Tonsillectomy – Orthodontics: Which sequences in children?

P. Garrec, L. Jordan, N. Beydon
2015 Journal of Dentofacial Anomalies and Orthodontics  
Childhood obstructive sleep apnea syndrome (OSAS) affects 2% to 3% of the pediatric population. It is characterized by increased upper airway resistance due to pharyngeal narrowing, leading to episodic snoring, apnea or hypopnea. These events often cause intermittent hypoxia, hypercapnia and disordered sleep. Without treatment, the consequences may include 4 : -poor school performance (cognitive deficit); -behavioral disorder (hyperactivity, aggression, attention deficit); -cardiovascular
more » ... (pulmonary hypertension, right cardiac insufficiency); -growth disorder. ABSTRACT The most common cause of childhood obstructive sleep apnea syndrome (OSAS) is adenotonsillar hypertrophy. Aside from nocturnal symptoms, children with OSAS may present with lower school performance, behavioral disorder, cardiovascular complications and failure to thrive. First-line treatment is adenotonsillectomy; however, residual OSAS on postoperative polygraphy is reported in 20% to 40% of cases. In well-selected cases, orthodontic treatment can play an important role in the management of light to moderate childhood OSAS or residual OSAS after surgery, using growth activators or oral mandibular advancement appliances, rapid maxillary expansion and orofacial rehabilitation. Nevertheless, clinical studies with a high level of evidence of efficacy are lacking. To illustrate therapeutic sequences that may include an orthodontic phase, we present clinical cases encountered in our multidisciplinary outpatients clinic.
doi:10.1051/odfen/2018103 fatcat:6irscwdvh5afdlxeqegu46hiqq