Traitements orthodontiques dans le syndrome d'apnées obstructives du sommeil pédiatrique

Obstructive sleep apnea syndrome (OSAS) is a multifactorial condition, which main cause in childhood is related to the hypertrophy of Waldeyer's ring lymphoid tissue, and can explain the increased incidence between the age of 3 and 5. OSAS can also be associated to the narrowing of the skeletal frame of the upper airway or the reduction of its lumen because of abnormal deposition within the pharyngeal walls (obesity, mucopolysaccharidosis…). Neuromuscular control abnormalities, with a reduction of the pharyngeal dilatator muscles tone, can lead to OSAS or worsen preexisting morphological predispositions. Adenoid and palatal tonsil removal is the first line of treatment of pediatric OSAS, but some patients might show persistence of sleep disordered breathing after surgery or recurrence of symptoms a few years later. Specific maxillo-facial characteristics have been related to these surgical failures, and also are known risk factors of OSAS, found in about one third of apneic children: maxilla hypoplasia with narrow, high arched hard palate, and mandibular retrusion or hyperdivergence. The aim of this article is to describe the place and practical steps of orthodontic interceptive treatments, among which two appliances have shown efficacy on pediatric OSAS: mandibular protruding appliances (activators, Herbst appliance…) and rapid palatal expansion. The results of the main clinical studies and the potentially implicated mechanisms are discussed for each treatment modality.