Abstract

R.M.E.: Innovation in the Treatment of Pediatric OSA

by Pirelli Paola

Orthodontists may play an important role in the interdisciplinary treatment of OSAS because a high percentage of patients with OSAS suffer from maxillary narrowness. In OSA children, RME treatment can be effective and can have a favorable orthopedic role in modifying facial bony structures and in conditioning further developmental processes positively. R.M.E. is a therapeutic device which we successfully adopted for many years to obtain a skeletal expansion of the upper jaw. The anatomical criteria of this technique consist in the application of orthopaedic forces through particular procedures on the midpalatal suture. This is mainly made up of compact bone laterally, and fibrous tissue with fibroblasts, collagen fibres and vessels centrally. Bone distraction is possible thanks to the very biology of the bone and can be obtained by applying heavy forces through the orthodontic device anchored on to the teeth Bone distraction at the suture level causes an actual widening of the maxilla increasing its cross-section as well as the anatomical space of the nasal cavity.X-ray findings and Computed Tomography clearly show how the RME manoeuvre separates the nasal and palatal bones. A substantial increase is reported at cross- sectional level with a relevant improvement in nasal airflow. Increasing of upper jaw cross-section also clearly affects the nasal cavities and it is a true anatomic change that brings about an increased patency of the upper airways. This is also the basis for the positive effects induced by the RME manoeuvre on the respiratory function, based on polysomnography. Associated orthodontic movements can also indirectly improve the oropharyngeal space by modifying the resting posture of the tongue. We also evaluated the long-term efficacy of rapid maxillary expansion (RME) in a group of children with obstructive sleep apnea (OSA). Yearly clinical evaluations, including orthodontic and otolaryngological examinations and questionnaire scores, were consistently normal over time, and PSG findings remained normal at the 12-year follow-up period. The stability and maintenance of the expansion over time was demonstrated by the maxillary base width and the distance of the pterygoid processes measured using CT imaging. In conclusion a subgroup of OSA children, with isolated maxillary narrowing initially and followed up into adulthood, present stable, long-term good results post RME treatment for pediatric OSA.

Learning Objectives

After this lecture, you will be able to recognize that the orthodontist can really contribute to the treatment of OSA children
After this lecture, you will be able to propose R.M.E. therapy to OSA children
After this lecture, you will be able to demonstrate how R.M.E. can lead to an increased patency of the upper airways