Prevalence of mouth breathing, with or without nasal obstruction, in children with moderate to severe obstructive sleep apnea.

BACKGROUND: Mouth breathing (MB) is a symptom of obstructive sleep apnea (OSA) in children, but its diagnosis remains challenging. The main objectives of our study were to evaluate whether parents' and physician's diagnose of MB were concordant and to evaluate the prevalence of nasal obstruction in children with OSA and MB. METHODS: Ninety-three children (median age: 10.6 years, range 3-18) with moderate to severe OSA prospectively underwent otorhinolaryngologist (endoscopy, acoustic rhinometry and pharyngometry allowing calculation of pharyngeal compliance) and orthodontist (clinical exam and cephalometry) assessments together with parental interview (daytime MB: never, sometimes, often, always). MB was also assessed by the otorhinolaryngologist (nasal obstruction on endoscopy) and the orthodontist (incompetent lips or anterior open bite or low tongue position). RESULTS: Thirty-eight children (41%) were mouth (parental criterion: MB often or always, median age 8.2 years) and 55 nasal (11.4 years, p = 0.016) breathers. The agreement of parental and physician diagnosis of MB was slight (orthodontist) to moderate (otorhinolaryngologist). Parental diagnosis of MB was associated with nasal obstruction on acoustic rhinometry and endoscopy (hypertrophy of inferior turbinate, n = 18 or adenoids, n = 15) and with an adenoid facies (increased Frankfort's mandibular plane angle on cephalometry). Eleven children had MB by habit and were characterized by more severe OSA and higher pharyngeal compliance than mouth breathers with nasal obstruction. CONCLUSION: MB diagnosis by parents is acceptable and is mainly related to nasal obstruction. A subset of children had MB by habit associated with worst OSA and increased pharyngeal compliance that could benefit from myofunctional therapy.

New surgical method of tongue reduction for macroglossia: technical note.

OBJECTIVE: We describe here a new surgical technique, which allows for efficient tongue reduction with satisfactory appearance and avoids the complications of tip excision. STUDY DESIGN: This is a retrospective case review that includes 6 patients who had macroglossia and underwent tongue reduction using our new central V-shaped excision technique. Three patients were operated on at an early age because of significant macroglossia with permanent tongue protrusion, cosmetic disorder, and speech delay. The other 3 patients underwent surgery performed in their teenage years because medical treatment had been unsuccessful. We assessed tongue shape, mobility, taste, and sensitivity. RESULTS: The postoperative follow-up period ranged from 2 months to 16 years (average 7 years). On subjective evaluation, all patients were satisfied with the appearance of the tongue and reported no sensitive or sensory difficulties. The patients reported normal food progression in the oral cavity. Objective evaluation showed that the tongue had normal mobility, taste, and sensitivity. Postoperatively, there was no residual tongue protrusion, cosmetic disorder, or speech delay. None of the patients needed revision surgery. CONCLUSIONS: This central V-shaped excision offers good surgical results, with efficient tongue reduction and none of the complications of other tongue reduction techniques, such as tip amputation or anterior wedge resection.