Retrospective evaluation of mandibular advancement therapy in children with obstructive sleep apnea syndrome with mandibular retrusion

The aim of our study was to investigate the changes in cephalometric radiograph, polysomnographic sleep test and pediatric sleep questionnaire data obtained before (T0) and after (T1) mandibular advancement treatment in children aged 9-14 years with mandibular retrusion and to evaluate the relationship between dentofacial changes and pediatric obstructive sleep apnea syndrome (POSAS) change.The study included 16 pediatric patients (6 females, 10 males) with a mean age of 11.21±1.62 years. Dental, skeletal, airway and sleep test evaluations were performed on lateral cephalometric films, polysomnography and Pediatric Sleep Questionnaire data obtained before (T0) and after (T1) functional treatment in the archival records of patients who underwent bionator appliance.When comparing T0 and T1, the "Significance Test of the Difference Between Two Pairs" was used for normally distributed variables and the nonparametric "Wilcoxon Test" was used for non-normally distributed variables. After mandibular advancement treatment, the SNB angle increased by an average of 2.01° ± 0.81° and the ANB angle decreased by 2.08° ± 1.0° (p<0.001).An average increase of 2 mm was observed in the upper and lower facial, total facial and posterior facial heights of the maxilla and mandible. In dental variables, the inclination of the protrusive upper incisors decreased to normal inclination and the inclination of the lower incisors increased.In airway measurements, the lower airway size increased by 1.7 mm (min. 0.1 - max. 5.7) (p<0.05), the hyoid bone moved upward by 2 mm and forward by 1 mm on average. When polysomnographic changes were examined, a significant decrease of 1.2/h (min. 3.6 - max. 15.5) in AHI and 1/h (min. 4 - max. 26.1) in supine AHI were observed (p<0.05). Pediatric sleep questionnaire risk score decreased significantly with a mean value of 0.11 ± 0.11 (p<0.05).In children with an average of 4 mm mandibular retrusion and an average of 4 mm mandibular advancement treatment with functional appliance, more than 50% reduction in AHI score was observed in 8 patients and more than 50% reduction in supine AHI score was observed in 7 patients at the end of treatment. Subjective OSA symptoms of the patients significantly decreased.