**21. Conclusion**

**d.** Mouth breathing is mostly seen in pediatric OSA [39–42].

retropharyngeal and retrolingual pathologies are more effective.

adenotonsillectomy is advised rather than CPAP therapy.

**19.4. Clinical inspection in pediatric sleep apnea syndrome**

dition functions and weight.

**20. Pediatric OSA treatment protocol**

**2.** Weight loss and behavioral changes

tonus.

upper and lower dental arches and anterior open bite.

or thin.

190 Current Approaches in Orthodontics

**e.** Obesity is mostly seen in adult OSA; in pediatric OSA, the patient can be of normal weight

**f.** The etiology of pediatric OSA is mostly hypertrophic adenoids and tonsils. In adult OSA

**g.** The gold standard treatment protocol for adult OSA is CPAP appliance. In pediatric OSA

**a.** Nose-ear-throat and head-neck inspection: Craniofacial, orofacial, and maxillofacial characteristics are investigated. In craniofacial inspection symptoms of various syndromes are investigated. In orofacial inspection features of the tongue, soft palate, and tonsils are investigated. In maxillofacial inspection maxillofacial characteristics like facies adenoidalis, rhinolalia clausa, long-thin face, narrow maxilla and maxillary segment, overlenght-

**b.** Systemic inspection: Includes inspection of pulmonary, cardiac, physical, and mental con-

**1.** Surgical approaches: In pediatric patients dentists should examine oropharynx carefully. Both the lingual and pharyngeal tonsils can be visible intraorally, but the adenoids will not. When hypertrophic tonsils are observed clinically or radiographically, referral for endoscopic evaluation and possible surgical removal by a pediatric otolaryngologist should be made. Early removal of these tissues can prevent the long-face growth pattern with narrow

**3.** Rapid maxillary expansion (RME): Cephalometric and acoustic rhinometry studies report that with RME maxilla, the palate and floor of nasal cavity expand, which leads to increase the volume and decrease the airflow resistance in nasal cavity. It also makes statistically significant changes in tongue size position and hyoid position. The expansion in maxillary dentition gives the tongue a greater space and more forward positioning to the tongue. The widened maxillary basal bone on the velum, the superior pharyngeal constrictor muscles, and the surrounding orofacial musculature can increase the muscle

**4.** Class 2 growth modification therapy: When the pediatric and adolescent patients have both mandibular deficiency and obstructive sleep apnea, mandibular advancement devices like Herbst, twin block, monobloc, bionator, Frankel 2, etc. can be used for the treatment.

ened teeth, hypoplastic mandible, and septum deviation are investigated.

Sleep-related breathing disorders are complicated problems, which decrease life quality and increase morbidity and mortality in patients.

Dentists, who are specialized in dental sleep medicine, can see the early symptoms of these diseases and can be frontline screeners for potential OSAS diagnosis. In the treatment of snoring and mild-to-moderate obstructive sleep apnea, the oral appliance therapy was found to be a very effective treatment option.
