Restricted Upper Airway Dimensions in Patients with Dentofacial Deformity from Juvenile Idiopathic Arthritis

Overview

Journal Pediatr Rheumatol Online J

Publisher Biomed Central

Specialty Pediatrics

Date 2022 Apr 28

PMID 35477405

Authors

Xiaowen Niu

Julianne Moland

Thomas Klit Pedersen

Anders Ellern Bilgrau

Paolo M Cattaneo

Mia Glerup

Peter Stoustrup

Affiliations

Soon will be listed here.

Abstract

Background: This retrospective, cross-sectional study aimed to assess the pharyngeal airway dimensions of patients with juvenile idiopathic arthritis (JIA) and moderate/severe JIA-related dentofacial deformity (mandibular retrognathia/micrognathia), and compare the results with JIA patients with a normal mandibular appearance and a group of non-JIA patients.

Methods: Seventy-eight patients were retrospectively included in a 1:1:1 manner as specified below. All patients had previously been treated at the Section of Orthodontics, Aarhus University, Denmark. All had a pretreatment cone beam computed tomography (CBCT). Group 1 (JIA+); 26 JIA patients with severe arthritis-related dentofacial deformity and mandibular retrognathia/micrognathia. Group 2 (JIA-); 26 JIA patients with normal mandibular morphology/position. Group 3 (Controls); 26 non-JIA subjects. Dentofacial morphology and upper airway dimensions, excluding the nasal cavity, were assessed in a validated three-dimensional (3D) fashion. Assessment of dentofacial deformity comprised six morphometric measures. Assessment of airway dimensions comprised nine measures.

Results: Five morphometric measures of dentofacial deformity were significantly deviating in the JIA+ group compared with the JIA- and control groups: Posterior mandibular height, anterior facial height, mandibular inclination, mandibular occlusal inclination, and mandibular sagittal position. Five of the airway measurements showed significant inter-group differences: JIA+ had a significantly smaller nasopharyngeal airway dimension (ad2-PNS), a smaller velopharyngeal volume, a smaller minimal cross-sectional area and a smaller minimal hydraulic diameter than JIA- and controls. No significant differences in upper airway dimensions were seen between JIA- and controls.

Conclusion: JIA patients with severe arthritis-related dentofacial deformity and mandibular micrognathia had significantly restricted upper airway dimensions compared with JIA patients without dentofacial deformity and controls. The restrictions of upper airway dimension seen in the JIA+ group herein were previously associated with sleep-disordered breathing in the non-JIA background population. Further studies are needed to elucidate the role of dentofacial deformity and restricted airways in the development of sleep-disordered breathing in JIA.

References

Chervin , Hedger , Dillon , Pituch . Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000; 1(1):21-32. DOI: 10.1016/s1389-9457(99)00009-x. View

Flores-Mir C, Korayem M, Heo G, Witmans M, Major M, Major P . Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis. J Am Dent Assoc. 2013; 144(3):269-77. DOI: 10.14219/jada.archive.2013.0113. View

Chervin R, Ruzicka D, Giordani B, Weatherly R, Dillon J, Hodges E . Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006; 117(4):e769-78. PMC: 1434467. DOI: 10.1542/peds.2005-1837. View

Niu X, Madhan S, Cornelis M, Cattaneo P . Novel three-dimensional methods to analyze the morphology of the nasal cavity and pharyngeal airway. Angle Orthod. 2021; 91(3):320-328. PMC: 8084467. DOI: 10.2319/070620-610.1. View

Kirjavainen M, Kirjavainen T . Upper airway dimensions in Class II malocclusion. Effects of headgear treatment. Angle Orthod. 2007; 77(6):1046-53. DOI: 10.2319/081406-332. View

Katyal V, Pamula Y, Martin A, Daynes C, Kennedy J, Sampson W . Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: Systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2013; 143(1):20-30.e3. DOI: 10.1016/j.ajodo.2012.08.021. View

Owens J . Neurocognitive and behavioral impact of sleep disordered breathing in children. Pediatr Pulmonol. 2009; 44(5):417-22. DOI: 10.1002/ppul.20981. View

Stinson J, Hayden J, Ahola Kohut S, Soobiah C, Cartwright J, Weiss S . Sleep problems and associated factors in children with juvenile idiopathic arthritis: a systematic review. Pediatr Rheumatol Online J. 2014; 12:19. PMC: 4060142. DOI: 10.1186/1546-0096-12-19. View

Petty R, Southwood T, Manners P, Baum J, Glass D, Goldenberg J . International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004; 31(2):390-2. View

10.

Stoll M, Sharpe T, Beukelman T, Good J, Young D, Cron R . Risk factors for temporomandibular joint arthritis in children with juvenile idiopathic arthritis. J Rheumatol. 2012; 39(9):1880-7. DOI: 10.3899/jrheum.111441. View

11.

Glerup M, Stoustrup P, Matzen L, Rypdal V, Nordal E, Frid P . Longterm Outcomes of Temporomandibular Joints in Juvenile Idiopathic Arthritis: 17 Years of Followup of a Nordic Juvenile Idiopathic Arthritis Cohort. J Rheumatol. 2019; 47(5):730-738. DOI: 10.3899/jrheum.190231. View

12.

Yamashina A, Tanimoto K, Sutthiprapaporn P, Hayakawa Y . The reliability of computed tomography (CT) values and dimensional measurements of the oropharyngeal region using cone beam CT: comparison with multidetector CT. Dentomaxillofac Radiol. 2008; 37(5):245-51. DOI: 10.1259/dmfr/45926904. View

13.

Grauer D, Cevidanes L, Styner M, Ackerman J, Proffit W . Pharyngeal airway volume and shape from cone-beam computed tomography: relationship to facial morphology. Am J Orthod Dentofacial Orthop. 2009; 136(6):805-14. PMC: 2891076. DOI: 10.1016/j.ajodo.2008.01.020. View

14.

Kristensen K, Stoustrup P, Kuseler A, Pedersen T, Twilt M, Herlin T . Clinical predictors of temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic literature review. Semin Arthritis Rheum. 2015; 45(6):717-32. DOI: 10.1016/j.semarthrit.2015.11.006. View

15.

de Freitas M, Alcazar N, Janson G, Freitas K, Henriques J . Upper and lower pharyngeal airways in subjects with Class I and Class II malocclusions and different growth patterns. Am J Orthod Dentofacial Orthop. 2006; 130(6):742-5. DOI: 10.1016/j.ajodo.2005.01.033. View

16.

Guijarro-Martinez R, Swennen G . Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature. Int J Oral Maxillofac Surg. 2011; 40(11):1227-37. DOI: 10.1016/j.ijom.2011.06.017. View

17.

Schuckmann L, Klotsche J, Suling A, Kahl-Nieke B, Foeldvari I . Temporomandibular joint involvement in patients with juvenile idiopathic arthritis: a retrospective chart review. Scand J Rheumatol. 2020; 49(4):271-280. DOI: 10.1080/03009742.2020.1720282. View

18.

Lenza M, Lenza M, Dalstra M, Melsen B, Cattaneo P . An analysis of different approaches to the assessment of upper airway morphology: a CBCT study. Orthod Craniofac Res. 2010; 13(2):96-105. DOI: 10.1111/j.1601-6343.2010.01482.x. View

19.

Xu Z, Wu Y, Tai J, Feng G, Ge W, Zheng L . Risk factors of obstructive sleep apnea syndrome in children. J Otolaryngol Head Neck Surg. 2020; 49(1):11. PMC: 7057627. DOI: 10.1186/s40463-020-0404-1. View

20.

Tan H, Alonso Alvarez M, Tsaoussoglou M, Weber S, Kaditis A . When and why to treat the child who snores?. Pediatr Pulmonol. 2016; 52(3):399-412. DOI: 10.1002/ppul.23658. View