI: 10.4317/jced.56855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 11/05/2022] Open
Abstract
Background The paediatric population has a high incidence of sleep-related breathing disorders (SRBD). A notable risk factor is the presence of craniofacial abnormalities. The objective of the study was therefore to survey the prevalence of SRBD in patients presenting for interceptive treatment. Material and Methods Prospective study with a sample of 249 healthy patients. The "Paediatric Sleep Questionnaire" and "Sleep Disturbance Scale for Children" were completed by the children's parents and the results were evaluated. All patients had their medical records reviewed and underwent orthodontic diagnosis by oral examination, as well as dental cast and cephalometric analysis. Finally, we compared the results of the pre- and post-treatment questionnaires of 50 patients in the sample. Results Based on the results of the questionnaires, 22.8% of the study sample had SRBD. No statistically significant correlation was found between SRBD and the anthropometric characteristics and occlusal variables assessed. According to the cast analysis, patients with SRBD had a smaller maxillary width (p<0.003), and according to the cephalometric study, less overbite (p<0.003). Furthermore, the prevalence of SRBD was higher among patients with a history of adenotonsillectomy (p<0.02). Comparison of the results of pre- and post-treatment questionnaires revealed significant differences after orthodontic treatment (p<0.0005). Conclusions It is necessary to identify the presence of SRBD in orthodontic patients given its high prevalence. Patients with SRBD have a smaller maxillary width and less overbite. Key words:Sleep-related breathing disorders, paediatric sleep questionnaire, cephalometry.
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Affiliation(s)
- Ivette Vázquez-Casas
- Graduate in dentistry from University of Barcelona, Master of Ortodoncia y malformaciones dentofaciales from Sant Joan de Déu /University of Barcelona
| | - Oscar Sans-Capdevila
- Medical director of AdSalutem Institute. Coordinator of Sleep disorders unit from Sant Joan de Déu Hospital
| | - Jordi Moncunill-Mira
- Adjunct in Department of Odontopediatria and Orthodontics from Sant Joan de Déu Hospital. Hospital Dentistry, Clinical Orthodontics & Periodontal Medicine Research Group. Institut de Recerca Sant Joan de Déu (IRSJ), Fundació Sant Joan de Déu (FSJ)
| | - Alejandro Rivera-Baró
- Director in Department of Odontopediatria and Orthodontics from Sant Joan de Déu Hospital. Hospital Dentistry, Clinical Orthodontics & Periodontal Medicine Research Group. Institut de Recerca Sant Joan de Déu (IRSJ), Fundació Sant Joan de Déu (FSJ)
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50
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Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK, Parikh S, Simons JP, Wohl DL, Lambie E, Satterfield L. Clinical Consensus Statement: Ankyloglossia in Children. Otolaryngol Head Neck Surg 2020; 162:597-611. [PMID: 32283998 DOI: 10.1177/0194599820915457] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify and seek consensus on issues and controversies related to ankyloglossia and upper lip tie in children by using established methodology for American Academy of Otolaryngology-Head and Neck Surgery clinical consensus statements. METHODS An expert panel of pediatric otolaryngologists was assembled with nominated representatives of otolaryngology organizations. The target population was children aged 0 to 18 years, including breastfeeding infants. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus, per established methodology published by the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS After 3 iterative Delphi method surveys of 89 total statements, 41 met the predefined criteria for consensus, 17 were near consensus, and 28 did not reach consensus. The clinical statements were grouped into several categories for the purposes of presentation and discussion: ankyloglossia (general), buccal tie, ankyloglossia and sleep apnea, ankyloglossia and breastfeeding, frenotomy indications and informed consent, frenotomy procedure, ankyloglossia in older children, and maxillary labial frenulum. CONCLUSION This expert panel reached consensus on several statements that clarify the diagnosis, management, and treatment of ankyloglossia in children 0 to 18 years of age. Lack of consensus on other statements likely reflects knowledge gaps and lack of evidence regarding the diagnosis, management, and treatment of ankyloglossia. Expert panel consensus may provide helpful information for otolaryngologists treating patients with ankyloglossia.
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Affiliation(s)
- Anna H Messner
- Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | | | | | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Scott E Brietzke
- Nemours Specialty Care, Wolfson Children's Hospital, St. Johns, Florida, USA
| | | | | | - Jessica Levi
- Boston University and Boston Medical Center, Boston, Massachusettes, USA
| | - Anna K Meyer
- UCSF School of Medicine, San Francisco, California, USA
| | - Sanjay Parikh
- University of Washington Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey P Simons
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel L Wohl
- Pediatric Otolaryngology Associates, LLC, Jacksonville, Florida, USA
| | - Erin Lambie
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Lisa Satterfield
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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