Bimaxillary expansion therapy for pediatric sleep-disordered breathing

- Forty-five children with sleep-disordered breathing, aged 3-14 years, not preselected based on any type of facial morphology or cephalometric measure, underwent bimaxillary expansion.
- The majority of the children (66%) showed improvement in their sleep scores and symptoms after bimaxillary expansion.
- However, retrognathia in an anterior growth rotation pattern may not respond to efforts of bimaxillary expansion and has limited impact on sleep-disordered breathing.

IntroductionThe aim of this retrospective study was to evaluate the results of bimaxillary expansion as a treatment option for pediatric sleep-disordered breathing.MethodsForty-five children, aged 3-14 years, with sleep-disordered breathing underwent bimaxillary expansion. They were subjected to baseline clinical evaluations, cephalometric X-rays, and polygraphic sleep studies. Three to six months after bimaxillary expansion, posttreatment sleep studies were performed. Data were analyzed with nonparametric Wilcoxon signed-rank test, and Spearman's correlations were performed to correlate cephalometric facial structures to the effectiveness of treatment.ResultsThe majority of the children (n = 30) showed improvement in their sleep scores and symptoms after bimaxillary expansion. The initial severity of the obstructive sleep apnea (OSA) indicated by the apnea-hypopnea index (AHI) was a much better predictor of positive results. However, in the “mild OSA” group, patients with smaller MP-SN or counterclockwise mandibular growth, worsened with bimaxillary expansion, while patients with clockwise mandibular growth showed greater improvement; in the “severe OSA” group, patients who initially had shorter mandibular base lengths showed lesser AHI improvements.ConclusionsBimaxillary expansion can be a treatment option for improving respiratory parameters in children with sleep-disordered breathing. This study also suggests that retrognathia in an anterior growth rotation pattern may not respond to efforts of bimaxillary expansion.