Significant component of craniofacial development occurs within the first four years of life. A total of 90% of the craniofacial development is complete by the age of 12 years. Therefore, it can be concluded that morphometric features that puts an adult at risk of obstructive sleep apnoea(OSA)or sleep disordered breathing (SDB) were probably present at the age of 12 years. Class II malocclusions, narrow maxilla, mandibular deficiency, retrognathia, long face problems, inferiorly and posteriorly placed hyoid bone are all considered as craniofacial anomalies that predisposes a child to SDB.
Craniofacial anatomy can influence the upper airway and environmental factors, like adenotonsillitis, nasal allergy, pernicious oral habits (prolonged pacifier use, thumb sucking, tongue thrusting and mouth breathing), and can also influence the growth and development of the craniofacial complex. It has been stated that mouth breathing as an ongoing pattern may be a sign of impending sleep apnoea. So it is of paramount importance for the healthcare professionals to keep a close eye on the risk factors and make appropriate referrals for requisite preventive, interceptive and corrective treatment. Promotion and propagation of breast feeding in infants, adeno-tonsillectomy, maxillary expansion and functional appliances aimed at posturing the mandible in forward position/optimal position, habit breaking appliances and maxilla-mandibular distraction osteogenesiss are the preventive, interceptive and corrective treatment options at our disposal. This communication is aimed at providing an overview of orthodontist\'s role in the management of upper airway sleep disorders in children in the back drop of craniofacial risk factors, environmental influences and appropriate orthodontic and dentofacial orthopaedic intervention strategies.
Wildhaber JH, Moeller A. Sleep and respiration in children: time to wake up! Swiss Med Wkly 2007; 137(49-50): 689– 94.
Rosen CL, Larkin EK, Kirchner HL, et al. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-yearold children: association with race and prematurity. J Pediatr 2003; 142(4): 383–9.
Konno A, Hoshino T, Togawa K. Influence of upper airway obstruction by enlarged tonsils and adenoids upon recurrent infection of the lower airway in childhood. Laryngoscope 1980; 90(10 Pt 1): 1709–16.
Brouillette RT, Fernbach SK, Hunt CE. Obstructive sleep apnea in infants and children. J Pediatr 1982; 100(1): 31– 40.
Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983; 52(5): 490–4.
Morgan BJ, Dempsey JA, Pegelow DF, et al. Blood pressure perturbations caused by subclinical sleep-disordered breathing. Sleep 1998; 21(7): 737–46.
Shepard JWJ, Gefter WB, Guilleminault C, et al, Evaluation of upper air way in patients in OSA/SDB. Sleep 1991; 14: 361–71.
Jayan B, Vats RS, Sahu D, Kamat UR. Cranio-facial morphology, upper airway and orthodontics—the crucial connection. India J Sleep Med 2009; 4.4: 119–24.
Mitchell R. Sleep-disordered breathing in children. Mo Med 2008; 105: 267–9.
Moss ML, Salentijn L. The primary role of functional matrices in facial growth. Am J Orthod 1969; 55(6): 566–77.
Palmer B. Influence of breast feeding on the development of the oral cavity: a commentary. J Hum Lact 1998; 14(2): 93–98.
Page DC. Breast feeding is early functional jaw orthopedics. Funct Ortho 2001; 18(3): 24–7.
Barsh LI. The origin of pharyngeal obstruction during sleep. Sleep Breath 1999; 3(1): 17–22.
Peltomaki T. The effect of mode of breathing on Craniofacial growth—revisited. EJO 2007; 29: 426–429.
Douglas NJ. The sleep apnea/hypopnea syndrome and snoring. In: ABC of sleep disorders, Shapiro CM (Ed), BMJ Publishing Group, London 1993. pp. 19–22.
Guilleminault C, Quo S, Haynh NT, LI K. Orthodontic expansion treatment and Adenotonsillectomy in the treatment of obstructive sleep apnea in pre-pubertal children. Sleep 2008; 31(7): 953–7.
Cistulli, Palmisano RG, Poole MD. Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 1998; 21: 831–835.
Paola P, Maurizo S, Chiaro De Rosa. Med Clinics of North America 2010; 94(3): 517–529.
Ismail Seylan. The effect of RME on conductive hearing loss. Angle Orthod 1996; 66(4): 301–308.
Guilleminault C, Quo SD. Sleep disordered breathing. A view at the beginning of the new millennium. Dent Clin North Am 2001; 45(4): 643–56.
Robin P. Glossoptosis due atresia and hypertrophy of the mandible. Am J Dis Child 1934; 48: 541–7.
Clark WJ. Twin block technique: A functional orthopedic appliance system. Am J Orthod Dentofac Orthop 1988; 93(I): 1–18.
Page DC, Mahony D. The airway breathing and Orthodontics. J Am Orthod Soc Fall 2004; 39–42.
Dave Singh G, Willam Hang M. Evaluation of posterior airway space following bioblock therapy: Geometric morphometrics. Journal of Craniomandibular Pract 2007; 25(2): 84–89.
Muntz H, Wilson P, Park A, Smith M, Grimmer JF. Sleep disordered breathing and obstructive sleep apnea in the cleft population. Laryngoscope 2008; 118(2): 348–53.
Robison JG, Ottison TD. Increased prevalence of OSA in patients with cleft palate. Arch Otolaryngol Head Neck 2011; 137(3); 269–74.
Waite PD, Shashidhar MS. Maxillo-mandibular advancement surgery: A cure for obstructive sleep apneasyndrome. Oral Maxillofac Surg Clin North Am 1995; 7: 327–44.
Prinsell JR. Maxillomandibular advancement surgery in site specific treatment approach for obstructive sleep apnea in 50 consecutive patients. Chest 1999; 116: 1519–29.
Li KK, Riley RW, Powel NB. Maxillomandibular advancement for persistent obstructive sleep apnea after phase I surgery in patients without maxillomandibular deficiency. Laryngoscope 2000; 110: 1684–1688.
Hang WA. Obstructive sleep apnea: Dentistry's unique role in longetivity enhancement. J Am Orthod Soc. Spring 2007: 28–32.
Cobo P J, de Carlos UF, Maci as EE. Orthodontics and upper air way. Orthod Fr 2004; 75 (1): 31–37.