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.