Craniofacial Growth Modification to Improve Sleep Breathing in Growing Individuals: Facts & Hope

A significant interest has arisen in the potential impact of craniofacial interventions to help manage pediatric sleep-disordered breathing (PSDB). PSDB is a complex multifactorial disease that is unlikely to be fully solved with a unique intervention alone. Interdisciplinary management is a must for this chronic inflammatory disease. Although adenotonsillectomy (AT) is the most frequent first line of action, many cases do not respond or only partially to AT. Additionally, many cases do not have an AT indication. This leaves a significant number of children needing a clear intervention pathway. Multiple providers from different health specialties should get involved in diagnosing and managing the causes of PSDB correctly. Due to promising initial case series reports, palatal expansion (if palatal constriction is identified), mandibular forward repositioning (if a mandibular sagittal deficiency is determined), and maxillary complex advancements (if a maxillary complex sagittal deficiency is determined) have come to light as managing alternatives to consider when PSDB and are involved. This presentation will debate what we know, how much we need clarification, and where the future may lead us. The main points to be covered are the status of phenotyping of craniofacial characteristics in PSDB cases, the debate about the timing of AT and craniofacial intervention, when indicated, the current controversy of the best diagnostic methods to identify PSDB and awareness that some cases in which these craniofacial interventions generate a lack of response or unfavorable response may happen. The future is promising, but a step aside is indicated to weigh what we know adequately and appropriately.