Orthodontic and Facial Characteristics of Craniofacial Syndromic Children with Obstructive Sleep Apnea
Abstract
:1. Introduction
SYNDROME | EXTRA-ORAL FEATURES | INTRA-ORAL FEATURES | ASSOCIATION WITH OSA | |
---|---|---|---|---|
Down’s syndrome 1:700 Genetics: Trisomy 21+ mutation in GATA1 gene [10] | Face ▪ lat nasal bridge ▪ Small ears ▪ Epicanthic folds ▪ Up slanting palpebral fissures Cranium ▪ Flat cranial base (N-S-Ba angle) | Maxilla ▪ Hypoplastic ▪ Deficient development of length, depth, height but usually not width of palate ▪ High V-shaped palate | ▪ Macroglossia ▪ Microdontia of primary and permanent dentition ▪ Clinical crowns may be conical, shorter and smaller than normal and roots shorter ▪ Hypotonic perioral musculature ▪ Descending angles of mouth ▪ Everted lower lip w. tongue protrusion ▪ Mouth breathing ▪ Xerostomia | OSA prevalence [11,12,13,14,15] Childhood: 50–100%, Adulthood: 100% Predisposing factors—related to the syndrome: Macroglossia, adenotonsillar hypertrophy, midface hypoplasia, other associated conditions such as obesity, hypothyroidism, hypotonia, and gastroesophageal reflux [16] |
Goldenhar syndrome 1:3500 to 1:7000 Genetics: MYT1 [17] | Face ▪ Hemifacial microsomia ▪ Anterior-posterior and vertical dimensions reduced on affected side ▪ Lateral facial cleft ▪ Macrostomia Eyes: ▪ Epibulbar dermoids ▪ Narrowing of palpebral fissures ▪ Vertical dislocation of orbit ▪ Microphthalmia/anopthalmia ▪ Upper eyelid colobomas | Ears ▪ Pre-auricular tags ▪ Deformities of pinna ▪ Microtia (small external ear)/anotia ▪ Hearing loss Vertebral anomalies ▪ Scoliosis ▪ Abnormal rib structure (missing or fused) ▪ Hemi vertebrae and cervical fusion | ▪ Micrognathia ▪ Hypoplasia of maxilla and mandible ▪ High arched palate ▪ Delayed tooth eruption ▪ Supernumerary/missing teeth ▪ Enamel and dentin malformations ▪ Gingival hypertrophy ▪ CLP | OSA prevalence Up to 67% [1] Predisposing factors related to the syndrome: Maxillomandibular hypoplasia, glossoptosis, and abnormal control of breathing in patients with neurological compromise [18]. |
Cerebral Palsy 1 in 322 [19] Genetics: GAD1 on chromosome 2q31 [10] | Depends on the type and severity: ▪ Impaired motor control ▪ Delayed motor development ▪ Spastic muscles ▪ Difficulty walking | ▪ Drolling ▪ Difficulty swallowing ▪ Ataxia ▪ Seizures | ▪ Tongue thrust ▪ Mouth breathing ▪ Oral mucosa hypersensitivity ▪ Delayed eruption of permanent teeth ▪ Enamel hypoplasia ▪ Increased risk of dental caries ▪ Dental erosion | Risk of OSA: 38–55% [20] Predisposing factors—varies between CP types: Abnormal muscle tone, inability to change position on bed and as a side effect of some medication “for those with epilepsy” [21] |
Pierre Robin Sequence syndrome 1: 8500–14,000 Genetics SOX9, COL2A1 [10] | Cardiac: Cor pulmonale (right side heart failure) Ears: infections/hearing loss ear Mandible: Retrognathia | Triad of: 1. Cleft palate (U-shaped) 2. Mandibular retrognathism—but will still grow 3. Glossoptosis ▪ Posterior displacement of the tongue ▪ Lack of support of the tongue musculature ▪ Airway obstruction ▪ Hypodontia | OSA prevalence 85–100% [22,23] Predisposing factors related to the syndrome: Mandibular retrognathia Mechanical collapse of the pharyngeal wall [24] | |
DiGeorge syndrome 1:4000–7000 Genetics:TBX-1 [10] | CATCH 22 Cardiac defects (Tetralogy of Fallot) Abnormal facial features Thymic hypoplasia Cleft palate Hypocalcemia Craniosynostosis | Eyes: Ocular hypertelorism, hooding of upper lids, ptosis, tortuous retinal vessels. Nose: prominent nasal base, bulbous nasal dimples. Ears: over folded, microtic ears, pre auricular pits. | Enamel defects Hypomineralization Higher risk of dental decay | OSA prevalence 10.2% [25] Predisposing factors related to the syndrome: Micrognathia and VPL surgeries |
Treacher–Collin syndrome 1:25,000, 50,000 Genetics: Loss of function in gene TCOF-1 located on chromosome 5 [10] | Face Hypoplastic Zygoma Depressed cheeks Narrow face Mandible Underdeveloped mandible with retrusive chin Hypoplasia of condylar and coronoid processes Steep mandibular plane Prominent antegonial notching | Eyes Downward slanting palpebral fissures 75% have coloboma (notch on outer eyelid) Ears Deformed or displaced pinnae Extra ear tags Ossicle defects or absence of EA canal causing conductive hearing loss | Class II Malocclusion Open bite High arched palate Cleft palate in 30% of cases | OSA prevalence 29–95% [26,27] Predisposing factors related to the syndrome: Narrowing of the upper airway due to mandibular retrognathia and choanal atresia [28]. |
Prader–Willi syndrome 1:10,000–25,000 Genetics mutation chromosome 15q11-q13 [10] | Face Narrow bifrontal diameter Round face Eyes Almond-shaped eyes, | Others Small hands and feet Rapid weight gain Hyperphagia Hypogonadism | Downturned corners of the mouth Dental caries Enamel defects Tooth wear | OSA prevalence 44% to 100% [29,30] Predisposing factors related to the syndrome: Increase in viscosity of secretions Craniofacial abnormalities causing small airways, Hypotonia leading to airway collapsibility [31] |
Apert syndrome 1:65,000–160,000 Genetics FGFR2 on chromosome 10q26 [10] | Cranium: Acrobrachycephally (tower skull) Kleeblatt-schadel (cloverleaf) Frontal bossing and tall forehead Eyes: Ocular proptosis Hypertelorism Downward slanting palpebral fissures Vision loss | Ears Middle ear infection Conductive hearing loss Maxilla Midface deficient = class III Limbs Syndactyly of 2nd, 3rd, and 4th digits and toes, 1st and 5th may be separate or joined | V-shaped arches Upper crowding Anterior open bite with posterior crossbite 75% have cleft of SP or bifid uvula Trapezoidal shaped lips Increased gingival thickening may be associated with Delayed eruption of teeth Shovel shaped incisors | OSA prevalence 81% [31] Predisposing factors related to the syndrome: Decreased size of nasopharynx Narrowing of post choanae = respiratory distress Increased mouth breathing = open mouth appearance |
Achondroplasia 1:15,000–40,000 Genetics: FGFR 3 [10] | Body Dwarfism Short limbs Short fingers and toes Facial Underdeveloped midface Flattened nasal bridge | Ears: Increased ear infections Cranium: Hydrocephalus Short post cranial base | Retrognathic maxilla Normal mandible Protrusive maxillary incisors Anterior open bite Posterior crossbite Anterior reversed overjet | OSA prevalence 75% [32] Predisposing factors related to the syndrome: Increased airway resistance secondary to adenotonsillar hypertrophy |
2. Materials and Methods
2.1. Orofacial Examination
2.2. Craniofacial Photography
2.3. Statistical Analysis
3. Results
4. Craniofacial Measurements
5. Dental Characteristics
6. Discussion
7. Conclusions
- Specific craniofacial measurements were found to be correlated with the severity of OSA for craniofacial syndromic patients. Decreased upper facial height and mandibular plane angle were correlated with an increase in AHI and ODI, while increased cervicomental and thyromental angles were correlated with increase in AHI and ODI.
- In this study, for Down’s syndrome patients, an increase in intercanthal width was correlated with an increase in ODI.
- Considering the limitation of this study, dental characteristics of syndromic children with OSA do not seem to be different from non-OSA syndromic children. However, studies on a larger sample of non-OSA syndromic children are needed.
- Although some craniofacial measurements were moderately correlated with AHI, this does not support craniofacial prediction models for OSA in syndromic children at this point, and larger numbers would be needed to establish clinical utility.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AASM | American Academy of Sleep Medicine |
AHI | apnea–hypopnea index |
BMI | body mass index |
BMIP | body mass index percentile |
DS | Down’s syndrome |
ODI | oxygen desaturation index |
OR | odds ratio |
OSA | obstructive sleep apnea |
PSG | polysomnography |
SD | standard deviation |
References
- Caron, C.J.; Pluijmers, B.I.; Joosten, K.F.; Mathijssen, I.M.J.; Van Der Schroeff, M.P.; Dunaway, D.J.; Koudstaal, M.J. Obstructive sleep apnoea in craniofacial microsomia: A systematic review. Int. J. Oral Maxillofac. Surg. 2015, 44, 592–598. [Google Scholar] [CrossRef] [PubMed]
- Li, H.-Y.; Lee, L.-A. Sleep-disordered breathing in children. Chang. Gung Med. J. 2009, 32, 247–257. [Google Scholar] [PubMed]
- Sheldon, S.H.; Ferber, R.; Kryger, M.H. Principles and Practice of Pediatric Sleep Medicine; Elsevier Health Sciences: Amsterdam, The Netherlands, 2005. [Google Scholar]
- Bixler, E.O.; Vgontzas, A.N.; Lin, H.M.; Liao, D.; Calhoun, S.; Vela-Bueno, A.; Graff, G. Sleep disordered breathing in children in a general population sample: Prevalence and risk factors. Sleep 2009, 32, 731–736. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kheirandish-Gozal, L.; Gozal, D. Sleep Disordered Breathing in Children: A Comprehensive Clinical Guide to Evaluation and Treatment; Springer Science & Business Media: Cham, Switzerland, 2012. [Google Scholar]
- White, S.C.; Pharoah, M.J. Oral Radiology: Principles and Interpretation; Elsevier India: New Delhi, India, 2014. [Google Scholar]
- Lee, R.W.; Chan, A.S.; Grunstein, R.R.; Cistulli, P.A. Craniofacial phenotyping in obstructive sleep apnea—A novel quantitative photographic approach. Sleep 2009, 32, 37–45. [Google Scholar]
- Ayers, E. Altered Craniofacial Morphology in Children with OSAS: A Clinical and Photographic Study. Ph.D. Thesis, University of British Columbia, Vancouver, BC, USA, 2017. [Google Scholar]
- Sutherland, K.; Weichard, A.J.; Davey, M.J.; Horne, R.S.; Cistulli, P.A.; Nixon, G.M. Craniofacial photography and association with sleep-disordered breathing severity in children. Sleep Breath 2020, 24, 1173–1179. [Google Scholar] [CrossRef] [PubMed]
- McKusick, V.A.; McKusick, V. Mendelian Inheritance in Man: A Catalog of Human Genes and Genetic Disorders; JHU Press: Baltimore, MD, USA, 1998; Volume 1. [Google Scholar]
- Shott, S.R.; Amin, R.; Chini, B.; Heubi, C.; Hotze, S.; Akers, R. Obstructive sleep apnea: Should all children with Down syndrome be tested? Arch. Otolaryngol. Head Neck Surg. 2006, 132, 432–436. [Google Scholar] [CrossRef] [Green Version]
- Lal, C.; White, D.R.; Joseph, J.E.; van Bakergem, K.; LaRosa, A. Sleep-disordered breathing in Down syndrome. Chest 2015, 147, 570–579. [Google Scholar] [CrossRef] [Green Version]
- Maris, M.; Verhulst, S.; Wojciechowski, M.; Van de Heyning, P.; Boudewyns, A. Prevalence of obstructive sleep apnea in children with Down syndrome. Sleep 2016, 39, 699–704. [Google Scholar] [CrossRef] [Green Version]
- Hill, C.M.; Evans, H.J.; Elphick, H.; Farquhar, M.; Pickering, R.M.; Kingshott, R.; Gringras, P. Prevalence and predictors of obstructive sleep apnoea in young children with Down syndrome. Sleep Med. 2016, 27, 99–106. [Google Scholar] [CrossRef]
- Dyken, M.E.; Lin-Dyken, D.C.; Poulton, S.; Zimmerman, M.B.; Sedars, E. Prospective polysomnographic analysis of obstructive sleep apnea in Down syndrome. Arch. Pediatr. Adolesc. Med. 2003, 157, 655–660. [Google Scholar] [CrossRef] [Green Version]
- Simpson, R.; Oyekan, A.A.; Ehsan, Z.; Ingram, D.G. Obstructive sleep apnea in patients with Down syndrome: Current perspectives. Nat. Sci. Sleep 2018, 10, 287–293. [Google Scholar] [CrossRef] [Green Version]
- Berenguer, M.; Tingaud-Sequeira, A.; Colovati, M.; Melaragno, M.I.; Bragagnolo, S.; Perez, A.; Rooryck, C. A novel de novo mutation in MYT1, the unique OAVS gene identified so far. Eur. J. Hum. Genet. 2017, 25, 1083. [Google Scholar] [CrossRef] [Green Version]
- Baugh, A.; Wooten, W.; Chapman, B.; Drake, A.; Vaughn, B. Sleep characteristics in Goldenhar syndrome. Int. J. Pediatr. Otorhinolaryngol. 2015, 79, 356–358. [Google Scholar] [CrossRef]
- Christensen, D.; Van Naarden Braun, K.; Doernberg, N.S.; Maenner, M.J.; Arneson, C.L.; Durkin, M.S.; Yeargin-Allsopp, M. Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning—Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev. Med. Child Neurol. 2014, 56, 59–65. [Google Scholar] [CrossRef] [Green Version]
- Elsayed, R.M.; Hasanein, B.M.; Sayyah, H.E.; El-Auoty, M.M.; Tharwat, N.; Belal, T.M. Sleep assessment of children with cerebral palsy: Using validated sleep questionnaire. Ann. Indian Acad. Neurol. 2013, 16, 62. [Google Scholar] [CrossRef]
- Simard-Tremblay, E.; Constantin, E.; Gruber, R.; Brouillette, R.T.; Shevell, M. Sleep in children with cerebral palsy: A review. J. Child Neurol. 2011, 26, 1303–1310. [Google Scholar] [CrossRef]
- Anderson, I.C.W.; Sedaghat, A.R.; McGinley, B.M.; Redett, R.J.; Boss, E.F.; Ishman, S.L. Prevalence and severity of obstructive sleep apnea and snoring in infants with Pierre Robin sequence. Cleft Palate-Craniofacial J. 2011, 48, 614–618. [Google Scholar] [CrossRef]
- Daniel, M.; Bailey, S.; Walker, K.; Hensley, R.; Kol-Castro, C.; Badawi, N.; Waters, K. Airway, feeding and growth in infants with Robin sequence and sleep apnoea. Int. J. Pediatr. Otorhinolaryngol. 2013, 77, 499–503. [Google Scholar] [CrossRef]
- Sher, A.E. Mechanisms of airway obstruction in Robin sequence: Implications for treatment. Cleft Palate-Craniofacial J. 1992, 29, 224–231. [Google Scholar] [CrossRef]
- Kennedy, W.P.; Mudd, P.A.; Maguire, M.A.; Souders, M.C.; McDonald-McGinn, D.M.; Marcus, C.L.; Elden, L.M. 22q11. 2 Deletion syndrome and obstructive sleep apnea. Int. J. Pediatr. Otorhinolaryngol. 2014, 78, 1360–1364. [Google Scholar] [CrossRef]
- Johnston, C.; Taussig, L.; Koopmann, C.; Smith, P.; Bjelland, J. Obstructive sleep apnea in Treacher-Collins syndrome. Cleft Palate J. 1981, 18, 39–44. [Google Scholar] [PubMed]
- Plomp, R.G.; van Lieshout, M.J.; Joosten, K.F.; Wolvius, E.B.; van der Schroeff, M.P.; Versnel, S.L.; Mathijssen, I.M. Treacher Collins syndrome: A systematic review of evidence-based treatment and recommendations. Plast. Reconstr. Surg. 2016, 137, 191–204. [Google Scholar] [CrossRef] [PubMed]
- Akre, H.; Øverland, B.; Åsten, P.; Skogedal, N.; Heimdal, K. Obstructive sleep apnea in Treacher Collins syndrome. Eur. Arch. Oto-Rhino-Laryngol. 2012, 269, 331–337. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lin, H.Y.; Lin, S.P.; Lin, C.C.; Tsai, L.P.; Chen, M.R.; Chuang, C.K.; Huang, C.Y. Polysomnographic characteristics in patients with Prader–Willi syndrome. Pediatr. Pulmonol. 2007, 42, 881–887. [Google Scholar] [CrossRef] [PubMed]
- Al-Saleh, S.; Al-Naimi, A.; Hamilton, J.; Zweerink, A.; Iaboni, A.; Narang, I. Longitudinal evaluation of sleep-disordered breathing in children with Prader-Willi Syndrome during 2 years of growth hormone therapy. J. Pediatr. 2013, 162, 263–268.e261. [Google Scholar] [CrossRef]
- Sedky, K.; Bennett, D.S.; Pumariega, A. Prader Willi syndrome and obstructive sleep apnea: Co-occurrence in the pediatric population. J. Clin. Sleep Med. 2014, 10, 403–409. [Google Scholar] [CrossRef] [Green Version]
- Zucconi, M.; Weber, G.; Castronovo, V.; Ferini-Strambi, L.; Russo, F.; Chiumello, G.; Smirne, S. Sleep and upper airway obstruction in children with achondroplasia. J. Pediatr. 1996, 129, 743–749. [Google Scholar] [CrossRef]
- Lee, K.C.-H. Dentofacial Morphology in Children with Obstructive Sleep Apnea. Master’s Thesis, University of British Columbia, Vancouver, BC, USA, 2015. [Google Scholar]
- Shaw, W.; Richmond, S.; O’Brien, K. The use of occlusal indices: A European perspective. Am. J. Orthod. Dentofac. Orthop. 1995, 107, 1–10. [Google Scholar] [CrossRef]
- Kaditis, A.G.; Alvarez, M.L.A.; Boudewyns, A.; Alexopoulos, E.I.; Ersu, R.; Joosten, K.; Larramona, H.; Miano, S.; Narang, I.; Trang, H. Obstructive sleep disordered breathing in 2-to 18-year-old children: Diagnosis and management. Eur. Respir. J. 2016, 47, 69–94. [Google Scholar] [CrossRef] [Green Version]
- Flores-Mir, C.; Korayem, M.; Heo, G.; Witmans, M.; Major, M.P.; Major, P.W. Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: A systematic review and meta-analysis. J. Am. Dent. Assoc. 2013, 144, 269–277. [Google Scholar] [CrossRef]
- Katyal, V.; Pamula, Y.; Martin, A.J.; Daynes, C.N.; Kennedy, J.D.; Sampson, W.J. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: Systematic review and meta-analysis. Am. J. Orthod. Dentofacial. Orthop. 2013, 143, 20–30.e23. [Google Scholar] [CrossRef]
- Bull, M.J. Health supervision for children with Down syndrome. Pediatrics 2011, 128, 393–406. [Google Scholar] [CrossRef] [Green Version]
- Jheeta, S.; McGowan, M.; Hadjikoumi, I. Is oximetry an effective screening tool for obstructive sleep apnoea in children with Down syndrome? Arch. Dis. Child. 2013, 98, 164. [Google Scholar] [CrossRef]
- Skotko, B.G.; Macklin, E.A.; Muselli, M.; Voelz, L.; McDonough, M.E.; Davidson, E.; Allareddy, V.; Jayaratne, Y.S.N.; Bruun, R.; Ching, N.; et al. A predictive model for obstructive sleep apnea and Down syndrome. Am. J. Med. Genet. A. 2017, 173, 889–896. [Google Scholar] [CrossRef]
- Ng, C. Craniofacial Morphology in Children with Obesity or Down Syndrome with and without Obstructive Sleep Apnea. Master’s Thesis, University of Toronto, Toronto, ON, Canada, 2018. [Google Scholar]
- Ørntoft, M.; Andersen, I.G.; Homøe, P. Night-to-night variability in respiratory parameters in children and adolescents examined for obstructive sleep apnea. Int. J. Pediatr. Otorhinolaryngol. 2020, 137, 110206. [Google Scholar] [CrossRef]
All (n = 52) | Non-OSA (n = 6) | Mild OSA (n = 16) | Moderate OSA (n = 9) | Severe OSA (n = 21) | |
---|---|---|---|---|---|
Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | |
Age | 9.38 ± 3.36 | 11.00 ± 2.83 | 8.00 ± 3.06 | 7.44 ± 2.69 | 10.71 ± 3.32 |
Males (%) | 25/51 (49.0%) | 3/6 (50%) | 8/16 (50%) | 3/8 (37.5%) | 11/21 (52.4%) |
Caucasians (%) | 36/52 (69.2%) | 6/6 (100%) | 9/16 (56.3%) | 7/9 (77.8%) | 14/21 (66.7%) |
BMI | 20.11 ± 6.78 | 20.04 ± 2.63 | 19.41 ± 7.47 | 19.06 ± 6.66 | 21.08 ± 7.43 |
Obese | 13/47 (27.7%) | 0/6 (0%) | 5/15 (33.3%) | 2/7 (28.6%) | 6/19 (31.6%) |
Tonsils ≥3 | 16/52 (30.8%) | 3/6 (50%) | 2/16 (12.5%) | 4/9 (44.4%) | 7/21 (33.3%) |
Mouth Breather | 44/49 (89.8%) | 6/6 (100%) | 13/15 (86.7%) | 8/8 (100%) | 17/20 (85%) |
Total Sleep Time (min) | 375.49 ± 65.85 | 401.08 ± 42.95 | 346.86 ± 72.51 | 413.20 ± 35.94 | 373.82 ± 68.13 |
Sleep Efficiency (%) | 81.15 ± 11.66 | 84.78 ± 7.76 | 76.65 ± 11.83 | 87.27 ± 8.70 | 80.92 ± 12.62 |
Sleep Latency (min) | 31.58 ± 23.39 | 31.75 ± 14.22 | 39.03 ± 30.27 | 21.49 ± 16.00 | 30.19 ± 21.49 |
Mean O2 Saturation (%) | 95.11 ± 2.09 | 96.00 ± 2.25 | 95.41 ± 1.94 | 95.37 ± 2.41 | 94.52 ± 2.02 |
Mean Heart Rate (bpm) | 83.14 ± 13.92 | 77.42 ± 17.03 | 81.31 ± 11.98 | 85.76 ± 13.22 | 85.16 ± 14.96 |
AHI Index (events/h) | 13.04 ± 18.36 | 1.02 ± 0.66 | 3.14 ± 0.70 | 6.86 ± 1.32 | 26.67 ± 22.89 |
Measurements | Correlation (r) | |
---|---|---|
AHI (r) | ODI (r) | |
Total face height (cm) | −0.336 | −3.11 |
Upper face height (cm) | −0.572 ** | −0.536 * |
Lower face height (cm) | −0.193 | −0.153 |
Upper to lower facial height ratio | −0.357 | −0.347 |
Lateral facial height (cm) | −0.065 | −0.137 |
Face width (cm) | 0.110 | 0.123 |
Eye width (cm) | −0.107 | −0.060 |
Mandibular length (cm) | 0.102 | 0.053 |
Mandibular width (cm) | 0.165 | 0.210 |
Neck width (cm) | 0.107 | 0.172 |
Neck depth (cm) | 0.146 | 0.189 |
Mid-face depth (cm) | −0.010 | −0.059 |
Maxillary-mandibular relationship angle (°) | −0.164 | −0.296 |
Mandibular width-length angle (°) | −0.037 | −0.041 |
Mandibular plane angle (°) | −0.528 ** | −0.487 * |
Face width-midface depth angle (°) | −0.029 | −0.005 |
Thyromental angle (°) | 0.467 * | 0.414 * |
Cricomental distance (cm) | −0.053 | −0.221 |
Cricomandibular distance (cm) | −0.036 | −0.082 |
Cervicomental angle (°) | 0.439 * | 0.431 * |
Measurements | Non-Obese (n = 16) | Obese (n = 6) |
---|---|---|
AHI (events/h) | 19.5 | 13.1 |
Total face height (cm) | 11.5 | 12.8 * |
Upper face height (cm) | 4.2 | 4.3 |
Lower face height (cm) | 5.3 | 6.3 * |
Lateral facial height (cm) | 9.2 | 9.6 |
Face width (cm) | 12.9 | 14.4 * |
Eye width (cm) | 2.6 | 2.9 |
Mandibular length (cm) | 6.6 | 7.3 |
Mandibular width (cm) | 10.9 | 12.6 * |
Neck width (cm) | 9.4 | 11.5 * |
Neck depth (cm) | 9.9 | 12.8 * |
Mid-face depth (cm) | 9.2 | 10.5 |
Maxillary-mandibular relationship angle (°) | 7.7 | 6.9 |
Mandibular width-length angle (°) | 79.1 | 80.7 |
Mandibular plane angle (°) | 24.2 | 19.6 |
Face width-midface depth angle (°) | 64.4 | 66.0 |
Thyromental angle (°) | 132.6 | 145.0 |
Cricomental distance (cm) | 5.6 | 5.5 |
Cricomandibular distance (cm) | 5.1 | 8.8 |
Cervicomental angle (°) | 129.8 | 149.7 * |
Facial Profile | Increased Lower Facial Height | Mouth Breather | Retrognathic Maxilla | Retrognathic Mandible | Class II Malocclusion | Facial Asymmetry | Narrow Palate | Macroglossia | Crowding/Spacing | Lip Incompetency | IOTN Score | Others | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Down’s Syndrome (n = 21) | Straight: 62% Concave: 33% Convex: 5% | 70% | 95% | 52% | 5% | 5% | 33% | 57% | 81% | Crowding: 67% Spacing: 29% | 52% | 6.3 ± 2.7 | Anterior cross-bite: 48% Posterior cross-bite: 43% |
Goldenhar Syndrome (n = 4) | Convex: 100% | 100% | 50% | No | 100% | 75% | 100% | 50% | 75% | Crowding: 75% | No | 10 | Posterior cross-bite: 100% |
Cerebral Palsy (n = 4) | Concave: 75% Convex: 25% | 50% | 100% | No | 50% | 50% | 50% | 50% | 75% | Crowding: 75% Spacing: 25% | 75% | 9.5 ± 0.7 | Anterior open-bite: 75% Anterior cross-bite: 25% Posterior cross-bite: 25% |
Pierre Robin Sequence (n = 3) | Straight: 33% Convex: 67% | Zero | 100% | No | 100% | 67% | 33% | No | 100% | Crowding | 33% | 8.0 ± 2.8 | Posterior cross-bite: 33% |
Treacher Collins Syndrome (n = 3) | Convex: 100% | Zero | 100% | No | 100% | 100% | No | 50% | 50% | Crowding | No | 8.5 ± 1.0 | Anterior open-bite: 100% Posterior cross-bite: 50% |
DiGeorge Syndrome (n = 3) | Convex: 67% Concave: 33% | 33% | 100% | No | 67% | 67% | 33% | 33% | 67% | Spacing | 33% | 1.5 | Posterior cross-bite: 33% |
Prader–Willi Syndrome (n = 3) | Straight: 33% Convex: 67% | No | 67% | No | 33% | 33% | No | 67% | 33% | Spacing | No | 4 | Severe bruxism |
Ehlers–Danlos Syndrome (n = 2) | Convex | 100% | No | No | Yes | Yes | 100% | No | 100% | Crowding | 100% | 8 | Anterior open bite |
Fetal Alcohol Syndrome (n = 1) | Convex | No | Yes | No | Yes | Yes | No | Yes | No | Crowding | Yes | 7 | N/A |
Frontometaphyseal Dysplasia (n = 1) | Straight | No | Yes | Yes | Yes | No | Yes | No | Yes | Spacing | No | 10 | Posterior open-bite |
Joubert Syndrome (n = 1) | Convex | Yes | Yes | No | No | No | No | No | Yes | Spacing | No | 4 | Deviated nasal septum |
Neurofibromatosis Type I (n = 1) | Straight | Yes | Yes | No | No | No | Yes | Yes | No | Crowding | No | 1 | Anterior cross-bite |
Ohdo Syndrome (n = 1) | Convex | Yes | No | No | Yes | Yes | Yes | No | Yes | Crowding | No | 3 | Deep Overbite |
15q13.3 Microdeletion Syndrome (n = 1) | Convex | Yes | Yes | No | Yes | Yes | No | No | No | Crowding | Yes | 2 | Deep overbite |
Dubowitz Syndrome (n = 1) | Straight profile | Yes | Yes | No | No | No | Yes | No | Yes | Spacing | Yes | 3 | Deep overbite |
Cleft lip and palate (n = 1) | Concave | Yes | Yes | Yes | No | No | No | Yes | No | Crowding | No | 9 | Anterior open-bite and cross-bite Posterior cross-bite |
Coffin–Siris Syndrome (n = 1) | convex | No | Yes | No | Yes | Yes | No | Yes | No | Spacing | No | 9 | N/A |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Alsaeed, S.; Huynh, N.; Wensley, D.; Lee, K.; Hamoda, M.M.; Ayers, E.; Sutherland, K.; Almeida, F.R. Orthodontic and Facial Characteristics of Craniofacial Syndromic Children with Obstructive Sleep Apnea. Diagnostics 2023, 13, 2213. https://doi.org/10.3390/diagnostics13132213
Alsaeed S, Huynh N, Wensley D, Lee K, Hamoda MM, Ayers E, Sutherland K, Almeida FR. Orthodontic and Facial Characteristics of Craniofacial Syndromic Children with Obstructive Sleep Apnea. Diagnostics. 2023; 13(13):2213. https://doi.org/10.3390/diagnostics13132213
Chicago/Turabian StyleAlsaeed, Suliman, Nelly Huynh, David Wensley, Kevin Lee, Mona M. Hamoda, Evan Ayers, Kate Sutherland, and Fernanda R. Almeida. 2023. "Orthodontic and Facial Characteristics of Craniofacial Syndromic Children with Obstructive Sleep Apnea" Diagnostics 13, no. 13: 2213. https://doi.org/10.3390/diagnostics13132213
APA StyleAlsaeed, S., Huynh, N., Wensley, D., Lee, K., Hamoda, M. M., Ayers, E., Sutherland, K., & Almeida, F. R. (2023). Orthodontic and Facial Characteristics of Craniofacial Syndromic Children with Obstructive Sleep Apnea. Diagnostics, 13(13), 2213. https://doi.org/10.3390/diagnostics13132213