Cephalometric and pharyngometric evaluation in snoring children with sleep-disordered breathing and adenotonsillar hypertrophy under an orthodontic or orthopedic treatment
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Abstract Altered craniofacial growth has been implicated in sleep-disordered breathing (SDB) in children. The authors aimed to evaluate the cephalometric measurements and pharyngeal dimensions related to SDB in snoring children with adenotonsillar hypertrophy (ATH) treated with an orthodontic and orthopedic oral appliance (OOA). Forty habitually snoring children, 6 to 9 years old with evidence of grade 3 to 4 ATH, maxillary constriction, and class II dental malocclusion were enrolled, with 24 children being treated with OOA, and 16 remaining untreated children as controls. All children underwent a cephalometric X-ray and acoustic pharyngometry for airway measurements at the start and 6 months after. Cephalometric measurements related to SDB reduced in the treated group (p < 0.01) as follows: maxillary–mandibular relationship: –2.2 ± 1.70°; maxillary–mandibular planes angle: –2.4 ± 3.80°; and hyoid bone position: –4 ± 3.8 mm (p < 0.001). OOA treatment revealed improvements in pharyngeal minimum cross-section area (MCA) (0.2 ± 0.2 cm2) and volume (V) (3.15 ± 2.5 cm3), while reductions in MCA (–0.2 ± 0.3 cm2) and in V (–1.25 ± 1.3 cm3) occurred in controls (p < 0.001 vs. OOA). Six months of OOA treatment in snoring children with SDB promotes enlargement of the pharyngeal dimensions and beneficial cephalometric changes.
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Nunes Jr et al. (2019) reported that snoring improved significantly (p < 0.001) in snoring children with sleep-disordered breathing after six months of OOA treatment.
“Snoring <0.001”
From Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review (2022) · cites this paper as Nunes Jr et al.,25 2019
Nunes Jr et al. (2019) reported that six months of OOA treatment in snoring children with sleep-disordered breathing promotes enlargement of pharyngeal dimensions and beneficial cephalometric changes.
“Six months of OOA treatment in snoring children with SDB promotes the enlargement of pharyngeal dimensions and beneficial cephalometric changes.”
From Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review (2022) · cites this paper as Nunes Jr et al.,25 2019
Nunes Jr et al. (2019) reported that mouth breathing improved significantly (p < 0.001) in snoring children with sleep-disordered breathing after six months of OOA treatment.
“Mouth breathing <0.001”
From Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review (2022) · cites this paper as Nunes Jr et al.,25 2019
Several randomized clinical trials suggest that orthodontic treatments, such as mandibular advancement with functional appliances, can be effective in the management of pediatric snoring and OSA.
“Several randomized clinical trials23, 24, 25 suggest that orthodontic treatments, such as mandibular advancement with functional appliances, can be effective in the management of pediatric snoring and OSA.”
From Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review (2022) · cites this paper as [25]
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Cites
A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea
Marcus, C. L., Moore, R. H., Rosen, C. L., Giordani, B., Garetz, S. L., Taylor, H. G., Mitchell, R. B., Amin, R., Katz, E. S., Arens, R., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1215881 · Cited by 1,422 · see citing works
Treatment of malocclusion of the teeth
Angle, E. H. (1907) · Cited by 515 · see citing works
Chervin, R. D., Weatherly, R. A., Garetz, S. L., Ruzicka, D. L., Giordani, B., Hodges, E. K., Dillon, J. E., & Guire, K. E. (2007) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.133.3.216 · Cited by 363 · see citing works
Hunter, S. J., Gozal, D., Smith, D. L., Philby, M. F., Kaylegian, J., & Gozal, D. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201510-2099oc · Cited by 270 · see citing works
Katyal, V., Pamula, Y., Martin, A. J., Daynes, C. N., Kennedy, J. D., & Sampson, W. J. (2013) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2012.08.021 · Cited by 255 · see citing works
The functional matrix hypothesis revisited. 4. The epigenetic antithesis and the resolving synthesis
Moss, M. L. (1997) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/s0889-5406(97)70049-0 · Cited by 240 · see citing works
Camacho, M., Chang, E. T., Song, S. A., Abdullatif, J. D., Zaghi, S., Pirelli, P., Certal, V., & Guilleminault, C. (2016) · The Laryngoscope · doi:10.1002/lary.26352 · Cited by 223 · cited 2× · see citing works
“13 – 16, 18, 19 , 32,”
BackgroundThe effect of mode of breathing on craniofacial growth--revisited
Peltomäki, T. (2007) · European Journal of Orthodontics · doi:10.1093/ejo/cjm055 · Cited by 219 · cited 1× · see citing works
“2 This could be related to a more intense bone formation at the mandibular ramus, re fl ecting an increase in the total facial index (S-Go/ N-Me), thus helping normalize the ANB as indicated by the current results.”
ResultCritical role of myofascial reeducation in pediatric sleep-disordered breathing
Guilleminault, C., Huang, Y., Monteyrol, P.-J., Sato, R. M., Quo, S. D., & Lin, C.-H. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.01.013 · Cited by 181 · see citing works
Huynh, N. T., Desplats, E., & Almeida, F. R. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.02.002 · Cited by 171 · see citing works
Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up
Pirelli, P., Saponara, M., & Guilleminault, C. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.04.012 · Cited by 143 · see citing works
Pediatric Obstructive Sleep Apnea and the Critical Role of Oral-Facial Growth: Evidences
Huang, Y., & Guilleminault, C. (2013) · Frontiers in Neurology · doi:10.3389/fneur.2012.00184 · Cited by 138 · cited 3× · see citing works
“14,20,32 We could objectively demonstrate the morphological changes, and the results achieved can be related to the improvement of pharyngeal dynamics re fl ecting on a better breathing and sleep pattern.”
BackgroundHuynh, N. T., Morton, P. D., Rompre, P. H., Papadakis, A., & Remise, C. (2011) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2011.03.023 · Cited by 132 · cited 2× · see citing works
“14,20,32 We could objectively demonstrate the morphological changes, and the results achieved can be related to the improvement of pharyngeal dynamics re fl ecting on a better breathing and sleep pattern.”
BackgroundThe evaluation of radiographs of the nasopharynx
Cohen, D., & Konak, S. (1985) · Clinical Otolaryngology · doi:10.1111/j.1365-2273.1985.tb01170.x · Cited by 130 · see citing works
Cephalometric evaluation of children with nocturnal sleep-disordered breathing
Pirilä-Parkkinen, K., Löppönen, H., Nieminen, P., Tolonen, U., & Pirttiniemi, P. M. (2010) · European Journal of Orthodontics · doi:10.1093/ejo/cjp162 · Cited by 123 · cited 1× · see citing works
“1,10,11 28 The distance between gonion and point S, and the total facial index (S-Go/N-Me) increased more in the treatment group.”
BackgroundIncreased Upper Airway Collapsibility in Children with Obstructive Sleep Apnea during Wakefulness
Gozal, D., & Burnside, M. M. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200304-590oc · Cited by 113 · cited 1× · see citing works
“7,8 Both the MCA and the volume of the airway improved in the treatment group and decreased in the control group at the end of the study period.”
BackgroundKatyal, V., Pamula, Y., Daynes, C. N., Martin, J. M., Dreyer, C. W., Kennedy, D., & Sampson, W. J. (2013) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2013.08.015 · Cited by 113 · see citing works
Utility of Symptoms to Predict Treatment Outcomes in Obstructive Sleep Apnea Syndrome
ROSEN, C. L., Wang, R., Taylor, H. G., Marcus, C. L., Katz, E. S., Paruthi, S., Arens, R., Muzumdar, H. V., Garetz, S. L., Mitchell, R. B., et al. (2015) · PEDIATRICS · doi:10.1542/peds.2014-3099 · Cited by 111 · cited 1× · see citing works
“30 The current fi ndings concur with a previous similar study by Jena et al. 31 The anterior displacement of the tongue that was made possible by the maxillary expansion and the appliance tongue guide, in fl uenced the position of the hyoid bone and consequently improved the morphology of the upper…”
ResultJena, A. K., Singh, S. P., & Utreja, A. K. (2012) · The Angle Orthodontist · doi:10.2319/083112-702.1 · Cited by 91 · cited 3× · see citing works
“30 The current fi ndings concur with a previous similar study by Jena et al. 31 The anterior displacement of the tongue that was made possible by the maxillary expansion and the appliance tongue guide, in fl uenced the position of the hyoid bone and consequently improved the morphology of the upper…”
BackgroundResultMonahan, K. J., Larkin, E. K., ROSEN, C. L., Graham, G. C., & Redline, S. S. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200111-061oc · Cited by 76 · see citing works
Anatomic correlates of normal and diseased adenoids in children
Brodsky, L. S., & Koch, R. J. (1992) · The Laryngoscope · doi:10.1288/00005537-199211000-00013 · Cited by 75 · see citing works
Sawchuk, D., Currie, K., Lagravère, M. O., Palomo, J. M., & Flores‐Mir, C. (2016) · The Korean Journal of Orthodontics · doi:10.4041/kjod.2016.46.5.331 · Cited by 58 · see citing works
Löfstrand-Tideström, B., & Hultcrantz, E. (2009) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2009.10.025 · Cited by 55 · see citing works
Löfstrand-Tideström, B., & Hultcrantz, E. (2007) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2007.03.005 · Cited by 46 · see citing works
Lip seal training in the treatment of skeletal open bite
Fränkel, R. (1980) · European Journal of Orthodontics · doi:10.1093/ejo/2.4.219 · Cited by 46 · cited 1× · see citing works
“1,10,11 28 The distance between gonion and point S, and the total facial index (S-Go/N-Me) increased more in the treatment group.”
BackgroundDental Treatment for Paediatric Obstructive Sleep Apnea
Ngiam, J., & Cistulli, P. A. (2014) · Paediatric Respiratory Reviews · doi:10.1016/j.prrv.2014.11.002 · Cited by 45 · see citing works
Variation of Patterns of Malocclusion by Site of Pharyngeal Obstruction in Children
Nunes, W. R., & Francesco, R. C. D. (2010) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archoto.2010.187 · Cited by 41 · see citing works
Rapid maxillary expansion in children with Obstructive Sleep Apnoea Syndrome (OSAS).
Marino, A., Ranieri, R., Chiarotti, F., Villa, M. P., & Malagola, C. (2012) · PubMed · Cited by 38 · see citing works
DeYoung, P. N., Bakker, J. P., Sands, S. A., Batool‐Anwar, S., Connolly, J. G., Butler, J. P., & Malhotra, A. (2013) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3158 · Cited by 32 · see citing works
Defraia, E., Marinelli, A., Baroni, G., & Tollaro, I. (2007) · European Journal of Orthodontics · doi:10.1093/ejo/cjm079 · Cited by 21 · see citing works
The Reliability of Oral and Pharyngeal Dimensions Captured with Acoustic Pharyngometry
Molfenter, S. M. (2016) · Dysphagia · doi:10.1007/s00455-016-9713-y · Cited by 20 · cited 1× · see citing works
“29 The MCA can be a valuable measurement for evaluating SDB risk factor in preadolescent children.”
BackgroundCiavarella, D., Russo, L. L., Mastrovincenzo, M., Padalino, S., Montaruli, G., Giannatempo, G., Cassano, M., Laino, L., & Muzio, L. L. (2014) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2014.08.008 · Cited by 12 · see citing works
Idris, G., Galland, B. C., Robertson, C. J., & Farella, M. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00353 · Cited by 7 · see citing works
Anatomic correlates of normal and diseased adenoids in children
(1993) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/0165-5876(93)90103-a · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Bates C, Mc Donald J. The relationship between severity of OSAHS and lateral cephalometric radiograph values: a clinical diagnostic tool. Surgeon 2005;3:338-346
Cited by
Sorted by citations
Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision
Gozal, D., Tan, H.-L., & Kheirandish-Gozal, L. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9030888 · Cited by 99 · see citing works
Bariani, R. C. B., Bigliazzi, R., Cappellette Junior, M., Moreira, G., & Fujita, R. R. (2022) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2021.02.010 · Cited by 28 · see citing works
Alternatives to surgery in children with mild OSA
Gozal, D., Ismail, M., & BROCKMANN, P. E., V (2021) · World Journal of Otorhinolaryngology - Head and Neck Surgery · doi:10.1016/j.wjorl.2021.03.005 · Cited by 10 · see citing works
“The initial study aiming to examine the potential use of systemic corticosteroids in OSA in children was conducted over a period of 5 days and resulted in no significant changes in the severity of OSA.50 In 2001, the same group led by Brouillette conducted the first randomized, tripleblind controlled trial investigati…”
MethodOrthodontic Perspectives in the Interdisciplinary Management of Pediatric Obstructive Sleep Apnea
Müller-Hagedorn, S., Abadie, V., & Bartzela, T. N. (2025) · Children · doi:10.3390/children12081066 · Cited by 4 · see citing works
“Myofunctional therapy [122,123], both active (e.g., orofacial exercises) and passive (e.g., intraoral appliances) [127,128], has emerged as a valuable non-invasive adjunctive strategy for improving airway patency and respiratory parameters, as well as enhancing sleep quality and daytime function…”
Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases
Narmada, I. B., Winoto, E. R., & Hakim, A. M. (2022) · Indonesian Journal of Dental Medicine · doi:10.20473/ijdm.v5i1.2022.12-17 · Cited by 1 · see citing works
“The mean oxygen saturation was 96%, nadir was 50 and ODI was 3.2 (Nunes et al., 2019)16 BioAJustax oral appliance Pharyngometry dan cephalometric analysis Airway volume (V) and MCA increases significantly in the treatment group, while a significant decrease in MCA and V occurred in the controls (p …”
BackgroundInfluential
- Authors
- Nunes Jr, W. R., Gozal, D., & Di Francesco, R. C.
- Affiliations
- Department of Otolaryngology, Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil
- University of Missouri (US)
- Department of Pediatric Otolaryngology, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clinicas, São Paulo, Brazil
- Venue
- Journal of Child Science
- Published
- 2019-01
- Volume
- 09
- Issue
- 01
- Pages
- e68-e74
- ISSN
- 2474-5871 (ISSN-L)
- OpenAlex
- W2955539000
- Cited by
- 5
- References
- 34
- Citations by year
- 2025: 1 · 2022: 1 · 2021: 2 · 2020: 1
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Child Science (publishedVersion, cc-by)
- 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
- snoring, sleep-disordered breathing, adenotonsillar hypertrophy, oral appliances, orthodontic appliances, hyoid bone position, maxillary transverse deficiency, Class II malocclusion, craniofacial growth, children
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