1 research outputs found
Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children: a pilot study
Introduction When both narrow maxilla and moderately
enlarged tonsils are present in children with obstructive
sleep apnea, the decision of which treatment to do first is
unclear. A preliminary randomized study was done to
perform a power analysis and determine the number of
subjects necessary to have an appropriate response. Thirtyone
children, 14 boys, diagnosed with OSA based on
clinical symptoms and polysomnography (PSG) findings
had presence of both narrow maxillary complex and
enlarged tonsils. They were scheduled to have both
adeno-tonsillectomy and RME for which the order of
treatment was randomized: group 1 received surgery
followed by orthodontics, while group 2 received
orthodontics followed by surgery. Each child was seen
by an ENT, an orthodontist, and a sleep medicine
specialist. The validated pediatric sleep questionnaire
and PSG were done at entry and after each treatment
phase at time of PSG. Statistical analyses were ANOVA
repeated measures and t tests.
Results The mean age of the children at entry was 6.5±
0.2 years (mean ± SEM). Overall, even if children
presented improvement of both clinical symptoms and
PSG findings, none of the children presented normal
results after treatment 1, at the exception of one case.
There was no significant difference in the amount of
improvement noted independently of the first treatment
approach. Thirty children underwent treatment 2, with an
overall significant improvement shown for PSG findings
compared to baseline and compared to treatment 1,
without any group differences.
Conclusion This preliminary study emphasizes the need to
have more than subjective clinical scales for determination
of sequence of treatments