Functional therapy and adenotonsillectomy clinical trial for class II malocclusion (FACT-II): protocol for a randomised controlled trial.

INTRODUCTION: Class II malocclusion with mandibular retrognathia is a common complication of paediatric obstructive sleep apnoea (OSA), often accompanied by transverse maxillary deficiency. In early orthodontic treatment, a twin block (TB) is a regular functional appliance for correcting this malocclusion. For paediatric OSA, the most common risk factor is adenotonsillar hypertrophy (AHT). Untreated AHT may lead to the persistence and worsening of obstructive sleep-disordered breathing traits, including habitual mouth breathing. Additionally, the clockwise mandibular rotation associated with AHT-induced pharyngeal crowding can undermine the effectiveness and stability of TB treatment. Adenotonsillectomy (T&A) is currently the first-line treatment for paediatric OSA. This proposed trial will investigate the impact of T&A surgery timing on the efficacy and stability of TB functional treatment in children with class II mandibular retrognathia and ATH. METHODS AND ANALYSIS: This will be a single-centre, parallel-group, superiority randomised controlled trial with participants randomised to intervention (T&A followed by TB treatment) or control arms (TB treatment followed by T&A) in a 1:1 ratio. A total of 40 patients aged 8-14 years, diagnosed with class II mandibular retrognathia and co-existing ATH-induced OSA, and indicated for both T&A surgery and TB treatment, will be recruited at the School and Hospital of Stomatology, Wuhan University. The primary outcomes will be the changes in the apnoea-hypopnoea index and the point A-nasion-point B angle from baseline to postorthodontic treatment between the two groups. Secondary outcomes will include other dental, skeletal, upper airway and soft tissue changes, as well as subjective sleep-related and oral-related quality of life. Outcome changes within each group and between groups will be analysed. ETHICS AND DISSEMINATION: This study is approved by the Ethics Committee of the School and Hospital of Stomatology, Wuhan University (no. 2022-D07). The research findings will be faithfully disseminated through scientific conferences or published articles. TRIAL REGISTRATION NUMBER: ChiCTR2200061703 (https://www.chictr.org.cn).

Use of At-Breast Supplementers to Facilitate Feeding Solely at the Breast for Infants with Retrognathia: Two Case Studies.

Objective: Infants with significant retrognathia often have difficulty forming a latch adequate to establish exclusive breastfeeding. This article describes the use of at-breast supplementers (ABSs) to facilitate extended breastfeeding relationships, even when supplementation is necessary for growth. Methods: Two cases are described where infants with severe retrognathia initially struggled with weight gain necessitating supplementation but were able to ultimately exclusively feed at-breast with the use of ABSs. Results: While the two cases differed in the form of supplemental milk used and duration of ABS use, both dyads breastfed for beyond 2 years. Conclusions: Feeding solely at the breast and subsequent extended breastfeeding may be possible even for infants who require supplementation, including those with anatomical or functional challenges such as retrognathia. The ABS is a relatively simple system that may be beneficial for difficulties such as poor latch and low milk supply. More awareness and education is needed so that clinicians consider supporting dyads with this approach.

Machine Learning Effectively Diagnoses Mandibular Deformity Using Three-Dimensional Landmarks.

BACKGROUND: Jaw deformity diagnosis requires objective tests. Current methods, like cephalometry, have limitations. However, recent studies have shown that machine learning can diagnose jaw deformities in two dimensions. Therefore, we hypothesized that a multilayer perceptron (MLP) could accurately diagnose jaw deformities in three dimensions (3D). PURPOSE: Examine the hypothesis by focusing on anomalous mandibular position. We aimed to: (1) create a machine learning model to diagnose mandibular retrognathism and prognathism; and (2) compare its performance with traditional cephalometric methods. STUDY DESIGN, SETTING, SAMPLE: An in-silico experiment on deidentified retrospective data. The study was conducted at the Houston Methodist Research Institute and Rensselaer Polytechnic Institute. Included were patient records with jaw deformities and preoperative 3D facial models. Patients with significant jaw asymmetry were excluded. PREDICTOR VARIABLES: The tests used to diagnose mandibular anteroposterior position are: (1) SNB angle; (2) facial angle; (3) mandibular unit length (MdUL); and (4) MLP model. MAIN OUTCOME VARIABLE: The resultant diagnoses: normal, prognathic, or retrognathic. COVARIATES: None. ANALYSES: A senior surgeon labeled the patients' mandibles as prognathic, normal, or retrognathic, creating a gold standard. Scientists at Rensselaer Polytechnic Institute developed an MLP model to diagnose mandibular prognathism and retrognathism using the 3D coordinates of 50 landmarks. The performance of the MLP model was compared with three traditional cephalometric measurements: (1) SNB, (2) facial angle, and (3) MdUL. The primary metric used to assess the performance was diagnostic accuracy. McNemar's exact test tested the difference between traditional cephalometric measurement and MLP. Cohen's Kappa measured inter-rater agreement between each method and the gold standard. RESULTS: The sample included 101 patients. The diagnostic accuracy of SNB, facial angle, MdUL, and MLP were 74.3, 74.3, 75.3, and 85.2%, respectively. McNemar's test shows that our MLP performs significantly better than the SNB (P = .027), facial angle (P = .019), and MdUL (P = .031). The agreement between the traditional cephalometric measurements and the surgeon's diagnosis was fair. In contrast, the agreement between the MLP and the surgeon was moderate. CONCLUSION AND RELEVANCE: The performance of the MLP is significantly better than that of the traditional cephalometric measurements.

Severity of Mandibular Dysmorphology in Treacher Collins Syndrome for Stratification of Perioperative Airway Risk.

BACKGROUND: Patients with Treacher Collins syndrome (TCS) and attendant airway dysmorphology may be predisposed to airway complications in the perioperative period. However, limited data correlates severity of mandibular hypoplasia and airway status. This study aims to improve risk stratification for perioperative airway insufficiency in TCS by using a previously proposed mandibular severity index. METHODS: Patient demographics, perioperative airway status, difficulty of intubation, and Cormack Lehane grade were collected and compared using a TCS mandibular hypoplasia severity grading scale in patients with TCS treated between 2000 and 2022. RESULTS: Twenty-six patients underwent 222 procedures with institutional mandibular severity gradings as follows: 23% Grade I, 31% Grade II, 39% Grade III, 8% Grade IV. Our severity index was associated with intubation difficulty ( P <0.001) and difficult airway status ( P <0.001), with 72% of difficult airways found in grade III and grade IV patients. Mandibular retrusion and ramal hypoplasia subscores were positively correlated with measures of airway severity ( P <0.001), whereas the gonial angle was negatively correlated ( P <0.001). Age was negatively correlated with difficult visualization for endotracheal intubation ( P =0.02) but had no association with difficult airway status ( P =0.2). CONCLUSIONS: This study found a positive correlation between severity of maxillomandibular dysmorphology and perioperative airway difficulty in TCS patients. Our findings suggest that severely affected patients require heightened vigilance throughout life, as difficult airways may not completely resolve with aging. Given the risk of morbidity and mortality associated with airway complications, proper identification and preparation for challenging airways is critical for TCS patients.

Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis.

In growing children, temporomandibular joint (TMJ) ankylosis and septic arthritis are uncommon. Retrognathia and micrognathia affect airway patency and can cause obstructive sleep apnea (OSA). No unified diagnostic criteria have been established for the management of this pathology. We describe the first case of treatment for pediatric TMJ ankylosis and severe OSA due to neonatal group B streptococcal septic TMJ arthritis. Untreated pathological changes in the TMJ will eventually lead to ankylosis. Among children, this will include facial growth disturbances leading to mandibular retrognathia, reduction in the oropharyngeal spaces, and OSA. Our patient had severe OSA with an apnea-hypopnea index of 24.9 events/h and oxygen saturation nadir of 73% as measured by polysomnography. She was treated successfully according to Andrade protocol. This is the first report of pediatric OSA due to TMJ ankylosis following neonatal group B streptococcal septic arthritis. CITATION: Pesis M, Goldbart A, Givol N. Surgical correction of neonatal obstructive sleep apnea due to a temporomandibular joint ankylosis. J Clin Sleep Med. 2024;20(1):173-179.

Screening for Obstructive Sleep Apnea and Associated Risk Factors in Adolescents and Adults With Isolated Robin Sequence.

OBJECTIVE: To investigate the subjective risk for obstructive sleep apnea (OSA) in adolescents and young adults with isolated Robin sequence (IRS). Additionally, to investigate the association of OSA risk with respiratory signs/symptoms, and retrognathia. DESIGN: Prospective, observational, and cross-sectional study. SETTING: Tertiary reference hospital for the rehabilitation of craniofacial anomalies. PARTICIPANTS: Adolescents and adults (n = 30) with IRS were clinically evaluated and screened through the Berlin Questionnaire (BQ) and Respiratory Symptoms Questionnaire. The maxillomandibular relationship was assessed on lateral cephalograms of those that reached skeletal maturity (n = 13). Polysomnography (PSG) was performed in a subgroup of 4 individuals. RESULTS: The mean age of the sample was 18.2 (±3.4) years, 17 (56.7%) were adolescents (14-19 years), and 16 were (53.3%) female, all presented a repaired cleft palate. CLINICAL PARAMETERS: Systemic arterial pressure (118.0 ± 4.1/76.3 ± 4.9 mmHg), body mass index (BMI) (20.9 ± 2.8 kg/m2), neck (33.2 ± 2.3 cm), and waist circumferences (72.0 ± 5.8 cm) were within normal ranges. A skeletal class I pattern was observed in 61.5% of the participants while a class II was seen in 15.4% of them. A high risk for OSA was detected in 16.7%, and it was associated with nasal obstruction, snoring and drowsiness, and a skeletal class II pattern (P ≤ .05). One patient presented with mild OSA (apnea-hypopnea index [AHI] = 10.1 events/hour) at the PSG exam. CONCLUSIONS: A high risk for OSA can be observed with a moderate frequency among adolescents and young adults with IRS, especially among those who are concurrently suffering from nasal obstruction, snoring and retrognathia.

[Effect of Twin-block in adolescents with mandibular retrusion and normal anterior overjet].

PURPOSE: To investigate the therapeutic effect of modified fixed Twin-block on patients whose mandible was retruded and anterior overjet was normal. METHODS: Thirty-six adolescents with mandibular retrusion and normal anterior overjet were selected. The goal of occlusal reconstruction was to move the soft tissue pogonion forward to the zero meridian(0°). Fixed Twin-block combined with the mini-implants on the mandibular buccal shelf was used to promote mandibular growth. After 12 months, the appliances were removed step by step to observe the stability of the jaw relationship. Fixed orthodontic treatment was performed to achieve ideal occlusion and coordinated profile. SPSS 13.0 software package was used for Student's t test. RESULTS: The length of mandibular body increased significantly which facilitated the forward movement of the soft tissue pogonion, and the profile changed from convex to straight. Comparison of the results before and after Twin-block treatment showed that Co-Gn, SNB, U1-SN, U6-0°, U1-0°, U1-L1, anterior overbite, anterior overjet, Pog's-0°, L1-0° and lower anterior facial height changed significantly (P＜0.05). Comparison of the results before and after fixed orthodontic treatment showed that PP-MP, SN-MP, U6-0°, IMPA, L1-0°,U1-SN, U1-L1, anterior overbite and overjet changed significantly(P＜0.05). CONCLUSIONS: Modified fixed Twin-block combined with mini-implants on the mandibular buccal shelf can effectively stimulate the mandibular growth and improve the lateral profile of patients with mandibular retrusion and normal overjet.

Efficacy of a modified twin block appliance compared with the traditional twin block appliance in children with hyperdivergent mandibular retrognathia: protocol for a single-centre, single-blind, randomised controlled trial.

INTRODUCTION: Compensatory mouth breathing, caused by nasopharyngeal obstructive diseases, is the main cause of hyperdivergent mandibular retrognathia in children. Such deformities require effective growth guidance before pubertal growth peaks. The traditional mandibular advancement device, twin block (TB), can guide the forward development of the mandible. However, the side effect of increasing the vertical dimension of the lower facial third, worsens the facial profile of children with divergent growth trends. To solve this problem, a modified TB (LLTB) appliance was designed to control the vertical dimension by intruding incisors and inhibiting the elongation of posterior teeth during the advancement of the mandible, which could avoid the side effects of traditional appliances and effectively guide the growth of the mandible in a normal direction. METHODS AND ANALYSIS: The study was designed as a single-centre, single-blind, randomised, parallel controlled trial. We aim to enrol 60 children aged 9-14 years with hyperdivergent skeletal class II malocclusion, using a 1:1 allocation ratio. The participants were will be randomly assigned to receive either the TB or LLTB treatment. The primary outcome will be a change in the angle of the mandibular plane relative to the anterior cranial base. The secondary outcomes will include changes in the sagittal maxillomandibular relation, occlusal plane, facial height, morphology of the mandible and upper airway width. Safety endpoints will also be evaluated. ETHICS AND DISSEMINATION: Ethical approval was obtained from the ethics committee of Shanghai Stomatological Hospital. Both participants and their guardians will be fully informed of the study and sign an informed consent form before participating in the trial. The results will be publicly available in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: ChiCTR2000035882.

An interpretable machine learning approach to study the relationship beetwen retrognathia and skull anatomy.

Mandibular retrognathia (C2Rm) is one of the most common oral pathologies. Acquiring a better understanding of the points of impact of C2Rm on the entire skull is of major interest in the diagnosis, treatment, and management of this dysmorphism, but also permits us to contribute to the debate on the changes undergone by the shape of the skull during human evolution. However, conventional methods have some limits in meeting these challenges, insofar as they require defining in advance the structures to be studied, and identifying them using landmarks. In this context, our work aims to answer these questions using AI tools and, in particular, machine learning, with the objective of relaying these treatments automatically. We propose an innovative methodology coupling convolutional neural networks (CNNs) and interpretability algorithms. Applied to a set of radiographs classified into physiological versus pathological categories, our methodology made it possible to: discuss the structures impacted by retrognathia and already identified in literature; identify new structures of potential interest in medical terms; highlight the dynamic evolution of impacted structures according to the level of gravity of C2Rm; provide for insights into the evolution of human anatomy. Results were discussed in terms of the major interest of this approach in the field of orthodontics and, more generally, in the field of automated processing of medical images.

Stress distribution of the modified clear twin-block aligner on the temporomandibular joint, alveolar bone and teeth: A finite element analysis.

OBJECTIVE: The modified clear twin-block aligner (CTBA) was developed to provide a mandibular advancement appliance for the treatment of mandibular retrognathia. The objective of this study was to analyse the stress distribution changes of CTBA with 45°, 60° and 70° bite blocks. MATERIAL AND METHODS: A three-dimensional model of the craniomaxillofacial bones and teeth was generated from a spiral computed tomography (CT) scan. The models of the articular disc, capsule, periodontal ligament and CTBA were constructed mathematically. After assigning the appropriate material properties and the boundary condition using ABAQUS software, we simulated the CTBA with different bite blocks to analyse the mechanical effects. RESULTS: In the temporomandibular joint (TMJ) region, the posterior aspect of the condyle and glenoid fossa experienced tensile stress that was approximately about 22 times greater at 70° than at 45°. The Von Mises stress distribution on the articular disc tended to be uniform. The strain direction of the condyle was backward. In the maxillary bone, the stress on the labial alveolar bone was about 5.83MPa at 70° and greater than that on the lingual side. The resulting displacement of the dentition revealed a tendency for the upper teeth to shift backward and the lower teeth to move forward by 0.46 to 0.49mm. The foregoing stress and displacement rose as the angle of the bite blocks increased. CONCLUSIONS: CTBA with 70° bite blocks constituted an advantageous biomechanical setting for the treatment of mandibular retrognathia in teenagers and provided a superior therapeutic effect.

Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study.

Twin-block appliance had been advocated as a potential treatment option in paediatric obstructive sleep apnoea (OSA) due to their favourable effect in enhancing upper airway parameters and improving OSA symptoms. The aim of this study was to evaluate the effect of twin-block appliance therapy on upper airway parameters/dimensions and the apnoea-hypopnea indexes (AHIs) in OSA children with class II mandibular retrognathic skeletal malocclusion using cone-beam computed tomography. This prospective longitudinal study comprised 34 polysomnography-proven OSA growing children with class II mandibular retrognathic skeletal malocclusion between the ages of 8 and 12 years who had completed myofunctional twin-block therapy and matched corresponding controls. The upper airway was segmented into the nasopharynx, oropharynx, and hypopharynx, and the effect of twin-bock treatment on upper airway parameters/dimensions was assessed pre- and posttreatment using CBCT analysis, while a second standard overnight PSG was performed to determine changes in the AHI. At the nasopharynx level, minimal (nonsignificant) increases in all variables were observed within the twin-block group and between the groups (P > 0.05). At the level of the oropharynx, all variables increased significantly in the treatment group and between groups (P < 0.001), but these increases were nonsignificant in the control group. At the level of the hypopharynx, only the minimum cross-sectional area (MCA) increased significantly in the treatment group (P = 0.003). The change in MCA was also significant between the groups (P = 0.041). In addition, the upper airway length increased significantly in the twin-block group (P = 0.0154), and the AHI decreased by 74.8% (P < 0.001). CONCLUSION: Correction of class II mandibular retrognathic skeletal malocclusion with twin-block appliance resulted in a significant increase in upper airway volume, MCA, anteroposterior and lateral distances of the MCA at the level of the oropharynx, MCA at the level of the hypopharynx and upper airway length, and a significant decrease in AHI, but it had no effect on nasopharynx parameters. WHAT IS KNOWN: • CBCT imaging has been shown to be an effective and precise diagnostic tool for analyzing the upper airways and craniofacial structures. • Twin block appliance may be an effective treatment modality in children with OSA. WHAT IS NEW: • Minimal cross-sectional area of upper ways may be the most relevant potential parameter when explaining how the upper airway anatomy plays role of in the pathogenesis of pediatric OSA. • Twin block appliance induced favorable changes in upper airway morphology (oropharynx area mainly) and respiratory parameters in OSA children with class II malocclusion.

Three-dimensional evaluation of upper pharyngeal airway, hyoid bone, and craniocervical changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation: A retrospective study.

OBJECTIVE: This study aimed primarily to analyze the three-dimensional (3D) changes in the pharyngeal airway (PA), and secondarily, the hyoid bone (HB) and the craniocervical (CC) following stabilization splint (SS) therapy in adult patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD). METHODS: Thirty-five adult patients with TMD and MD, who were treated using SS with a mean age of 25.14 ± 6.11 years, were enrolled in this retrospective clinical study. Pre- and post-therapeutic cone-beam computed tomography (CBCT) scans were analyzed. PA dimension,nasopharyngeal, oropharyngeal, hypopharyngeal, sub-hypopharyngeal, and total pharyngeal airway spaces were measured in surface area, volume, minimum constricted area (MCA) and width, HB position, and CC posture were analyzed three-dimensionally using InVivo 6.0.3 and Dolphin 11.95 software. Wilcoxon rank-sum or Paired t-test was conducted, and P < 0.05 was considered significant. RESULTS: SS therapy was administered for a period of 9.49 ± 4.02 months. The oropharyngeal airway space showed a significant decrease in sagittal width. The hypopharyngeal surface area, volume, MCA, and sagittal width decreased significantly. In terms of HB, hyoid-mandibular plane (H-MP), retrognathia-third vertebra's most inferior-anterior (RGN-C3ia), and retrognathia-Sella (RGN-S) distances significantly decreased. The Nasion-Sella line and the line that passes through C2ip to the odontoid process posterior tangent (NSL-OPT) angle in CC posture also decreased significantly. CONCLUSION: SS therapy in TMD patients with MD mainly results in narrowing of the hypopharyngeal region, no change in HB position and improvement in head posture. These results undoubtedly assist in diagnosis and treatment of clinical conditions.

Thirteen-year-old female patient with class II division 2 and normodivergent mandibular retrognathia treated with a fixed buccal appliance. Clinical case No. 221052, Commission of Titularisation. European College of Orthodontics.

Date of birth>09/06/2004; sex: female. Pre-treatment documents>13years 4months old: 07/07/2017. Diagnosis>Skeletal class II with mandibular retrusion, normodivergent facial pattern; class II division 2. Treatment planning>bimaxillary buccal fixed appliance. Duration of active treatment>29months. Post-treatment documents>15years 6months; 20/12/2019. Post-retention documents>16years 7months old; 04/01/2021. Retention period>2years 9months and still continued.

Craniofacial growth and function in achondroplasia: a multimodal 3D study on 15 patients.

BACKGROUND: Achondroplasia is the most frequent FGFR3-related chondrodysplasia, leading to rhizomelic dwarfism, craniofacial anomalies, stenosis of the foramen magnum, and sleep apnea. Craniofacial growth and its correlation with obstructive sleep apnea syndrome has not been assessed in achondroplasia. In this study, we provide a multimodal analysis of craniofacial growth and anatomo-functional correlations between craniofacial features and the severity of obstructive sleep apnea syndrome. METHODS: A multimodal study was performed based on a paediatric cohort of 15 achondroplasia patients (mean age, 7.8 ± 3.3 years), including clinical and sleep study data, 2D cephalometrics, and 3D geometric morphometry analyses, based on CT-scans (mean age at CT-scan: patients, 4.9 ± 4.9 years; controls, 3.7 ± 4.2 years). RESULTS: Craniofacial phenotype was characterized by maxillo-zygomatic retrusion, deep nasal root, and prominent forehead. 2D cephalometric studies showed constant maxillo-mandibular retrusion, with excessive vertical dimensions of the lower third of the face, and modifications of cranial base angles. All patients with available CT-scan had premature fusion of skull base synchondroses. 3D morphometric analyses showed more severe craniofacial phenotypes associated with increasing patient age, predominantly regarding the midface-with increased maxillary retrusion in older patients-and the skull base-with closure of the spheno-occipital angle. At the mandibular level, both the corpus and ramus showed shape modifications with age, with shortened anteroposterior mandibular length, as well as ramus and condylar region lengths. We report a significant correlation between the severity of maxillo-mandibular retrusion and obstructive sleep apnea syndrome (p < 0.01). CONCLUSIONS: Our study shows more severe craniofacial phenotypes at older ages, with increased maxillomandibular retrusion, and demonstrates a significant anatomo-functional correlation between the severity of midface and mandible craniofacial features and obstructive sleep apnea syndrome.

Treatment effects of the MARA appliance and Activator-Headgear combined with fixed appliances in Class II division 1 malocclusion patients: A retrospective longitudinal study.

INTRODUCTION: Class II division 1 malocclusion treatment with functional devices offers acceptable results. These devices can be removable or fixed, and the essential difference between them is the need for compliance. It is clinically important to investigate if there are differences in the treatment effects of these devices that present different characteristics. OBJECTIVE: This retrospective longitudinal study compared the treatment effects of Class II correction with the MARA appliance, Activator-Headgear (AcHg) combination, both followed by multibracket fixed appliances, and an untreated control group. MATERIAL AND METHODS: Each experimental group was composed of 18 patients, with a baseline mean age of 11.70 and 10.88 years, treated for 3.60 and 3.17 years. The control group consisted of 20 subjects with baseline mean age of 11.07 years. The groups were evaluated before (T1) and after (T2) treatment. Lateral radiographs were used to evaluate the treatment changes with treatment (T2-T1), compared to the control group. Intergroup comparisons were performed using repeated-measures analysis of variance (ANOVA), followed by Tukey's test. RESULTS: The AcHg group showed significantly greater maxillary growth restriction than the MARA, while the mandibular changes were due to natural growth. Both devices promoted significantly greater maxillary incisors retrusion, mandibular incisors labial inclination, and improvement of overjet and molar relationships, compared to the control. CONCLUSIONS: Both functional devices followed by multibracket appliances were effective to correct Class II malocclusion. Nonetheless, the AcHg combination presents superior skeletal effects, due to significantly greater maxillary growth restriction compared to the MARA appliance. Moreover, the appliances presented similar dentoalveolar effects.

The dental and craniofacial characteristics among children with obstructive sleep apnoea: a systematic review and meta-analysis.

BACKGROUND: Paediatric obstructive sleep apnoea (OSA) is a sleep breathing disorder which may have dramatic effects on childhood behaviour, neurodevelopment, metabolism, and overall health in children. Malocclusion and craniofacial morphology may be related to paediatric OSA, and therefore provide information for clinicians to recognize, evaluate and treat patients with this sleeping disorder. OBJECTIVE: The aim of this systematic review was to summarize evidence regarding the association between paediatric OSA and children's dental and craniofacial characteristics. SEARCH METHODS: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to 1 June 2022. SELECTION CRITERIA: Cross-sectional studies, comparing dental or craniofacial characteristics using clinical dental examinations or radiographic findings between OSA children (less than 18 year, diagnosed with overnight polysomnography) and healthy children, were included. DATA COLLECTION AND ANALYSIS: The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used to assess the quality of included studies. RevMan software was used for performing the Meta-analyses. RESULTS: Sixteen studies were included. Meta-analyses showed that the overjet (MD = 0.86, 95% CI: 0.20 to 1.51; P = 0.01), the saggital skeletal jaw discrepancy (ANB; MD = 1.78, 95% CI: 1.04 to 2.52; P < 0.00001) and mandibular plane angle (FH-MP; MD = 3.65, 95% CI: 2.45 to 4.85; P < 0.00001) were greater in OSA-affected children. In contrast, the upper molar arch width (upper first deciduous molar width; MD = -1.86, 95% CI: -3.52 to -0.20; P = 0.03), (Upper second deciduous molar width; MD = -1.06, 95% CI: -1.88 to -0.24; P = 0.01), SNB (MD = -2.10, 95% CI: -3.11 to -1.09; P < 0.0001), and maxillary length (ANS-PNS; MD = -1.62, 95% CI: -2.66 to -0.58; P = 0.002) were smaller in the OSA group. CONCLUSIONS: This review shows that OSA-affected children tend to present with mandibular retroposition or retrognathia, increased mandibular plane angle and excess anterior overjet. However, these findings need to be viewed with caution as the corresponding differences may not be significant clinically. REGISTRATION: PROSPERO (CRD42020162274).

Craniofacial morphology of patients with unilateral cleft lip and palate at two stages of skeletal maturation.

The aim of this retrospective cross-sectional investigation was to perform a 3D analysis of craniofacial morphology of patients with unilateral cleft lip and palate (UCLP) at two stages of skeletal maturation. Cone-beam computed tomography (CBCT) scans of 52 UCLP patients (34 prepubertal; 18 pubertal) were collected from an outpatient referral center for the treatment of craniofacial deformities. In total 15 multiplanar craniofacial landmarks were identified, 3D virtual surface models were created, and 13 variables were measured to assess the 3D Euclidean distances between landmarks and spatial position of the landmarks in the projected X, Y and Z components. Maxillary and mandibular pitch (clockwise, counterclockwise) rotation relative to the cranial base was also evaluated. The significance level was set at 5%. Maxillary retrusion value relative to the cranial base was higher and statistically significant greater (p = 0.028) in pubertal (SNA, 77.4° ± 6.2; N-ANS Y, 3.3 mm ± 3.1) than in prepubertal patients (SNA 81.0° ± 5.2; N-ANS Y, 5.8 mm ± 2.7). The posterior cranial base length (S-Ba Y) was significantly longer (p = 0.013) in pubertal (20.7 mm ± 3.4) than in prepubertal patients (18.4 mm ± 2.7). The upper facial height (N-ANS Z) was significantly greater (p = 0.01) in pubertal (46.9 mm ± 4.5) than in prepubertal patients (43.4 mm ± 3.0). Prepubertal and pubertal UCLP patients presented distinct patterns of craniofacial morphology, mainly in the sagittal component of the maxilla and in the posterior cranial base length. Pubertal patients had greater maxillary retrusion and posterior cranial base length.

Fetal Profile Markers for the Detection of Robin Sequence in Fetuses with Retrognathia.

OBJECTIVE: To determine whether the prefrontal space ratio (PSFR), inferior facial (IFA) and maxilla-nasion-mandible angle (MNM), and the fetal profile line (FPL) are helpful in identifying fetuses with Robin sequence (RS) in cases with isolated retrognathia, and thus better predict the likelihood of immediate need for postnatal respiratory support. METHODS: This was a retrospective matched case-control study of fetuses/infants with isolated retrognathia with or without RS receiving pre- and postnatal treatment at the University Hospital of Tübingen, Germany between 2008 and 2020. The PFSR, IFA, MNM, and FPL were measured in affected and normal fetuses according to standardized protocols. Cases were stratified into isolated retrognathia and RS. RESULTS: 21 (n=7 isolated retrognathia, n=14 RS) affected fetuses and 252 normal fetuses were included. Their median gestational age at ultrasound examination was 23.6 and 24.1 weeks, respectively. In fetuses with isolated retrognathia and RS, the PSFR, IFA, and FPL were significantly different from the normal population. At a false-positive rate of 5%, the detection rate was 76.2% for the PFSR, 85.7% for the IFA, and 90.5% for both parameters combined. However, all parameters failed to distinguish between isolated retrognathia and RS. CONCLUSION: PSFR and IFA are simple markers for identifying retrognathia prenatally. However, they are not helpful for the detection of RS in fetuses with isolated retrognathia. Therefore, delivery should take place in a center experienced with RS and potentially life-threatening airway obstruction immediately after birth.