At 17 weeks, the overjet was recorded at 9 millimeters. No paradoxical breathing was observed during the sleep study. The patient used RPE and facemask for a period 7 months.Ī sleep study performed 15 weeks after starting a facemask therapy showed a significant reduction of AHI to 7 episodes/h with an average oxygen saturation of 97%. The patient was instructed to wear it for 12 h/ day. An orthodontic facemask was then delivered after the expansion was completed. Following the last cycle, the parents were asked to activate the RPE (1 turn/day) only to expand the palate for 4 weeks. The alternate expansion and constriction were repeated for 5 cycles. After the initial expansion, the parents were instructed to constrict the palate (1 turn/day) to the original width. The second option was chosen, as it was a less invasive treatment.Īfter bonding an RPE to upper posterior teeth, parents were instructed to activate the expansion screw 1 turn/day for 7 days. This protocol allows for a greater degree of maxillary advancement.4 No surgical procedure is involved in this protocol. In this protocol, the maxilla is expanded, and then constricted, and re-expanded and re-constricted for several cycles before a facemask is applied to start maxillary protraction. The second option was a combined use of RPE and protraction facemask with alternate expansion and constriction protocol. This treatment option also requires pre- and post-surgical orthodontic treatment. The advancement would significantly increase a nasopharyngeal space and allow for an increased airflow during sleep. The first option was to perform a maxillary advancement with distraction osteogenesis. Pretreatment intraoral pictures and lateral cephalogram. The lateral cephalogram ( Figure 1) also showed a constricted sagittal nasopharyngeal space (u-mpaw = 2 mm). A cephalometric analysis indicated that both maxilla and mandible were hypoplastic (SNA = 74°, SNB = 74°) with Class III skeletal pattern (ANB = 0°). The palate is high vaulted and narrow (Figure 1). The patient presented with class III malocclusion with anterior crossbite and severe anterior crowding in mixed dentition. She has a history of adenoidectomy and tonsillectomy. She was also diagnosed with hypothyroidism, GERD, controlled epilepsy, and seasonal allergy. As a result, she did not use CPAP regularly and continued to have clinical symptoms of OSA (witnessed loud snoring, apneic episodes, fatigue, and daytime sleepiness). She was prescribed CPAP but could not tolerate it. REPORT OF CASEĪn 8-year-old female Caucasian patient presented with severe OSA with AHI of 51 episodes/hour. This case report demonstrates that RPE/protraction facemask therapy with alternate constriction/expansion protocol is an effective treatment for severe OSA associated with maxillary hypoplasia in a preadolescent patient. 6 However, a combined RPE/ facemask therapy has never been reported to improve OSA symptoms or reduce apnea-hypopnea index (AHI). 5 The use of protraction facemask to advance a maxilla was demonstrated to increase a sagittal nasopharyngeal airway. The expansion of the maxilla with RPE has been shown to resolve OSA in pediatric patients by simultaneously expanding nasal cavity to increase airflow. 3 An alternate expansion and constriction protocol for RPE/facemask allowed a greater degree of maxillary advancement compared to a conventional technique. 2 The treatment is the most effective when performed in preadolescence. A combined rapid palatal expander (RPE) and protraction facemask therapy has been traditionally advocated to treat maxillary hypoplasia. 1 The treatment often focuses on improving an underlying skeletal pattern.
Patients with craniofacial abnormalities have a higher prevalence of obstructive sleep apnea (OSA). Journal of Dental Sleep Medicine 2016 3(1):33–34.
RPE and orthodontic protraction facemask as an alternative therapy for severe obstructive sleep apnea associated with maxillary hypoplasia. Protraction facemask, RPE, OSA, maxillary hypoplasia, orthodontic Citation: This report demonstrates the treatment as an effective nonsurgical alternative for resolving a severe OSA associated maxillary hypoplasia in a preadolescent patient. When the treatment is performed with an alternate constriction and expansion protocol, a greater degree of maxillary advancement could be achieved. Rapid palatal expander (RPE) and facemask therapy has been used as a treatment for maxillary hypoplasia. Case Report 3, Issue 3.1 RPE and Orthodontic Protraction Facemask as an Alternative Therapy for Severe Obstructive Sleep Apnea Associated with Maxillary Hypoplasia
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