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Respiratory & Sleep Medicine Physician
The lack of response to upper airway surgery with regards to the snoring certainly increases his likelihood of having other issues, such as obstructive sleep apnoea. We know that even mild degrees of OSA in children can have substantial adverse effects on development. A proper assessment by a sleep physician is warranted, who will be able to determine the need or not for an appropriate in-laboratory sleep study.
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Check the BMI! Loud snoring will persist in obese cases, despite T/A. In this age group, patient is best managed with examination of the airway, starting with dental malocclusion. A retrognathic profile and/or constricted maxilla can be treated with palatial expansion and/or jaw position with a variety of appliances, fixed or removable. Palatal expansion is proven to increase nasal volume and tongue posture. Traditional mandibular advancement splints (MAS) and CPAP are not recommended in the growing individual. Ideally this is undertaken by an orthodontist with an interest in sleep disordered breathing in collaboration with a R&S Physician. More extreme cases are treated surgically with maxilla-mandibular (MMA) advancement, although this is not so common. Diagnostic sleep study may assist in presence of other symptoms eg excessive daytime somnolence or mood disorder.
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