Influence of rapid maxillary expansion and mandibular advancement in the treatment of obstructive sleep apnea in children: a review

Abstract

This article presents orthodontic alternatives for the treatment of pediatric obstructive sleep apnea (OSA). OSA is a multifactorial disease that impairs craniofacial growth and the general health of a developing child, negatively worsening the quality of life. Therefore, the importance of timely diagnosis and treatment of OSA is essential, in order to avoid the progress and persistence of the disease due to its important systemic, neurocognitive and social consequences in the patient. In the transverse direction, the compression of the maxilla determines that there is a decrease in the diameter of the upper airways, reducing air flow. On the other hand, in the sagittal direction, a retrognathic mandible will position the tongue more posteriorly, thus reducing the available upper airway space, decreasing airflow during sleep. Orthopedic treatments for mild to moderate OSA include maxillary expansion using rapid maxillary expansion devices and mandibular advancement using mandibular advancement appliances, are both treatment options only for orthodontic (skeletal) reasons and should be applied after appropriate individual diagnosis for each orthodontic patient. Current limited evidence suggests that these therapies result in an improvement in the signs and symptoms of the condition as well as a decrease in apnea hypopnea index (AHI)scores.