Obstructive Sleep Apnea in a 2-Year-Old Down Syndrome Child: Successful Management With Adenotonsillectomy Followed by Rapid Maxillary Expansion Treatment

Due to glossal and craniofacial skeletal abnormalities, children with Down syndrome (DS) are prone to obstructive sleep apnea (OSA), thus demanding an increased necessity for an earlier diagnosis and more strict control for OSA. Adenotonsillectomy (T&A op) is an effective surgical treatment method to reduce OSA in children. Nevertheless, it should be noted that T&A op in DS children might be insufficient to completely resolve OSA and that extra care is needed when performing a T&A op for airway obstruction in DS during the immediate postoperative period. The objective of the present study was to report a case of a 2-year-old male DS patient with severe OSA (apnea-hypopnea index [AHI] of 61.7/hr) which was consequently reduced to moderate OSA (AHI of 7.6/hr), followed by reduction to mild OSA (AHI of 4.8/hr) with an one-year of rapid maxillary expansion (RME) device application. With a 2-year application of the RME device, the hard palate width in the 1st and 2nd molar region was increased to 5.86 mm and 5.26 mm, respectively. This is the first case report describing that a severe OSA is reduced to moderate OSA with T&A op and further reduced to mild OSA with an RME device application.