Management of the pediatric OSAS: what about simultaneously expand the maxilla and advance the mandible? A retrospective non-randomized controlled cohort study.

Objective/background: This retrospective non-randomized controlled cohort study aimed to evaluate the efficiency of simultaneous maxillary expansion and mandibular advancement for the management of pediatric OSAS.
Patients/methods: The sample was composed of 94 children treated with an innovative orthopedic device to correct a Class II malocclusion associated with an OSAS. Polysomnographic recordings were performed before and after the treatment. We also included a group of 113 age-matched control patients who had the same pathologies, but who did not receive the orthopedic treatment at the time they undergone polysomnographic exams. Statistical tests evaluated the significance of the evolution of these data, both in treated and untreated control patients.
Results: After nine months (±3 months) of treatment, respiratory OSAS symptoms significantly improved: the AHI significantly decreased as it became inferior to the pathological threshold (<1) for 53% of the treated patients' sample, with a greater proportion within the youngest age group (63%). Only two patients still presented a moderate OSAS after treatment, with an AHI slightly superior to 5. This positive evolution of OSAS respiratory symptoms was not observed within the control group, highlighting the real impact of the orthopedic treatment over the children's natural growth. However, sleep remained fragmented following the treatment.
Conclusions: This study confirmed that simultaneous maxillary expansion and mandibular advancement induced a modification of the maxilla-mandibular anatomy, helping in the significant improvement of the respiratory OSAS symptoms. Then, considering these preliminary results, pediatric OSAS can be managed with this new orthopedic strategy, especially if it is performed early.
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