소아 수면장애호흡 환자의 악안면 성장조절 교정치료
Craniofacial Growth Modification for OSA Children
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Pediatric sleep disordered breathing (SDB) includes snoring and obstructive sleep apnea (OSA) in growing children. Because diagnostic criteria and subjective symptoms of OSA in children differ from those in adults, different diagnostic and therapeutic approach is necessary. Based on the differential growth of craniofacial structure and upper airway soft tissues, phenotype-based, timely-target intervention is needed to interrupt abnormal craniofacial growth inducing or aggravating SDB symptoms and ultimately to prevent the progression to adulthood OSA. Although adenotonsillar hypertrophy is known to be first-line treatment in pediatric OSA patients, craniofacial growth modification treatment needs to be primarily considered for the patients with craniofacial skeletal phenotypic cause. Growth modification treatment can be categorized into four modalities depending on the craniofacial target related to the upper airway collapsibility: 1) Unlocking the mandibular growth for skeletal Class II patients with retruded small mandible; 2) Nasomaxillary protraction for skeletal Class III patients with deficient midface; 3) Nasomaxillary expansion for the patients with transverse discrepancy and nasal obstruction; 4) Control of vertical maxillary excess in patients with long face and structural mouth breathing.
Abstract
Pediatric sleep disordered breathing (SDB) includes snoring and obstructive sleep apnea (OSA) in growing children. Because diagnostic criteria and subjective symptoms of OSA in children differ from those in adults, different diagnostic and therapeutic approach is necessary. Based on the differential growth of craniofacial structure and upper airway soft tissues, phenotype-based, timely-target intervention is needed to interrupt abnormal craniofacial growth inducing or aggravating SDB symptoms and ultimately to prevent the progression to adulthood OSA. Although adenotonsillar hypertrophy is known to be first-line treatment in pediatric OSA patients, craniofacial growth modification treatment needs to be primarily considered for the patients with craniofacial skeletal phenotypic cause. Growth modification treatment can be categorized into four modalities depending on the craniofacial target related to the upper airway collapsibility: 1) Unlocking the mandibular growth for skeletal Class II patients with retruded small mandible; 2) Nasomaxillary protraction for skeletal Class III patients with deficient midface; 3) Nasomaxillary expansion for the patients with transverse discrepancy and nasal obstruction; 4) Control of vertical maxillary excess in patients with long face and structural mouth breathing.
참고문헌 (11)
- Fauroux B, "Facial side effects during noninvasive positive pressure ventilation in children", Intensive Care Med, 31(7), pp.965~969 (2005)
- Imanguli M, "Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children", Laryngoscope, 126(11), pp.2624~2629 (2016)
- Bell RB, "Skeletal advancement for the treatment of obstructive sleep apnea in children", Cleft Palate Craniofac J, 38(2), pp.147~154 (2001)
- Ahn H-W, "Stability of modified maxillomandibular advancement surgery in a patient with preadolescent refractory obstructive sleep apnea", J Oral Maxillofac Surg, 73(9), pp.1827~1841 (2015)
- Xiang M, "Changes in airway dimensions following functional appliances in growing patients with skeletal class II malocclusion : a systematic review and meta-analysis", Int J Pediatr Otorhinolaryngol, 97, pp.170~180 (2017)
- Li L, "CBCT evaluation of the upper airway morphological changes in growing patients of class II division 1 malocclusion with mandibular retrusion using twin block appliance : a comparative research", PLoS One, 9(4), pp.e94378~ (2014)
- Carvalho FR, "Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children", Cochrane Database Syst Rev, (10) (2016)
- Ming Y, "Effects of maxillary protraction appliances on airway dimensions in growing class III maxillary retrognathic patients : a systematic review and meta-analysis", Int J Pediatr Otorhinolaryngol, 105, pp.138~145 (2018)
- Baratieri C, "Does rapid maxillary expansion have long-term effects on airway dimensions and breathing?", Am J Orthod Dentofacial Orthop, 140(2), pp.146~156 (2011)
- Kirjavainen M, "Upper airway dimensions in Class II malocclusion : effects of headgear treatment", Angle Orthod, 77(6), pp.1046~1053 (2007)
- Hanggi MP, "Long-term changes in pharyngeal airway dimensions following activator-headgear and fixed appliance treatment", Eur J Orthod, 30(6), pp.598~605 (2008)