Changing the growth trajectory in children through skeletal traction

Title : Changing the growth trajectory in children through skeletal traction

Abstract:

Midface retrusion creates a size deficiency problem in the upper airway that has been improved in children using surgical midface advancement and orthopedic protraction of the maxilla.  The results of these treatments have been mostly promising at enlarging the pharyngeal airway.  Recently introduced bone anchored maxillary protraction (BAMP) uses implant inserted devices to the jaws to bring the maxilla forward against a backward pressure to the lower jaw.

Objective: This retrospective study examines the use of BAMP as a strategy to treat maxillary retrusion, including children with obstructive sleep apnea.

Materials and Methods: 17 children, ages 11-17, with maxillary hypoplasia with a resulting malocclusion had bimaxillary traction against four bone anchors placed in the maxilla and mandible.  100-200 grams of elastic traction was applied full time, over an average duration of 12 months.  Pre and progress treatment cephalometric films were taken to measure skeletal changes.  Of the 17 children, 5 children had polysomnography at the onset and progress of treatment.

Results: Preliminary results show improvement in respiratory and cephalometric parameters, with the outcomes dependent on the length of treatment.  The maxilla was advanced in a forward direction.  The mandibular growth direction was variable.  Positive outcomes were not seen in all patients, with the results dependent on compliance wearing the elastic traction. The PSG studies similarly show variable results. The small sample size precludes any conclusive findings, but offers another possible treatment option for pediatric SDB that should be further investigated.

Conclusion: The application of Bollard implants may be an approach he children older than 10 years of age with important maxillary restriction. But these results must be balanced against the long term effect of BAMP, as there is growth restraint against the lower jaw and this may impact the size of the hypopharyngeal airway space.  This suggests that BAMP offers potential improvement for those pediatric SDB patients with maxillary retrusion.

Biography:

Stacey Quo DDS, MS, maintains a full time private practice in Palo Alto, California, limited to orthodontics.  She has been involved in the treatment of sleep disordered breathing (SDB) patients since 1998, and also maintains a position as Adjunct Assistant Clinical Professor at the Stanford School of Medicine's Sleep Clinic, and as Clinical Professor at the UCSF School of Dentistry.  She serves as Co-Director of the UCSF Dental Continuing Education Series on Sleep Medicine for Dentists.  Treating  both adults and children, her practice is a balanced mix of multidisciplinary cases, surgical orthodontics, and early interceptive care.   Dr. Quo has extensive experience in treating pediatric and adult SDB. Having published and lectured internationally on the treatment of pediatric sleep disordered breathing in both medical and dental conferences, she has co-authored chapters on facial growth and treatments for the SDB patient.