SLEEP APNEA IN CHILDREN IS FREQUENTLY TREATED WITH REMOVAL OF TONSILS AND/ OR ADENOIDS. ORTHOPEDIC APPLIANCES AND SLEEP APPLIANCES ALSO HAVE A ROLE.

Dawn: My 5yo daughter had T&A sx at 22mos which seemed to help her osa up until about 8months ago. She is now going to start using a cpap for severe osa. I now know she will need orthodontic and/or maxillofacial close monitoring. I am wondering if any of thes oral applianced are used with children this young also, and if there is anyone in the northern ******** area who is best trained for this.

Dr Shapira: Dear Dawn,

There is an excellent Sleep Apnea Dentist in your area Dr *********** I just talked to him and he would be happy to work with you and your daughter. If there are any questions during treatment we can discuss it as treatment pprogresses.

There would actully be two appliances involved a nightime appliance and a daytime appliance. This will allow the widening of the maxilla while using an appliance to prevent apnea...Dr ******* has a great deal of experience in treating sleep apnea.

This will not only treat the sleep apnea but begin treating the underlying orthopedic problem. You child will still need orthodontics (probably) in the future but the early orthopedic therapy will make future orthodontics easier.

MORE ON THIS TOPIC: SLEEP APNEA IN CHILDREN IS FREQUENTLY TREATED WITH REMOVAL OF TONSILS AND/ OR ADENOIDS. ORTHOPEDIC APPLIANCES AND SLEEP APPLIANCES ALSO HAVE A ROLE IN TREATING CHILDHOOD SLEEP APNEA TREATMENT.

There is a question whether tonsilectomy and adenoidectomy should occur before of after widening of the maxilla. Widening the maxilla will improve the airway and possibly lower post-op complications. If T&A is done prior to widening studies have shown that it does not correct the development orthopedic problems. All patients should be reevaluated for sleep apnea and for maxillary expansion.

# year old with (OSA) Sleep Apnea. Are there alternatives to tonsil and adenoid removal

comments : my 3yr old grandaughter has been diagnosed with OSA, they are referring surgery to remove adenoids & tonsils. would like to know if there are any alternatives out there. we are going to try the oxygen therapy 1st. is there anythings else we can do

This is an interesting question for several reasons. The first is that they have discussed oxygen therapy, unfortunately oxygen therapy is not helpful for obstructive sleep apnea because the airway is obstructed and therefore the oxygen does not get to the lungs.

The second part of the question is there an alterrnative to tonsil and adenoid removal. Rapid maxillary expansion can open the airway in children and is often indicated IN ADDITION to removal of tonsils and/or adenoids. A Swedish researcher suggested at the Dental Sleep Meeting that doing maxillary expansion prior to surgery make reduce complications and create easier and/or faster healing. Another recent report has shown that even if tonsils and adenoids are removed there will remain orthopedic jaw problems that will still usually require widening of the palate.

The question which should be done first surgery or widening of the maxilla is still open.

What is not open is that pediatric patients with sleep apnea should be treated ASAP. ADD, ADHD and other learning and behavioral disorders have been linked to pediatric sleep apnea and time is of the essence.

Various studies have shown delayed brain development and/or permanent changes in brain development as a consequence to sleep apnea in children. Read the story in my profile about my sons sleep apnea and how treating it changed his life.

DEVELOPMENTAL CHANGES IN CHILDREN WITH SLEEP APNEA MUST BE ADDRESSED AFTER REMOVAL OF TONSILS AND ADENOIDS

A recent study in the International Journal of Pediatric Otorhinolaryngology looked at arch Maxillary (upper jaw) development in children with snoring and sleep apnea and evaluated changes after adenotonsillar surgery. The physical changes did not correct after surgery and these children were left with residual problems that could plague the for their entire life. The authors concluded " Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended."

It is essential that the pediatric and dental communities recognize that children do not grow and eliminate the problems of enlarged tonsils and adenoids but rather they experience distorted growth that must be corrected. Early diagnosis and treatment of airway is essential for proper dento-facial growth. The NHLBI considers sleep apnea to be a TMJ Disorder. Sleep Apnea, Snoring, Migraines, Tension Headaches, Chronic Daily Headaches and TMJ disorders all begin in a common developmental pathway.

Dental Sleep Meicine and Neuromuscular Dentistry are key in improving the quality of live of these patients as adults. Early intervention may greatly reduce the number of patients who develop these problems.

nt J Pediatr Otorhinolaryngol. 2009 Nov 23. [Epub ahead of print]
Development of craniofacial and dental arch morphology in relation to sleep disordered breathing from 4 to 12 years. Effects of adenotonsillar surgery.
Löfstrand-Tideström B, Hultcrantz E.

Department of Surgical Sciences, Division of Otorhinolaryngology, University of Uppsala, SE - 751 85 Uppsala, Sweden.
OBJECTIVES: To study the development of craniofacial and dental arch morphology in children with sleep disordered breathing in relation to adenotonsillar surgery. SUBJECTS AND METHODS: From a community-based cohort of 644 children, 393 answered questionnaires at age 4, 6 and 12 years. Out of this group, 25 children who were snoring regularly at age 4 could be followed up to age 12 together with 24 controls not snoring at age 4, 6 and 12 years. Study casts were obtained from cases and controls and lateral cephalograms from the cases. Analysis regarding facial features and dento-alveolar development was performed. RESULTS: Children snoring regularly at age 4 showed reduced transversal width of the maxilla and more frequently had anterior open bite and lateral cross-bite than the controls. These conditions persisted for most cases at age 6, by which time 18/25 had been operated for snoring. In most of the cases, surgery cured the snoring temporarily, but their width of the maxilla was still smaller by age 12-even when nasal breathing was attained. At age 12, the frequency of lateral cross-bite was much reduced and anterior open bite was resolved, both in cases and controls. The children who snored regularly at age 12 operated or not operated, showed a long face anatomy and were oral breathers (this applied even to those who were operated). The seven cases who were not operated and the five who were still snoring in spite of surgery at age 12, did not have reduced maxillary width as compared to the controls. CONCLUSION: Dento-facial development in snoring children is not changed by adenotonsillar surgery regardless of symptom relief. If snoring persists or relapses orthodontic maxillar widening and/or functional training should be considered. Collaboration between otorhinolaryngologist, orthodontists and speech and language pathologists is strongly recommended.

PMID: 19939470 [PubMed - as supplied by publisher]

TONSILS AND ADENOIDS CAUSING SLEEP APNEA.

My nearly 6 yr old son has developed sleep apnea nearly 1yr ago, we've seen an ENT who recommended T&A surgery. we decided not to have the surgery yet and leave it for last resort, now we have come to be desperate, he isn't sleeping very well at all. wondering if there is anything we need to know before going ahead with the surgery. thank you, looking forward to your response

DR SHAPIRA RESPONSE: I would encourage you to go ahead with the T&A ASAP because rersearch has shown permenant changes in brain development associated with Apnea in children.

There is always risk associated with any surgery. The biggest risk is the general anaesthesia, I recommend having a pediatric anaesthesiologist for the surgery if one is available in your area. The surgery can have risks of post op bleeding but this is usually not a big concern.

I believe the T & A was the best thing we ever did for my sons health and welfare.

ADD ADHD, DYSLEXIA AND OTHER LEARNING AND BEHAVIORAL DISORDERS HAVE BEEN SHOWN TO HAVE HIGH CORRELATION TO SLEEP APNEA. IN FACT 80% OF ADD AND ADHD PATIENTS HAVE SLEEP APNEA. PROBLEMS LIKE DIABETES, OBESITY AND DEPRESSION ARE ALSO LINKED TO SLEEP APNEA.

IT IS IN THE BEST INTEREST OF CHILDREN TO HAVE EARLY TREATMENT OF AIRWAY OBSTRUCTION AND MAY HAVE MAJOR LIFETIME EFFECTS.

A NEW STUDY HAS SHOWN THAT URINE OR BLOOD TESTS MAY BE EXCELLENT SCREENIG TOOLS FOR PEDIATRIC SLEEP APNEA.


hello, and thank you for your quick response, we appreciate the advice, it's very reassuring and even relieving:). i'm not a big fan of surgery(i prefer to try the most natural routes first and leave it for last resort, plus I had a bad experience with the anesthesia myself a few years ago and have dreaded the idea of it ever since. I do realize that was just me and he will probably be fine. for the last couple of days we have been doing more sinus rinses and that has seemed to help him quite a bit with his sleeping but we'll still go ahead with the surgery... thanks again for the info, really appreciate it, sincerely The C....... family

I HOPE ALL GOES WELL WITH YOUR SON'S SURGERY AND I UNDERSTAND COMPLETELY. IT TOOK ME TWO YEARS BEFORE MY WIFE ELISE AND I FELT READY TO DO SURGERY. IN HINDSIGHT I AM SORRY I DID NOT HAVE IT DONE SOONER. SINUS IRRIGATION PRIOR TO SURGERY WILL MKE FOR AN EASIER RECOVERY. DR SHAPIRA

Response: very interesting! thanks! this is helpful, can't wait to share it with my husband. is there any research that shows he should just skip right to this mouth widening surgery instead of the T&A? I did read about that on your site, that it is a most effective solution to apnea. what is your recommendation?

Dr S response: Excellent Thought but you still need to do T&A. There was a presentation at the Baltimore meeting discussing doing widening first in ages as young as 2. The thought was less post op problems but this should probably be reserved for the most severe cases with high probability of post op problems.

response: once again, thanks sooo much:) feel so much more confident that we are doing the right thing for him, funny how someone else sharing their experience with you can do that, i guess that is one of the reasons the Lord puts "strangers" and there situations together GOD BLESS you and yours... keep up the helpful work, it's worth it to families like us:)