The New Norm?

Recently we examined an 11 year old boy referred to us from an ENT physician who diagnosed him with OSA (obstructive sleep apnea) and tongue tie. He sat there with his mouth hanging wide open next to his very concerned mother. She had plenty of reasons to be concerned. Her son has OSA which means when he stops breathing while sleeping brain cells may be being damaged. And this may be happening EVERY night!  According to researchers who know a lot more about this than I do, this means he may have motor coordination issues for his whole life and his IQ may go down!     

His mouth at rest has been hanging open his entire life. No pediatrician or anyone else has apparently said anything. He was only diagnosed with OSA after he was at camp this summer and a camp counselor noticed he was stopping breathing when he was sleeping. Why hasn’t anyone asked the important questions in the pediatrician’s office? Why hasn’t a teacher registered concern that he was going to sleep in class? He was almost asleep in my office for this examination! How many more kids are in his class at school looking like he does with forward head posture, a tipped back forehead to keep his chin forward so he can breathe, and forward rolled shoulders? It isn’t hard to see all this, but is it so common now that we just don’t notice it? What happened to kids sitting up in class, looking alert, with their lips together? 

Most of this boy’s growth is behind him and both of his jaws are substantially recessed from ideal positions in his face. The angle of the upper lip and nose is about 140 degrees (ideal 100 degrees) which indicates that the upper jaw is very recessed. His chin is flat with the mentalis muscle straining to get his lips together in the few occasions when they are together.  I asked him if he likes sports just to make conversation. I knew the answer would be “no” before I asked the question because kids like this prefer the comfort of the couch to the excitement of the ball field. They are also usually overweight, and many are already beginning to have medical issues. Often these kids are not doing well in school because they are not sleeping well at night. The incidence of diabetes in this age group is skyrocketing, and he’s at risk because his current situation. It took a camp counselor to raise the flag of concern!     

We took an x-ray to see the size of his airway. It was about the size of a drinking straw at the narrowest! Imagine breathing through a drinking straw! For those in the profession the number was 32.9 square mm. for the minimal cross-section!  The refereed literature says anything under 55 square mm. places him in a high risk for OSA......but then we know he has an actual diagnosis.    

He’s way too late for us to do Orthotropics? to try to reverse the poor facial growth, reduce his long face, etc. He has severely crowded teeth which would cause many orthodontists to see that as a sign he needs bicuspid teeth removed to align the teeth. Extraction of teeth is unnecessary and might further decrease his already small airway. I’m not focused on the teeth, but his face, his poor body posture, his poor rest oral posture, his health. I notice the teeth and know that I can expand his arches laterally enough to accommodate all of them. 

I’m still going to be dealing with a child who has most of his growth in the rear view mirror, however. I won’t get his face to be forward where it would have been had he been a normal nasal breather. I can fix the teeth a bit to at least give him a nice smile, but who can fix the other issues that almost certainly are going to affect his health in the near future? Will we have to depend on another camp counselor to notice something isn’t right?