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Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study

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Abstract

Twin-block appliance had been advocated as a potential treatment option in paediatric obstructive sleep apnoea (OSA) due to their favourable effect in enhancing upper airway parameters and improving OSA symptoms. The aim of this study was to evaluate the effect of twin-block appliance therapy on upper airway parameters/dimensions and the apnoea-hypopnea indexes (AHIs) in OSA children with class II mandibular retrognathic skeletal malocclusion using cone-beam computed tomography. This prospective longitudinal study comprised 34 polysomnography-proven OSA growing children with class II mandibular retrognathic skeletal malocclusion between the ages of 8 and 12 years who had completed myofunctional twin-block therapy and matched corresponding controls. The upper airway was segmented into the nasopharynx, oropharynx, and hypopharynx, and the effect of twin-bock treatment on upper airway parameters/dimensions was assessed pre- and posttreatment using CBCT analysis, while a second standard overnight PSG was performed to determine changes in the AHI. At the nasopharynx level, minimal (nonsignificant) increases in all variables were observed within the twin-block group and between the groups (P > 0.05). At the level of the oropharynx, all variables increased significantly in the treatment group and between groups (P < 0.001), but these increases were nonsignificant in the control group. At the level of the hypopharynx, only the minimum cross-sectional area (MCA) increased significantly in the treatment group (P = 0.003). The change in MCA was also significant between the groups (P = 0.041). In addition, the upper airway length increased significantly in the twin-block group (P = 0.0154), and the AHI decreased by 74.8% (P < 0.001).

Conclusion: Correction of class II mandibular retrognathic skeletal malocclusion with twin-block appliance resulted in a significant increase in upper airway volume, MCA, anteroposterior and lateral distances of the MCA at the level of the oropharynx, MCA at the level of the hypopharynx and upper airway length, and a significant decrease in AHI, but it had no effect on nasopharynx parameters.

What is Known:

• CBCT imaging has been shown to be an effective and precise diagnostic tool for analyzing the upper airways and craniofacial structures.

• Twin block appliance may be an effective treatment modality in children with OSA.

What is New:

• Minimal cross-sectional area of upper ways may be the most relevant potential parameter when explaining how the upper airway anatomy plays role of in the pathogenesis of pediatric OSA.

• Twin block appliance induced favorable changes in upper airway morphology (oropharynx area mainly) and respiratory parameters in OSA children with class II malocclusion.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by the Health Campus in Universiti Sains Malaysia (grant code: USM/JEPeM/20060315).

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Authors and Affiliations

  1. Orthodontic Dep., School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia

    Maen Zreaqat & Rozita Hassan

  2. Maxillofacial Surgery Dep., College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates

    A.R. Samsudin

  3. Pediatric and Orthodontic Dep. College of Dentistry, Taibah University, Medina, Saudi Arabia

    Sahal Alforaidi

Authors
  1. Maen Zreaqat
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  2. Rozita Hassan
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  3. A.R. Samsudin
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  4. Sahal Alforaidi
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Contributions

The main conception was proposed by Rani Samsudin and Rozita Hassan. Material preparation, data collection were performed by Maen Zreaqat and Rozita Hassan. Data analysis were performed by Maen Zreaqat and Sahal Alforaidi. The first draft of the manuscript was written by Maen Zreaqat and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Rozita Hassan.

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Communicated by Peter de Winter

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Zreaqat, M., Hassan, R., Samsudin, A. et al. Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study. Eur J Pediatr 182, 5501–5510 (2023). https://doi.org/10.1007/s00431-023-05226-3

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  • DOI: https://doi.org/10.1007/s00431-023-05226-3

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