Retrospective evaluation of rapid maxillary expansion treatment in children with maxillary constriction and obstructive sleep apnea syndrome

Introduction: The aim of this retrospective study is to evaluate the effects of rapid maxillary expansion therapy (RME) on skeletal and dental structures and on sleep apnea in pediatric patients with obstructive sleep apnea syndrome with maxillary constriction. Individuals and Methods: 14 (5 girls, 9 boys) pediatric patients with a mean age of 12.22±1.95 years were included in the study. Dental model, lateral cephalometric, postero-anterior cephalometric film analysis, polysomnography and Pediatric Sleep Questionnaire data obtained at the beginning of treatment (T0) and at the end of retention after expansion (T1) of the archive records of patients treated with conventional bonded maxillary expansion appliance to perform skeletal, dental, faringeal airway, sleep test and risk evaluations. Paired two samples, Wilcoxon and Mann-Whitney U tests were used for T0 and T1 comparisons. Results: After expansion, the upper intermolar distance increased by an average of 4.46-5.61 mm according to the reference points (p<0.001). SNA angle increased by 0.40 (p<0.01), point A moved 1.34 mm forward (p<0.001), and 1.64 mm down (p<0.01) on average. SNB angle increased with a mean 0.460 (p<0.01), point B moved down 1.84 mm on average (p<0.01). SN/MD angle increased 0.50 (p<0.05). ANS-Me and S-Go distances increased by averages of 2.93 mm (p<0.01) and 2.98 mm (p<0.001), respectively. N-Me distance increased by 5.1 mm (p<0.05). Upper and lower airway distances, increased by averages 2.48 mm and 2.98 mm respectively (p<0.001). Vertical airway length increased 2.67 mm on average (p<0.001). Soft palate length and tongue lengths increased 1.2 mm (p<0.05) and with a mean 8.89 mm (p<0.001) respectively. Maxillary transverse width increased 2.98 mm (p<0.05). Nasal cavity width and height increased 2.99 mm on average and 0.85 mm, respectively (p<0.001). AHI, Supine AHI, hypopnea time, snoring time and were decreased 9.14/hr(p 0,001) and 4.4/hr, 3.5/hr, 1.65/hr (p<0 .01) respectively. Sleep efficiency and oxygen saturation (SpO2) were increased by 10.25% and with a mean 1.16% respectively (p<0.001). Pediatric Sleep Questionnaire risk score decreased by 0.34 (p<0.001). Conclusion: After RME treatment, an increase was observed in the transverse dimensions of the maxillary skeletal and dentoalveolar structures. Nasal cavity width and sagittal airway widths were increased. According to the polysomnographic data, sleep apnea was improved with a 64% decrease in AHI and a 78% decrease in Supine AHI. Keywords: Maxillary Constriction, Rapid Maxillary Expansion, Sleep Apnea