Pediatric obstructive sleep apnea: The role of orthodontic management - Review article

Pediatric obstructive sleep apnea (OSA) is a common breathing-related sleep disorder affecting 1% to 5% of children. It often presents with less recognized signs and symptoms compared to adult OSA. Consequently, many patients with pediatric OSA remain undiagnosed. Risk factors include adenotonsillar hypertrophy, craniofacial anomalies, retrognathia, nasal obstruction, macroglossia, nasal septal deviation, and obesity. Orthodontist as a healthcare provider could have a significant role in screening, diagnostic referral, and treatment. The management approach for pediatric OSA requires multidisciplinary collaboration to obtain an optimal treatment outcome. Currently, adenotonsillectomy is recommended as first-line therapy. However, the treatment success varies considerably among patients. Children with OSA are often found to have narrow and constricted maxilla, mandibular retrognathia, and posterior rotation of mandible. Therefore, orthodontic treatment such as rapid maxillary expansion (RME), functional jaw orthopedic appliances, and protraction facemask could improve pediatric OSA with proper case selections. Additional maxillary expansion can also be performed in conjunction with adenotonsillectomy regardless of treatment sequence. The present article reviewed the currently available literature on the efficacy of various orthodontic treatments on pediatric OSA. Additional high-quality evidence is required to further substantiate the effectiveness of these orthodontic therapy.