Cephalometric evaluation of facial pattern and hyoid bone position in children with obstructive sleep apnea syndrome

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Abstract

Objectives

To assess the development of face and hyoid bone in children with obstructive sleep apnea syndrome (OSAS) through lateral cephalometries.

Materials and methods

Children aged 7–10 years with mixed dentition and with no previous otorhinolaryngologic, orthodontic or speech therapy treatments were studied. Twenty nasal breathers were compared to 20 mouth breathing children diagnosed as OSAS patients. All children underwent otorhinolaryngologic evaluation and cephalometries; children with OSAS also underwent nocturnal polysomnography in a sleep laboratory.

Results

Children with OSAS presented increase in total and lower anterior heights of the face when compared to nasal breathers. In addition, children with OSAS presented a significantly more anterior and inferior position of the hyoid bone than nasal breathers. No significant differences in upper, anterior or posterior heights of the face were observed between groups.

Conclusion

The results suggest that there are evident and early changes in facial growth and development among children with OSAS, characterized by increased total and inferior anterior heights of the face, as well as more anterior and inferior position of the hyoid bone.

Introduction

Mouth breathing is one of the most frequent symptoms in childhood, and rhinitis and tonsils hypertrophy are the most frequent causes for it [1]. It influences the perioral muscles and soft tissues, and thus affects the apposition of bone tissue during the infant growth [2]. The severity of respiratory disorders may range from intermittent nasal obstruction to more exuberant symptoms such as obstructive sleep apnea syndrome (OSAS) [3].

It has been previously reported that adult patients with OSAS present a more anterior and inferior hyoid bone position when compared to controls, associated to lower position of the tongue. This is related to changes in geniohyoid muscle, which in turn worsen apnea during sleep [4]. The position of the hyoid bone may be also related to a poorer prognosis in surgeries for uvulopalatopharyngoplasty (UPPP) for OSAS in adults, and patients with a higher distance between the hyoid bone to the mandibular base present a poorer postoperative success [5].

Tonsils hypertrophy is the main cause of OSAS in children [6]. In this age group, OSAS may be more subtle and silent, whereas this characteristic does not prevent the development of serious neurobehavioral and cognitive impairment, as well as facial and occlusal changes.

The study of facial development and mainly of the hyoid position in children precisely diagnosed with OSAS has been scarcely reported in the literature. The purpose of this study was to evaluate children in scholar age, comparing children with OSAS (group 1) to nasal breathers (group 2), in terms of skeletal facial and hyoid changes.

Section snippets

Materials and methods

Twenty patients with OSAS and 20 nasal breathing patients, from 7 to 10 years, and with mixed dentition, were selected. Patients with systemic disorders and those with adjuvant orthodontic, speech therapeutic and otorhinolaryngologic treatment were excluded.

Group 1 patients (OSAS) were selected at the Mouth Breathing Center of the School of Medicine of Ribeirão Preto, University of São Paulo, and group 2 patients (nasal breathers) were selected at the Pediatric Clinic of the Dental School of

Results

A total of 40 non-obese children were selected, from which 20 belonged to the group of nasal breathers (mean age 7.35 years) and 20 were from OSAS group (mean age 7.85 years).

Discussion

OSAS in children has been extensively related to syndromic craniofacial changes, especially those in the middle and lower thirds of the face. However, the relation between non-syndromic craniofacial changes and OSAS in children is not definitive, and few cephalometric investigations are available in the literature for this group [8], [9], [10].

It is known that children with OSAS, in a mouth-breathing adaptation, change the posture of the head and the mandible, as well as the tonicity of the

Conclusion

Based on the present study, we may conclude that there is an important change in facial growth and development in children with OSAS, with a significant increase in the total and lower anterior heights of the face.

The hyoid bone was found to be in a more anterior and inferior position in children with OSAS, with extremely significant statistical results compared to nasal breathing children.

References (19)

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