Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study
- 648 Downloads
When both narrow maxilla and moderately enlarged tonsils are present in children with obstructive sleep apnea, the decision of which treatment to do first is unclear. A preliminary randomized study was done to perform a power analysis and determine the number of subjects necessary to have an appropriate response. Thirty-one children, 14 boys, diagnosed with OSA based on clinical symptoms and polysomnography (PSG) findings had presence of both narrow maxillary complex and enlarged tonsils. They were scheduled to have both adeno-tonsillectomy and RME for which the order of treatment was randomized: group 1 received surgery followed by orthodontics, while group 2 received orthodontics followed by surgery. Each child was seen by an ENT, an orthodontist, and a sleep medicine specialist. The validated pediatric sleep questionnaire and PSG were done at entry and after each treatment phase at time of PSG. Statistical analyses were ANOVA repeated measures and t tests.
The mean age of the children at entry was 6.5 ± 0.2 years (mean ± SEM). Overall, even if children presented improvement of both clinical symptoms and PSG findings, none of the children presented normal results after treatment 1, at the exception of one case. There was no significant difference in the amount of improvement noted independently of the first treatment approach. Thirty children underwent treatment 2, with an overall significant improvement shown for PSG findings compared to baseline and compared to treatment 1, without any group differences.
This preliminary study emphasizes the need to have more than subjective clinical scales for determination of sequence of treatments.
KeywordsRapid maxillary expansion Adeno-tonsillectomy Obstructive sleep apnea Treatment Power analysis
We thank the statistical expertise received from the University of Montreal Dental School (Montreal, Canada), and from Dr. YS Huang.
- 3.Cistulli PA, Palmisano RG, Pools MD (1998) Treatment of obstructive sleep apnea syndrome by rapid-maxillary-expansion. Sleep 21:11–15Google Scholar
- 8.Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Brain Research Institute, Los AngelesGoogle Scholar
- 9.The Sleep Disorders Atlas Task Force of the American Sleep Disorders Association (1992) EEG arousals: scoring rules and examples: a preliminary report of the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–184Google Scholar