Effects Of Adenotonsillectomy Combined With Orthodontic Treatment On Children With OSAS

Objective:The purpose of this study was to evaluate the effect of treatment that surgical resection of hypertrophic adenoid and tonsils combined with Twin-block functional appliance(TB)in the treatment of moderate to severe obstructive sleep apnea syndrome(OSAS)with mandibular retraction in children.By comparing with simple orthodontic Twin block functional appliance,to discuss the necessity of adenoidectomy and tonsillectomy for moderate to severe OSAS patients with mandibular retraction and adenotonsillar hypertrophy before orthodontic treatment.Methods:In this study,21 children aged 9-12 with moderate to severe OSAS with adenoid and/or tonsil hypertrophy and mandibular retraction were selected as the study subjects.According to whether adenoid and/or tonsillectomy was performed prior to the treatment of the TB,they were divided into two groups:group Ⅰ was treated with adenoid and/or tonsillectomy+TB treatment,and group Ⅱ was treated with simple TB treatment.Group I before the surgery and after the TB treatment and group Ⅱ before and after TB treatment were respectively evaluated clinical physician and patient subjective symptom(OSA-18 questionnaire),took lateral cephalometrics and performed portable polysomnography monitoring,and SPSS21.0 software was used for intra-group comparison and inter-group comparison of efficacy,to analyze the improvement of dental maxillofacial shape,upper airway morphology,sleep and respiratory function,and subjective symptoms of patients in two groups,in order to explore multidisciplinary combined treatment of child OSAS and its sequential treatment methods provide a reliable clinical path.Results:1.Changes of tooth and maxillofacial:Group Ⅰ according to adenoidectomy and/or tonsillectomy and Twin-block,SNB and NP-FH increased(P<0.01),ANB and NA-PA significantly decreased(P<0.01),showed that the mandibular forward and the jaw grew forward effectively;group Ⅱ after treatment with simple Twin-block,SNB increased(P<0.01),ANB and NA-PA significantly decreased(P<0.01),mandibular also moved forward,MP-FH,MP-SN and Y-axis increased(P<0.05),this indicates that the jaw is rotating clockwise.Compare the difference between the two groups,ANB Angle variation of group Ⅰ(2.41 10.79)°is more than the group Ⅱ(1.81±0.34)°,the MP-FH,MP-SN,Y-axis Angle variation of group Ⅰ is less than group Ⅱ,the difference was statistically significant(P<0.05),It is suggested that in group Ⅰ,the mandibular forward displacement is larger and there is no obvious clockwise rotation.2.Changes of upper airway morphology and structure:PNS-adl,PNS-ad2,SPP-SPPW,U-MPW,Tb-TPPW distance increased and A/N decreased in both groups after treatment(P<0.01),the difference was statistically significant(P<0.05).Compare the two groups,PNS-ad1,PNS-ad2 distance and A/N value variation of groupⅠ is bigger than the variation Ⅱ group(P<0.01),indicating that the distance of nasopharyngeal airway in the sagittal direction in group Ⅰ increased more significantly.3.Changes in sleep respiratory function:After treatment,the AHI and OAI values of the patients decreased(P<0.01)and the lowest blood oxygen saturation increased(P<0.01)in both groups,indicating that the respiratory function of the patients in both groups was significantly improved after treatment.The difference between groups showed that in the group Ⅰ the AHI value decreased by 5.57± 1.58(times/h),OAI decreased by 2.3 8± 1.49(times/h),and the minimum blood oxygen saturation increased by 7.90±7.52(%).In the group Ⅱ,the AHI value decreased by 2.63±0.63(times/h),the OAI decreased by 1.07±0.66(times/h),and the minimum oxygen saturation increased by 4.73±3.04(%).It is suggested that the sleep breathing status of patients in group Ⅰafter adenoidectomy and/or tonsillectomy+TB treatment is more obvious than that after simple TB treatment.4.Changes of systemic condition and subjective symptoms:The total score of OSA-18 in group Ⅰ changed from 75.20±10.32before treatment to 45.90±6.79 after treatment,and the total score of OSA-18 in group Ⅱ changed from 69.55±7.71 to 56.64±5.63.After treatment,the sleep disorder,physical condition,emotional status,daytime function and influence on guardians were significantly improved in both groups(P<0.01).However,the changes of total score of questionnaire,sleep disorder,physical condition,daytime function and influence on guardians in group Ⅰ were higher than those in group Ⅱ(P<0.05),It is suggested that the general condition and subjective symptoms of patients in group Ⅰ are improved more significantly after treatment.Conclusions:1.After removal of hypertrophic adenoid and tonsils,and then through orthodontic TB treatment,the mandibular retraction type was improved and the upper airway was further opened,which was more beneficial to the improvement of facial shape,upper airway,sleep breathing and quality of life of moderate to severe OASA patients with adenoid tonsillar hypertrophy.2.By guiding the mandible to move forward,the TB functional appliance can effectively treat moderate to severe OSAS in children with skeletal class Ⅱ mandibular retraction and the quality of life of the patients can be improved to some extent,but the patients with adenoid tonsillar hypertrophy still have mouth breathing and the mandible rotates clockwise,which will adversely affect the facial shape and therapeutic effect of the patients.3.Through a comparative study between the two groups,it was found that TB treatment after adenoid tonsillectomy is more beneficial to the improvement of dental maxillofacial shape,upper airway,sleep breathing and quality of life in patients with adenoid and tonsillar hypertrophy.This study believes that for patients with moderate to severe OSAS with mandibular retraction and no surgical contraindications,adenoid tonsillectomy combined with orthodontic treatment should be used in order to obtain a better clinical efficacy.