Lecture Description
Pediatric OSA is a kind of sleep-disordered breathing caused by upper airway obstruction, but is totally different from adult OSA in terms of the cause, clinical presentation and treatment. The most common cause of pediatric OSA is adenotonsillar hypertrophy. In most cases, symptoms related to pediatric OSA could be resolved by adenotonsillectomy, but incomplete results are often noted after surgery. This is because the underlying causes of pediatric OSA are complex. Such factors as obesity, anatomical and neuromuscular factors, and hypotonic neuromuscular disease are also involved.
Especially, anatomical and craniofacial features assessed during orthodontic exams such as macroglossia, midface hypoplasia, mandibular and maxillary retrognathia, maxillary constriction, short cranial base length, increased total and lower anterior facial heights, and a more anterior and inferior position of the hyoid bone are often associated with persistent symptoms of pediatric OSA after adenotonsillectomy. If small maxilla and/or mandible predisposed children with persistent symptoms, ENT doctors can refer those patients to orthodontists for dental or orthodontic approaches such as maxillomandibular advancement, rapid maxillary expansion, and distraction osteogenesis. On the other way, as dentists often look into children's mouths, they can play an active role in screening potential pediatric OSA and identifying those with enlarged tonsils and referring them to ENT for sleep assessment and soft tissue surgeries.
And nasal obstruction can be found in many pediatric SDB patients which is the most frequent cause of mouth breathing resulted in airway obstruction and also the cause of failure in orthodontic treatment after adenotonsillectomy. The causes of nasal obstruction are variable such as allergic rhinitis, nasal polyposis, and septal deviation etc. ENT doctors are able to define and deal with the cause of nasal obstruction. Orthodontist can help the patients with high palatal arch with expansion technique resulted in relief of nasal obstruction.
Therefore, both ENT doctors and orthodontist have beautiful collaboration in the pediatric patients with OSA. During the overall screening and treatment process for pediatric OSA, ENT doctors and orthodontists should collaborate as a transdisciplinary team for successful management of pediatric OSA.
October 28-30, 2022 กค COEX, Seoul, Korea