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Development of craniofacial and dental arch morphology in relation to sleep  disordered breathing from 4 to 12 years: Effects of adenotonsillar surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2010 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 74, no 2, 137-143 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the development of craniofacial and dental arch morphology in children with sleep disordered breathing in relation to adenotonsillar surgery. SUBJECTS AND METHODS: From a community-based cohort of 644 children, 393 answered questionnaires at age 4, 6 and 12 years. Out of this group, 25 children who were snoring regularly at age 4 could be followed up to age 12 together with 24 controls not snoring at age 4, 6 and 12 years. Study casts were obtained from cases and controls and lateral cephalograms from the cases. Analysis regarding facial features and dento-alveolar development was performed. RESULTS: Children snoring regularly at age 4 showed reduced transversal width of the maxilla and more frequently had anterior open bite and lateral cross-bite than the controls. These conditions persisted for most cases at age 6, by which time 18/25 had been operated for snoring. In most of the cases, surgery cured the snoring temporarily, but their width of the maxilla was still smaller by age 12-even when nasal breathing was attained. At age 12, the frequency of lateral cross-bite was much reduced and anterior open bite was resolved, both in cases and controls. The children who snored regularly at age 12 operated or not operated, showed a long face anatomy and were oral breathers (this applied even to those who were operated). The seven cases who were not operated and the five who were still snoring in spite of surgery at age 12, did not have reduced maxillary width as compared to the controls. CONCLUSION: Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended.

Place, publisher, year, edition, pages
2010. Vol. 74, no 2, 137-143 p.
Keyword [en]
snoring, sleep disordered breathing, dental arch morphology, surgery, adenoectomy, tonsillectomy, development
National Category
Otorhinolaryngology Dentistry
Identifiers
URN: urn:nbn:se:uu:diva-107999DOI: 10.1016/j.ijporl.2009.10.025ISI: 000274598500004PubMedID: 19939470OAI: oai:DiVA.org:uu-107999DiVA: diva2:233872
Available from: 2009-09-03 Created: 2009-09-03 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Sleep Disordered Breathing and Orofacial Morphology in Relation to Adenotonsillar Surgery: Development from 4-12 Years in a Community Based Cohort
Open this publication in new window or tab >>Sleep Disordered Breathing and Orofacial Morphology in Relation to Adenotonsillar Surgery: Development from 4-12 Years in a Community Based Cohort
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: To follow a cohort of children from age 4-6-12 with respect to sleep disordered breathing (SDB) and orofacial development. Questionnaires were completed about sleep, snoring, apneas, enuresis, sucking habits, and adenotonsillar surgery and, from age 12, about allergies, asthma, and general health. Children snoring regularly had an ENT- examinations including sleep studies (at ages 4 and 12) and an orthodontic evaluation. Development of biometric data in snoring children and not snoring controls was studied in relation to adenotonsillar surgery.

Result: Of the original group of 615 children, 509 (83%) participated at age 6 and 393 (64%) at age 12. 27 snored regularly and 231 did not snore at age 12. Differences between groups were seen on all answers. From age 4–12 the prevalence of OSA decreased from 3.1% to 0.8%, and the minimum prevalence of snoring regularly from 5.3% to 4.2%. The odds for a child who snored regularly at four or six to be snoring regularly at age 12 was 3.7 times greater than for a not snoring child in spite of surgery (OR 3.7, 95% CI 2.4-5.7). 63 children were operated for snoring by age 12, of them 14 never snored and 17 snored regularly at age 12. Cross-bite was more common among snoring children at ages 4, 6 and 12 as was a narrower maxilla. In most cases, surgery cured the snoring temporarily, but the maxillar width was still smaller by age 12—even when nasal breathing was attained.

Children snoring regularly at age 12, operated or not operated, showed long face anatomy and were oral breathers; the seven cases who were not operated and the five who were still snoring in spite of surgery, did not have reduced maxillary arch width.

Conclusion: The prevalence of children snoring regularly is about the same from age four to twelve in a cohort where adenotonsillar surgery has been performed on obstructed cases, but the prevalence of OSA decreases considerably. The children snoring regularly have a more narrow maxilla compared to children not snoring—a condition that is not changed by adenotonsillar surgery regardless of symptom relief.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 480
Keyword
snoring, children, epiddemiology, adenotonsilloectomy, craniofacial development
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:uu:diva-108031 (URN)978-91-554-7600-7 (ISBN)
Public defence
2009-10-10, Skoogsalen, Akademiska Sjukhuset ingång 79, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2009-09-18 Created: 2009-09-03 Last updated: 2009-10-08Bibliographically approved

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Löfstrand Tideström, Britta

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