Craniofacial phenotyping of pediatric sleep-disordered breathing: orthodontic management, timing, and treatment approaches

Pediatric obstructive sleep apnea (OSA) presents a multifactorial etiology distinct from adult OSA, necessitating orthodontists to recognize specific craniofacial features that influence upper airway collapsibility. Accurate diagnosis and effective management of pediatric OSA require understanding these phenotypes, categorized into subtypes such as Class II with retrognathic mandible, vertical maxillary excess, constricted nasomaxillary complex, Class III with retrognathic maxilla, and bimaxillary deficiency. Growth modification treatments targeting the nasomaxillary complex and mandible’s dimensions can enhance skeletal growth and airway patency, creating an optimal environment for normal respiratory function and craniofacial development. Tailored treatment strategies based on craniofacial phenotyping can significantly improve outcomes. Orthodontists play a crucial role in guiding craniofacial development at various stages, emphasizing the importance of a collaborative, team-based approach to managing sleep-disordered breathing. According to the differential growth theory, intervention timing and appliance type should be chosen based on the specific bony target and area of respiratory obstruction. The craniofacial complex and dentition undergo significant changes from infancy to adulthood, presenting critical windows for targeted intervention. This article proposes a clinical framework for multidisciplinary care, emphasizing refined phenotyping to determine the most appropriate management strategies. In the future, personalized care will identify children who would benefit most from targeted craniofacial management within an interdisciplinary team setting.

Pediatric sleep disordered breathing; Pediatric obstructive sleep apnea; Upper airway; Craniofacial abnormalities; Clinical phenotype

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