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October 14, 1998

Adenoids, Breastfeeding, Pacifiers, Obstructive Sleep Apnea, Airway, Functional Jaw Orthopedics

QUESTION: What do all the above topics have in common?

ANSWER: They all impact growth & development and health & sickness in known phenomenal ways, and ways yet to be charted.

CITATION: The effect of adenotonsillectomy in children with OSA, Int J Pediatr Otorhinolaryngol 1998 Jun 1;44(1):51-8 Shintani T, Asakura K, Kataura A Department of Otolaryngology, Sapporo Medical University, Japan.

Adenotonsillar hypertrophy and abnormal facial morphology are thought to be important for the occurrence of obstructive sleep apnea syndrome (OSA). We evaluated the effects of adenidectomy and/or tonsillectomy and the relationship between the treatment results and facial morphology in 134 children with OSA. Significant improvements in apnea-hypopnea indes (AHI) and lowest blood oxygen saturtion (SaO2) were noted and 78.5% of the patients improved after adenoidectomy and/or tonsillectomy. Additional operations were needed in two out of 13 cases of the adenoidectomy group and two out of four cases of the adeno-monotonsillectomy group. In the adenotonsillectomy group, the unimproved children tended to have smaller tonsils, narrower epipharyngeal airspace, and more poorly-developed maxillary and mandibular protrusion than the improved children. PMID: 9720681, UI: 98385635

DISCUSSION: It is apparent that growth and development can drastically affect infant health and for that matter health in life after infancy. While adenotonsillectomy seems to be a lost art in revival, Pediatricians for years balked at removing Tonsils and Adenoids. But with the SUPERBUGS coming and a generation of hypersensitive children, mainly due to the blatent over-use of anti-biotics, other modes of treatment are being revived--even leeches and maggots. But just as this surgical treatment--T&A-- to open the airway and get rid of bad bugs may be revived, so may other means of opening the airway. For airway is a major health issue....and one that is rarely measured or monitored. We assume all non-sick children have good airways...but that is not true. There are plenty of children with subclinical airway diseases including OSA because no one is concentrating on that area of diagnosis EXCEPT in the critically evident patients.

FUTURE: Just as height and weight are monitored from birth through teenage hood today, new measures of health await us in the future. New growth charts diffentiating between breastfed and bottle fed infants need be used; jaw growth; airway patency; and blood oxygen levels will all be major monitored areas in the future once norms are re-evaluated and protocols established. Breastfeeding will be shown to provide good growth and development of the jaws and airway, while pacifiers will be shown to be devastatingly destructive to growth and development of the jaws and airway. Adenotonsillectomy and the related removal of pathogens from the upper airway will become a welcome standard and lead to healthier children overall and billions in savings of time and money. And Functional Jaw Orthopedics which today so often targets repair of damaged jaw growth and development, will enter the preventive field and be used more soon after birth in post birth cranial evaluation, manipulation and treatment. This will give infants a greater chance for normal growth and development of the orofacial structures which is so important from the initial latching on to mom...to the extremely important 1st year of jaw and airway development...and throughout the next 14-20 years of growth.

Take Care,
Dr. David Page

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