Craniofacial Growth Modification for OSA Children

Pediatric sleep disordered breathing (SDB) includes snoring and obstructive sleep apnea (OSA) in growingchildren. Because diagnostic criteria and subjective symptoms of OSA in children differ from those in adults, different diagnostic and therapeutic approach is necessary. Based on the differential growth of craniofacial struc-ture and upper airway soft tissues, phenotype-based, timely-target intervention is needed to interrupt abnormal craniofacial growth inducing or aggravating SDB symptoms and ultimately to prevent the progression to adult-hood OSA. Although adenotonsillar hypertrophy is known to be first-line treatment in pediatric OSA patients, craniofacial growth modification treatment needs to be primarily considered for the patients with craniofacial skeletal phenotypic cause. Growth modification treatment can be categorized into four modalities dependingon the craniofacial target related to the upper airway collapsibility: 1) Unlocking the mandibular growth for skeletal Class II patients with retruded small mandible; 2) Nasomaxillary protraction for skeletal Class III pa-tients with deficient midface; 3) Nasomaxillary expansion for the patients with transverse discrepancy and nasalobstruction; 4) Control of vertical maxillary excess in patients with long face and structural mouth breathing.