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Australian Prescriber Apr 2024Obstructive sleep apnoea is the most common form of sleep-disordered breathing. It is characterised by recurrent occlusion of the airway during sleep. Ensuing apnoeas... (Review)
Review
Obstructive sleep apnoea is the most common form of sleep-disordered breathing. It is characterised by recurrent occlusion of the airway during sleep. Ensuing apnoeas terminate in arousal from sleep and lead to non-restorative sleep, excessive daytime sleepiness and adverse cardiovascular and neurocognitive effects. A sleep study should be offered to patients reporting witnessed apnoeas or symptoms related to non-restorative sleep. It should also be considered in the presence of predisposing factors for obstructive sleep apnoea (e.g. obesity, tonsillar hypertrophy, retrognathia, refractory hypertension). Treatment should aim to improve symptoms and reduce cardiovascular and neurocognitive risk. The treatment approach should consider the symptom burden, severity, anatomical factors, and patient preference. Positive airway pressure is the most effective treatment option, although intolerance and non-adherence are common. Other options include positional therapy, oral appliances and upper airway surgery. Weight loss and optimisation of cardiovascular disease risk should be considered in selected patients.
PubMed: 38737371
DOI: 10.18773/austprescr.2024.010 -
The Journal of Clinical Pediatric... Nov 2023Skeletal Class II malocclusion is a common malocclusion seen in clinics. It is characterized by maxillary protrusion and mandibular retrognathia and has a high incidence... (Review)
Review
Skeletal Class II malocclusion is a common malocclusion seen in clinics. It is characterized by maxillary protrusion and mandibular retrognathia and has a high incidence in adolescent mixed dentition and early permanent dentition. The early functional correction has achieved some clinical results in treating skeletal Class II malocclusion with mandibular hypoplasia. During treatment, the timing of correction is the key factor in determining the therapeutic effect, although it is difficult to understand. This review focuses on the timing of early correction of mandibular hypoplasia in combination with relevant assessment indicators and historical literature from four perspectives-the law of mandibular growth and development, the necessity of early treatment, the timing of early treatment, and the determination of the peak period of mandibular growth and development-to provide a theoretical reference for the timing of the treatment of clinical skeletal Class II malocclusion. This review shows that skeletal Class II mandibular growth has different characteristics in males and females. Bone growth assessment before treatment helps diagnose mandibular developmental morphology and the timing of early correction in adolescents with skeletal Class II malocclusion and hypoplasia of the mandible.
Topics: Male; Adolescent; Female; Humans; Cephalometry; Malocclusion, Angle Class II; Mandible; Malocclusion; Maxilla
PubMed: 37997230
DOI: 10.22514/jocpd.2023.077 -
Frontiers in Pediatrics 2023Pediatric obstructive sleep apnea (POSA) is a complex disease with multifactorial etiopathogenesis. The presence of craniofacial dysmorphisms influencing the patency of... (Review)
Review
Pediatric obstructive sleep apnea (POSA) is a complex disease with multifactorial etiopathogenesis. The presence of craniofacial dysmorphisms influencing the patency of the upper airway is considered a risk factor for POSA development. The craniofacial features associated with sleep-related breathing disorders (SRBD) - craniosynostosis, retrognathia and micrognathia, midface and maxillary hypoplasia - have high heritability and, in a less severe form, could be also found in non-syndromic children suffering from POSA. As genetic factors play a role in both POSA and craniofacial dysmorphisms, we hypothesize that some genes associated with specific craniofacial features that are involved in the development of the orofacial area may be also considered candidate genes for POSA. The genetic background of POSA in children is less explored than in adults; so far, only one genome-wide association study for POSA has been conducted; however, children with craniofacial disorders were excluded from that study. In this narrative review, we discuss syndromes that are commonly associated with severe craniofacial dysmorphisms and a high prevalence of sleep-related breathing disorders (SRBD), including POSA. We also summarized information about their genetic background and based on this, proposed 30 candidate genes for POSA affecting craniofacial development that may play a role in children with syndromes, and identified seven of these genes that were previously associated with craniofacial features risky for POSA development in non-syndromic children. The evidence-based approach supports the proposition that variants of these candidate genes could lead to POSA phenotype even in these children, and, thus, should be considered in future research in the general pediatric population.
PubMed: 37441579
DOI: 10.3389/fped.2023.1117493 -
Cureus Nov 2023A frequent facial abnormality called chin retrusion, also known as retrognathia, can be detrimental to a person's self-esteem and overall face aesthetics. Hyaluronic... (Review)
Review
A frequent facial abnormality called chin retrusion, also known as retrognathia, can be detrimental to a person's self-esteem and overall face aesthetics. Hyaluronic acid (HA) injections are one non-surgical approach to this problem that may provide individuals seeking chin augmentation with a relatively less invasive and potentially more affordable alternative. The present literature does not provide enough in-depth systematic reviews of the use of HA in chin augmentation. By completing a complete examination of the information that is currently available, this study intends to fill this knowledge gap, supporting physicians and researchers in better comprehending the efficacy and implications of HA in chin augmentation. The safety and success of any esthetic procedure should be made based on the results reported by the patients, including satisfaction and quality of life. Patients need to receive comprehensive surgical instructions from a medical professional to optimize the results of the HA injections for chin enhancement surgery. Regardless of the reported safety of using HA injections, some unwanted side effects have also been recorded. Indeed, healthcare professionals can make more informed decisions and give a patient comprehensive information about the procedure's risks and benefits to the patients. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE, OVID, and Google Scholar databases were searched up to June 2023. We concentrated on adult patients treated with HA for chin enhancement, and our research was limited to studies conducted in English. A total of 2,738 patients from 24 articles were studied, with 2,259 receiving HA injections for chin augmentation. When applicable, aesthetic outcomes were assessed using scales such as the Global Aesthetic Improvement Scale (GAIS)/FACE-Q and the Galderma Chin Retrusion Scale. Patient satisfaction increased noticeably. Among the studies, some reported complications following HA injection. While three studies found no significant negative effects, one highlighted a major necrotic complication. HA has proven to be an effective and safe alternative to chin augmentation surgery, with the majority of patients showing high satisfaction rates. However, large-scale randomized controlled trials are needed to obtain meaningful results, which will contribute to the further development of non-surgical cosmetic procedures. These studies may facilitate further innovation and refinement of these techniques and potentially expand the application of HA fillers in facial aesthetics.
PubMed: 38098909
DOI: 10.7759/cureus.48807 -
Cureus Jan 2024A seven-year-old female was followed in a developmental clinic from the age of nine months due to delayed psychomotor development. The first physical examination showed...
A seven-year-old female was followed in a developmental clinic from the age of nine months due to delayed psychomotor development. The first physical examination showed a newborn with irritability and a large anterior fontanelle. A transfontanellar ultrasound was performed, revealing mild enlargement of the lateral and third ventricles. Head circumference remained below the third percentile until the age of five months, then rose to the third percentile. Developmental milestones were globally delayed, with expressive language being more severely affected and axial hypotonia with appendicular hypertonia on neurological examination. Subsequent medical observation revealed deep-set eyes, mildly up-slanted palpebral fissures, a high nasal bridge with a broad nasal tip, a thin upper lip, widely spaced teeth, retrognathia, and a slight pectus excavatum. Genetic investigation revealed the diagnosis, with whole-exome sequencing consistent with the genetic diagnosis of autosomal dominant mental retardation type 7 (MRD7). All patients diagnosed with MRD7 have a development delay detected at a young age and, typically, a mild to severe intellectual disability later in life. All individuals present language impairment, especially in verbal expression. Motor development is typically affected by gait disturbances and generalized hypertonia, which are noted early in life. Microcephaly is a prominent feature of this syndrome, present in over 90% of the cases. The most common findings in MRD7 (microcephaly and intellectual disability) have a broad differential diagnosis. Some disorders have multiple findings in common with MRD7, such as Angelman syndrome (AS), MECP2 disorders, or Mowat-Wilson syndrome (MWS). MRD7 is a rare genetic syndrome characterized by developmental delay/intellectual disability, microcephaly, autism spectrum disorder, behavior problems, typical facial features, and seizures. Early intervention is more likely to be effective and potentially change a child's developmental path. Small gains early in life could represent a significant difference in the children's future autonomy.
PubMed: 38298296
DOI: 10.7759/cureus.51451 -
Frontiers in Pediatrics 2023The human upper airway regulates temperature, but its heating capacity remains unclear when the ambient temperature is low and the airway structure is abnormal....
INTRODUCTION
The human upper airway regulates temperature, but its heating capacity remains unclear when the ambient temperature is low and the airway structure is abnormal. Therefore, the purpose of this study was to evaluate the heat transfer characteristics of the upper airway in patients with mandibular retrognathia, and to quantitatively evaluate the influence of ambient temperature on the temperature field of the upper airway, which could provide a valuable reference for the prediction, diagnosis and treatment of respiratory tract related diseases.
METHODS
Two typical ambient temperatures of -10 °C and 20 °C were selected to numerically simulate the air flow and heat transfer synchronization in the upper airway model of mandibular retrognathia under quiet breathing and heavy breathing.
RESULTS AND DISCUSSION
The results showed that the inspired air could not be sufficiently heated after flowing through the upper airway and main trachea in the two breathing states under low temperature conditions, and the inferior bronchus was more stimulated under the state of heavy breathing. In addition, the vortex flow structure in the upper airway can enhance the convective heat transfer effect in the corresponding area.
PubMed: 38027258
DOI: 10.3389/fped.2023.1285812 -
Clinical Oral Investigations Sep 2023Zika virus infection has been associated to congenital zika syndrome (CZS) in newborns and is characterized by microcephaly, central/axial motor and sensory dysfunction,...
OBJECTIVE
Zika virus infection has been associated to congenital zika syndrome (CZS) in newborns and is characterized by microcephaly, central/axial motor and sensory dysfunction, dysphagia among other previously described severe health complications. CZS is usually diagnosed postpartum by evident/apparent neural development problems. Although there are some reports of craniofacial/dentition development in CZS, several clinical oral aspects are still unknown. This study describes some structural and functional characteristics of facial and cranial growth and deciduous dentition in CZS-affected children.
MATERIAL AND METHODS
Some cranial, facial and dental characteristics were determined in 14 children with CZS aged 3-5 years and compared them against 12 apparently healthy children paired by age and gender.
RESULTS
Fourteen CZS cases presented microcephaly, maxillary prognathism, altered facial thirds, asymmetric pupillary line, bruxism (p = 0.006), deep and anterior open bite and distal step decidual molar relationship (p = 0.031). CZS children cannot feed by themselves and most cannot walk and have not develop coordinated and intelligible language according to their chronological age. In contrast, controls presented normal skull features, have autonomous locomotion skills, speak intelligible language, feed by themselves, presented a harmonic intermaxillary relationship and have symmetrical facial thirds.
CONCLUSION
Microcephaly, dysphagia, bruxism, mandibular retrognathia, altered facial proportions and malocclusion are the main craniofacial and oral features at CZS.
CLINICAL RELEVANCE
The complications of CZS including those related with the face and the oral cavity are still being identified. This study revealed some cranial, facial and oral features in children affected by CSZ. Interdisciplinary rehabilitation protocols must address these syndromic features that could improve children and parents living conditions.
Topics: Pregnancy; Female; Humans; Infant, Newborn; Child; Zika Virus Infection; Microcephaly; Pregnancy Complications, Infectious; Bruxism; Deglutition Disorders; Zika Virus; Brazil
PubMed: 37578656
DOI: 10.1007/s00784-023-05137-5 -
Children (Basel, Switzerland) Sep 2023The Tübingen Palatal Plate (TPP) is a minimally invasive yet highly effective functional orthodontic treatment for upper airway obstruction in infants with Robin... (Review)
Review
The Tübingen Palatal Plate (TPP) is a minimally invasive yet highly effective functional orthodontic treatment for upper airway obstruction in infants with Robin Sequence (RS). It consists of a palatal plate to cover the cleft and a velar extension that shifts the root of the tongue forward. We review our practical experience with this approach. First, upon admission, our local orthodontists perform an (3-D) intraoral scan of the maxilla. Based on the scan data, the TPP is manufactured in a semi-digital workflow. The length and angulation of its extension is checked via awake laryngoscopy and the effectiveness confirmed by a sleep study. Plates are kept in place by adhesive cream. When inserting the TPP, the tip of the tongue must be visible. Next, metal fixation bows should be secured to the forehead using tape and elastic bands. Plates are removed daily for cleaning, and the oral mucosa is then checked for pressure marks. Feeding training (initially only via finger feeding) may even start before plate insertion. Breathing often normalizes immediately once the plate is inserted. For isolated RS, we have never had to perform a tracheostomy. This has largely been possible through our highly dedicated and competent team, particularly the nursing staff, and the early involvement of parents.
PubMed: 37892291
DOI: 10.3390/children10101628