Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study
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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Studies using cephalometry and cone beam computed tomography have demonstrated structural airway enlargement following mandibular advancement, although findings vary across appliance types and populations.
“Studies using cephalometry and cone beam computed tomography (CBCT) have demonstrated structural airway enlargement following mandibular advancement, although findings vary across appliance types and populations [12–14, 41, 43]”
From Long-Term Changes Following Orthopedic Mandibular Advancement Therapy in Pediatric Obstructive Sleep Apnea: a 7-Year Follow-up Study (2026) · cites this paper as [41]
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- Authors
- Zreaqat, M., Hassan, R., Samsudin, A. R., & Alforaidi, S.
- Affiliations
- Universiti Sains Malaysia (MY)
- University of Sharjah (AE)
- Taibah University (SA)
- Corresponding author
- Hassan, Rozita
- Venue
- European Journal of Pediatrics
- Published
- 2023-09-30
- Volume
- 182
- Issue
- 12
- Pages
- 5501-5510
- ISSN
- 0340-6199 (ISSN-L)
- 1432-1076
- OpenAlex
- W4387215517
- Semantic Scholar
- c55fba66b96005114d029e6594a5c32a4722837e
- Cited by
- 33
- References
- 40
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 9
- FWCI
- 5.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Keywords
- Twin Block appliance, pediatric obstructive sleep apnea, Class II malocclusion, mandibular retrognathism, upper airway dimensions, apnea-hypopnea index, oropharynx, hypopharynx, nasopharynx, minimum cross-sectional area, cone-beam computed tomography, airway volume, children aged 8-12
- MeSH terms
- Cephalometry, Child, Humans, Longitudinal Studies, Malocclusion, Malocclusion, Angle Class II, Prospective Studies, Sleep Apnea, Obstructive, Spiral Cone-Beam Computed Tomography, Retrognathia
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