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Impact of adenotonsillectomy and rapid maxillary expansion on the upper airways in children with obstructive sleep apnea syndrome – a randomized controlled clinical


Obstructive sleep apnea (OSA) is a prevalent disorder affecting 1% to 4% of the general pediatric population.


This study aimed to compare the volumetric changes from adenotonsillectomy (AT) and rapid maxillary expansion (RME) in the upper airways in children with diagnosis of OSA


Thirty children who presented with maxillary constriction and grade III/IV tonsillar hypertrophy were equally randomized into two groups and made to undergo polysomnography (PSG) and tomography (CBCT) examinations. One group underwent AT as the first treatment option, and the other underwent RME. Six months later, the participants underwent to a new PSG and CBCT. Individuals with AHI ≥ 1 received other treatments. Six months later, they underwent one last PSG and CBCT scan. Volumetric measurements from different areas of the upper airway were performed using the Mimics software. Intragroup analysis was performed using Friedman test, intergroup analysis was performed using the Mann Whitney test (α = 0.05).


There was a statistically significant difference in the both groups when comparing the total volume between initial and final. Intergroup analysis was statistically significant differences in the volume total upper airway and oropharyngx.


Adenotonsillectomy and rapid maxillary expansion contributed to the increase of airway volume; and the combined use of two types treatments greatest volumetric upper airway gain occurs when adenotonsillectomy was made as the first treatment option.


obstructive sleep apnea, upper airway, children


Área Clínica


Universidade Federal de Uberlândia - Minas Gerais - Brasil


Maria Cecília Monteiro Marques Magalhães, Carlos José Soares, Eustáquio Afonso Araújo, Gabriella Lopes de Rezende Barbosa, Anna Klycia Monteiro Magalhães, Ki Beom Kim, Guilherme Araújo Almeida