Mouth Breathing and Paediatric Obstructive Sleep Apnoea

orthodontics In summary

Join me for a summary of two lectures from this year’s international orthodontic symposium (IOF), looking at mouth breathing and paediatric obstructive sleep apnoea, by Hong He and Carlos Flores Mir. The lectures explore this controversial area in both medicine and orthodontics and review the current understanding of the topic, the relationship with facial features and current recommendations for orthodontists.

OSA is defined disruption to breathing American Academy of Sleep Medicine

• Adult > 5 apnoea/hour & 10 seconds

• Child apnoea for duration of 2 breaths 1

Defining mouth breathing at airflow over 25% through the mouth

Evidence of craniofacial effects

1. Mouth breathing

• Retrusive maxilla -1.33o (SNA -2.03 -0.63)

• Retrusive mandible -1.4 (SNB -2.20—0.6) Zhang 2020 SR

• Increased mandibular angle 3.38o (2.77-3.98)

• But is mouth breathing pathological?

1. pOSA

• no craniofacial difference in pOSA vs controls SR Fagundes 2022

• Recent study by Carlos Flores Mir, combine factors

• Demographics, lifestyle, craniofacial features and sleep features. Investigating effects of treatment on these categories

Treatment

• Twinblock improves pOSA AHI 14.08 to 4.25 in the short term, severe to mild Zhang 2012

• MARPE increases cross sectional area, by 40% oropharynx, 7% nasopharynx Zhao 2020

• RME increases nasal airway volume initially of 1604 mm3, but reduce to 579mm3 after 3-5 months and non-significant SR Zhao 2021

• Tonsillectomy

• Does not stop mouth breathing, even if OSA resolved Bae 2020

Conclusions

• Breathing involves complexity of 3D structures and fluid dynamics is not well understood

• Mouth breathing does seem to have craniofacial influence, however OSA does not

• Orthodontists role in OSA

• screening for OSA

• Refer to physician if risk factors present

• Refer adenoid hypertrophy to ENT

Contributions

Contents and video editing – Shanya Kapoor

Editing and Production – Farooq Ahmed