
口腔医学研究 ›› 2026, Vol. 42 ›› Issue (6): 472-477.DOI: 10.13701/j.cnki.kqyxyj.2026.06.003
吴子怡, 冯剑颖*
收稿日期:2025-08-01
出版日期:2026-06-28
发布日期:2026-06-23
通讯作者:
*冯剑颖,E-mail:twohorsejy@163.com
作者简介:吴子怡(2000~),女,浙江台州人,住院医师,学士,研究方向:口腔正畸学。
WU Ziyi, FENG Jianying*
Received:2025-08-01
Online:2026-06-28
Published:2026-06-23
摘要: 儿童阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)是一种以睡眠期间上气道反复塌陷为特征的疾病,其发病机制与腺样体、扁桃体肥大及其引发的颅面代偿性改变密切相关。腺样体扁桃体切除术(adenotonsillectomy,AT)作为一线治疗虽可解除软组织阻塞,但对已形成的颅面代偿性改变缺乏矫正作用,需进行正畸干预。本文旨在阐述OSA儿童颅面代偿的发生机制,介绍正畸治疗在其中的关键作用,以优化OSA儿童的综合诊疗策略,推动多学科诊疗策略的优化。
吴子怡, 冯剑颖. 儿童阻塞性睡眠呼吸暂停的颅面代偿机制与正畸治疗策略[J]. 口腔医学研究, 2026, 42(6): 472-477.
WU Ziyi, FENG Jianying. Craniofacial Compensation in Children with Obstructive Sleep Apnea: Mechanisms and Orthodontic Treatment Strategies[J]. Journal of Oral Science Research, 2026, 42(6): 472-477.
| [1] Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome[J]. Pediatrics, 2012, 130(3): 576-584. [2] Reynaud E, Vecchierini MF, Heude B, et al. Sleep and its relation to cognition and behaviour in preschool-aged children of the general population: a systematic review[J]. J Sleep Res, 2018, 27(3): e12636. [3] Mussi N, Forestiero R, Zambelli G, et al. The first-line approach in children with obstructive sleep apnea syndrome (OSA)[J]. J Clin Med, 2023, 12(22): 7092. [4] Finke H, Drews A, Engel C, et al. Craniofacial risk factors for obstructive sleep apnea-systematic review and meta-analysis[J]. J Sleep Res, 2024, 33(1): e14004. [5] Bucci R, Rongo R, Zunino B, et al. Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea: A systematic review and meta-analysis[J]. Sleep Med Rev, 2023, 67:101730. [6] Niedzielski A, Chmielik LP, Mielnik-Niedzielska G, et al. Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevance[J]. BMJ Paediatr Open, 2023, 7(1): e001710. [7] 邹明舜.儿童增殖腺-鼻咽腔比率测定的临床价值[J].中华放射学杂志,1997,31(3): 190-192. [8] Bateman RM, Sharpe MD, Jagger JE, et al. 36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016[J]. Crit Care, 2016, 20(Suppl 2): 94. [9] Yoo SH, Choi JH, Mo JH. Clinical characteristics of patients with dental malocclusion: An otolaryngologic perspective[J]. J Clin Med, 2022, 11(21): 6318. [10] Hu Z, Dong J, Lou M, et al. Effect of different degrees of adenoid hypertrophy on pediatric upper airway aerodynamics: a computational fluid dynamics study[J]. Biomech Model Mechanobiol, 2023, 22(4): 1163-1175. [11] Moss ML, Salentijn L. The primary role of functional matrices in facial growth[J]. Am J Orthod, 1969, 55(6): 566-577. [12] Grippaudo C, Paolantonio EG, Antonini G, et al. Association between oral habits, mouth breathing and malocclusion[J]. Acta Otorhinolaryngol Ital, 2016, 36(5): 386-394. [13] Zhao Z, Zheng L, Huang X, et al. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis[J]. BMC Oral Health, 2021, 21(1): 108. [14] Tse KL, Savoldi F, Li KY, et al. Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study[J]. Prog Orthod, 2023, 24(1): 31. [15] Zhao T, Yang Z, Ngan P, et al. Association between adenotonsillar hypertrophy and dentofacial characteristics of children seeking for orthodontic treatment: A cross-sectional study[J]. J Stomatol Oral Maxillofac Surg, 2024, 125(4): 101751. [16] Zhao T, Wang M, Ngan P, et al. Is adenotonsillar hypertrophy associated with dentofacial morphology? A systematic review and meta-analyses[J]. Am J Orthod Dentofacial Orthop, 2025, 168(5): 524-541.e29. [17] Festa P, Mansi N, Varricchio AM, et al. Association between upper airway obstruction and malocclusion in mouth-breathing children[J]. Acta Otorhinolaryngol Ital, 2021, 41(5): 436-442. [18] Tong X, Li Y, Yang G, et al. The association of tonsil hypertrophy with pediatric dentofacial development: evidence from a cross-sectional study of young children in Shanghai, China[J]. Nat Sci Sleep, 2022, 14:1867-1875. [19] Huang L, Zheng L, Chen X, et al. Age-group-specific associations between adenoid/tonsillar hypertrophy and craniofacial features[J]. BMC Oral Health, 2024, 24(1): 1212. [20] Zhan X, He W, Xu M, et al. The effect of adenoid hypertrophy duration on craniofacial development[J]. Int J Pediatr Otorhinolaryngol, 2025, 195:112397. [21] Xu L, Zhang Y. Meta-analysis: effects of adenoidectomy/tonsillectomy on pediatric maxillary growth development[J]. J Clin Pediatr Dent, 2024, 48(6): 29-44. [22] Su Y, Wang Z, Chang H, et al. Craniofacial development characteristics in children with obstructive sleep apnea for establishment and external validation of the prediction model[J]. Nat Sci Sleep, 2024, 16:2151-2170. [23] Xu Q, Wang X, Li N, et al. Craniofacial and upper airway morphological characteristics associated with the presence and severity of obstructive sleep apnea in Chinese children[J]. Front Pediatr, 2023, 11:1124610. [24] Yuen HM, Chan KC, Chu WCW, et al. Craniofacial phenotyping by photogrammetry in Chinese prepubertal children with obstructive sleep apnea[J]. Sleep, 2023, 46(3): zsac289. [25] Litsas G. Growth hormone and craniofacial tissues. An update[J]. Open Dent J, 2015, 9:1-8. [26] 刘大波,钟建文,陈倩,等.儿童阻塞性睡眠呼吸暂停综合征对生长激素分泌的影响[J].中国儿童保健杂志,2003,11(1): 22-23. [27] Funatsu M, Sato K, Mitani H. Effects of growth hormone on craniofacial growth[J]. Angle Orthod, 2006, 76(6): 970-977. [28] Becking BE, Verweij JP, Kalf-Scholte SM, et al. Impact of adenotonsillectomy on the dentofacial development of obstructed children: A systematic review and meta-analysis[J]. Eur J Orthod, 2017, 39(5): 509-518. [29] D'Elia C, Gozal D, Bruni O, et al. Allergic rhinitis and sleep disorders in children-coexistence and reciprocal interactions[J]. J Pediatr (Rio J), 2022, 98(5): 444-454. [30] Zaffanello M, Pietrobelli A, Nosetti L, et al. Intranasal corticosteroids and oral montelukast for paediatric obstructive sleep apnoea: A systematic review[J]. Pharmaceutics, 2025, 17(5): 588. [31] Yang DZ, Liang J, Zhang F, et al. Clinical effect of montelukast sodium combined with inhaled corticosteroids in the treatment of OSAS children[J]. Medicine (Baltimore), 2017, 96(19): e6628. [32] Sun YL, Zheng HT, Tao JL, et al. Effectiveness and safety of Chinese herbal medicine for pediatric adenoid hypertrophy: A meta-analysis[J]. Int J Pediatr Otorhinolaryngol, 2019, 119:79-85. [33] da Silva Dias FV, Trawitzki LVV, Garcia DM, et al. Comprehensive analysis of orofacial motor skills in children with obstructive sleep apnea[J]. Sleep Breath, 2024, 29(1): 8. [34] Bandyopadhyay A, Kaneshiro K, Camacho M. Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis[J]. Sleep Med, 2020, 75:210-217. [35] Ye M, Huang S, Wang F, et al.The therapeutic role of orofacial myofunctional therapy in childhood residual obstructive sleep apnea[J]. Pediatr Pulmonol, 2025, 60(2): e70993. [36] Guilleminault C, Huang YS, Monteyrol PJ, et al. Critical role of myofascial reeducation in pediatric sleep-disordered breathing[J]. Sleep Med, 2013, 14(6): 518-525. [37] Zreaqat M, Hassan R, Alforaidi S, et al. Effects of rapid maxillary expansion on upper airway parameters in OSA children with maxillary restriction: A CBCT study[J]. Pediatr Pulmonol, 2024, 59(10): 2490-2498. [38] Yoon A, Abdelwahab M, Bockow R, et al. Impact of rapid palatal expansion on the size of adenoids and tonsils in children[J]. Sleep Med, 2022, 92:96-102. [39] D'Alessandro G, Bagattoni S, Montevecchi M, et al. Rapid maxillary expansion on oral breathing children: effects on tongue location, hyoid position and breathing. A pilot study[J]. Minerva Dent Oral Sci, 2021, 70(3): 97-102. [40] Serafin M, Fastuca R, Caprioglio A. CBCT analysis of dento-skeletal changes after rapid versus slow maxillary expansion on deciduous teeth: A randomized clinical trial[J]. J Clin Med, 2022, 11(16): 4887. [41] Ugolini A, Abate A, Donelli M, et al. Spontaneous mandibular dentoalveolar changes after rapid maxillary expansion (RME), slow maxillary expansion (SME), and leaf expander-A systematic review[J]. Children (Basel), 2024, 11(4): 501. [42] Rutili V, Mrakic G, Nieri M, et al. Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis[J]. Eur J Orthod, 2021, 43(3): 301-312. [43] Pirelli P, Fiaschetti V, Mampieri G, et al. Effect of rapid maxillary expansion on nasomaxillary structure and sleep disordered breathing in children with obstructive sleep apnoea[J]. Aust Dent J, 2024, 69 Suppl 1:S112-S120. [44] Yu M, Ma Y, Xu Y, et al. Orthodontic appliances for the treatment of pediatric obstructive sleep apnea: A systematic review and network meta-analysis[J]. Sleep Med Rev, 2023, 72:101855. [45] Magalhāes MC, Normando D, Soares CJ, et al. Impact of adenotonsillectomy and palatal expansion on the apnea-hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross-over randomized controlled trial[J]. Pediatr Pulmonol, 2024, 59(12): 3507-3517. [46] Yanyan M, Min Y, Xuemei G. Mandibular advancement appliances for the treatment of obstructive sleep apnea in children: a systematic review and meta-analysis[J]. Sleep Med, 2019, 60:145-151. [47] Özköylü G, Saraç D, Sasany R, et al. Comparison of monoblock and twinblock mandibular advancement devices in patiens with obstructive sleep apnea and temporomandibular disorder: effects on airway volume, polysomnography parameters, and sleepiness scale scores[J]. BMC Oral Health, 2024, 24(1): 1026. [48] Yue Z, Yi Z, Liu X, et al. Comparison of invisalign mandibular advancement and twin-block on upper airway and hyoid bone position improvements for skeletal class Ⅱ children: a retrospective study[J]. BMC Oral Health, 2023, 23(1): 661. [49] 余磊,李紫薇,康芙嘉,等.隐形功能矫治器对比传统功能矫治器前导下颌治疗骨性Ⅱ类错牙合畸形患者疗效的meta分析[J].华西口腔医学志,2023,41(3): 305-314. [50] Duan J, Xia W, Li X, et al. Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances[J]. BMC Oral Health, 2025, 25(1): 162. [51] Sun Y, Jia Y, Wang S, et al. Effectiveness of mandibular advancement orthodontic appliances with maxillary expansion device in children with obstructive sleep apnea: a systematic review[J]. BMC Oral Health, 2024, 24(1): 1303. [52] Remy F, Boyer E, Daniel C, et al. Management of the pediatric OSAS: what about simultaneously expand the maxilla and advance the mandible? A retrospective non-randomized controlled cohort study[J]. Sleep Med, 2022, 90:135-141. |
| [1] | 黄珈昕, 王蕴蕾, 贺红, 杜明远. 隐形矫治器联合正颌手术治疗成人骨性Ⅲ类错𬌗畸形1例[J]. 口腔医学研究, 2026, 42(6): 545-550. |
| [2] | 毛婧, 胡涛. 唾液微生物作为生物标志物在低龄儿童龋风险预测模型中的研究进展[J]. 口腔医学研究, 2026, 42(1): 1-7. |
| [3] | 王云龙, 简铭. 成人骨性Ⅲ类错𬌗伴后牙段反𬌗患者掩饰性正畸治疗1例[J]. 口腔医学研究, 2026, 42(1): 80-84. |
| [4] | 陈意磊, 程梦可, 闫红娟, 沈玉凤, 仵楠, 陈敏. 喀什地区不同程度低龄儿童龋患者口腔菌斑微生物多样性研究[J]. 口腔医学研究, 2025, 41(9): 800-805. |
| [5] | 孙芳, 孟庆芳, 聂莉莉, 刘海霞. 上海市杨浦地区3~5岁儿童口腔微生物菌群结构与患龋程度的相关性研究[J]. 口腔医学研究, 2025, 41(6): 503-510. |
| [6] | 朱宁, 高红. 上颌恒尖牙萌出前牙冠内病损的诊治1例[J]. 口腔医学研究, 2025, 41(6): 529-530. |
| [7] | 祖丽胡马尔·努尔艾合买提, 麦克丽亚·帕力哈提, 古力巴哈·买买提力. OSAHS儿童与非OSAHS儿童唾液差异蛋白质组学研究[J]. 口腔医学研究, 2025, 41(4): 306-313. |
| [8] | 谢言, 郭星, 高丹妮, 毛舜, 郭锦材, 潘涛华, 谢辉. 牙周辅助加速成骨正畸治疗骨开裂/骨开窗1例[J]. 口腔医学研究, 2025, 41(3): 253-256. |
| [9] | 邓建清, 杨柳, 张晓磊. 骨性Ⅱ类高角患者正畸治疗前后牙槽骨形态特征的锥形束CT回顾性研究[J]. 口腔医学研究, 2025, 41(1): 40-44. |
| [10] | 林秀燕, 赵彩云, 石宏. 低龄儿童龋患者唾液微生物群落研究及预测模型构建[J]. 口腔医学研究, 2024, 40(9): 778-784. |
| [11] | 张弘驰, 龙金凤, 陈鹏辉. 口呼吸患者口腔内蝇蛆病1例[J]. 口腔医学研究, 2024, 40(8): 744-745. |
| [12] | 李孟如, 王小琴. 儿童/青少年口呼吸与口腔微生态的研究进展[J]. 口腔医学研究, 2024, 40(6): 479-483. |
| [13] | 李思赜, 包涵, 苏晓婕, 谷德奥, 苗雷英, 刘超. 上颌第一磨牙正畸移动对颧突支柱改建的影响研究[J]. 口腔医学研究, 2024, 40(6): 537-543. |
| [14] | 邱若兰, 马昊东, 房敏健, 刘亮. 186例儿童及青少年颌面部骨折患者的回顾性研究[J]. 口腔医学研究, 2024, 40(12): 1086-1090. |
| [15] | 辛昱娴, 余飞燕. 儿童行牙科全身麻醉治疗的术后反应和影响因素分析[J]. 口腔医学研究, 2024, 40(10): 895-899. |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||