In this presentation, Bill Hang explains how orthotropics—a growth‑guided orthodontic approach that first advances the maxillary anterior teeth and then the mandible—can be used to treat pediatric obstructive sleep apnea (OSA). He illustrates the protocol with a 5‑year‑old case: lateral maxillary expansion, ~10 mm anterior tooth advancement, and a mandibular‑development appliance, resulting in a markedly larger airway on post‑treatment imaging and a clean sleep study. Hang cites referrals and literature (Dr. Stephen Sheldon, Dr. Christian Guilleminault, cone‑beam studies, SNA correlations, Ron Harper) to argue that restoring nasal breathing is the true therapeutic endpoint, that mouth‑breathing outcomes are unacceptable, and that early orthotropic intervention can prevent the need for surgical maxillofacial procedures. He also connects untreated OSA to neuro‑developmental issues such as ADHD, hypertension, and brain cell loss, emphasizing the public‑health urgency. The talk concludes with a strong advocacy that orthotropics should become the standard of care for pediatric OSA.
Chapters
Welcome back. This segment is entitled Orthotropics and Obstructive Sleep Apnea. Let's first review what orthotropics is. It first develops the maxillary anterior teeth forward into their ideal position in the face, and then brings the mandible forward to meet the maxilla without a headgear effect, while helping the child develop proper restoral posture. Let's illustrate this with a child who has obstructive sleep apnea. This 5-year-old child was diagnosed with obstructive sleep apnea and failure to thrive. In his case, we expanded his maxilla laterally and advanced his maxillary anterior teeth dramatically forward, about 10 millimeters, over a period of a few months. We then utilized an appliance to develop the mandible forward and open the airway as well. Here you see him, his lateral head x-ray prior to the treatment, And the anterior-posterior plane of space. And here it is on the right-hand side after the treatment. You can see the dramatic improvement in his airway. In the cross-section, you can see a very tiny airway in cross-section and a much bigger airway on the right-hand side post-treatment. The important thing is, he was referred to me from Dr. Stephen Sheldon in Chicago, who's written this book on the principles and practice of pediatric sleep medicine. And Dr. Sheldon called me one day to inform me that this child, not the one pictured here, by the way, had a clean sleep report, and he was completely free of sleep apnea. This was then written up, this patient's case was written up in Dr. Sheldon's new book, in which you see here on the graph that the sleep apnea was completely eliminated because of our ability to develop the maxilla and the mandible forward properly, and help this child go from being a mouth breather to become a nasal breather. Looking at the refereed literature regarding sleep apnea and what we need to have as a goal, Dr. Christian Guilleminault talks about elimination of oral breathing. In other words, restoration of nasal breathing during wake and sleep may be the only valid endpoint when treating sleep apnea. And preventive measures in at-risk groups, such as premature infants, and usage of myofunctional therapy as part of the treatment of OSA, are proposed to be important approaches to treat appropriately sleep-disordered breathing and multiple comorbidities. That our patient here, in this case, did become a nasal breather from starting out as a complete mouth breather. Here's another article which lends further credence. Cone beam evaluation showed that pharyngeal airway dimensions were significantly greater in nasal breathers than mouth breathers. Orthotropic seeks to get nasal breathing to be the endpoint. In every case, mouth breathing is not acceptable as an outcome. And here's another article from the refereed literature talking about the importance. Our findings suggest that the improvement observed in the respiratory symptoms, namely the apnea-hypopnea episodes, is correlated with the SNA increase after surgery. This finding may help maxillofacial surgeons to establish selective criteria for the surgical approach to sleep apnea syndrome patients. The point here in this, in me presenting this here, is that surgeons advance the maxilla and the mandible to get rid of sleep apnea. What orthotropics does is it does the exact same thing in a younger population by taking advantage of growth and correcting poor restoral posture, and completely eliminating the need for surgery like this for sleep apnea patients. It's very important to realize just how big a deal this whole sleep apnea thing is in children. From this magazine, we now, last year, doctors have diagnosed ADHD in about 15% of American children and routinely prescribe stimulants such as Adderall and Ritalin to help kids focus and concentrate. Dr. Stephen Sheldon talks about the fact that he believes that all cases are airway and sleep related, and that ADHD does not exist. When you realize just how important it is to avoid sleep apnea, you look at things like Ron Harper has published here, where he states 5 hours of intermittent hypoxia can cause brain damage, killing the Purkinje cells responsible for motor coordination. And you can get a brain injury from sleep apnea resulting in 3 to 4 times increased risk of hypertension. So, it just underlines the importance of treating these young children early. And we see that orthotropics can be effective in doing that. The point is, I think that orthotropics should be the standard of care for treatment of pediatric sleep apnea.
