The impact of positive airway pressure on midface growth: a literature review

Introduction: The treatment of obstructive sleep apnea with positive airway pressure in children is restricted due to concerns that it could affect maxilla growth over time. Objective: To undertake a systematic review of the literature about the long-term impact of using a positive airway pressure mask on the midface in growing individuals. Methods: The literature search was conducted in September 2019 using the keywords ("long-term" OR "long term" OR "side effects" OR longitudinal) AND (children OR child OR preschool OR adolescents OR adolescent OR infant OR infants) AND (craniofacial OR "mid-face" OR midface OR midfacial OR facial OR maxillary) AND ("airway pressure" OR ventilation) in the databases PubMed, Web of Science and Lilacs. The search included papers published in English, until September 2019, on the effects of positive airway pressure on midfacial growth. Results: The search strategy identified five studies: two case reports, two cross-sectional studies and one retrospective cohort study. All studies evaluated the long-term effects of a using a nasal mask on the midface in children and adolescents; four showed midface hypoplasia and one no showed difference post- treatment compared to a control. Conclusion: Most of the studies demonstrated that long-term use of nasal positive airway pressure in childhood/adolescence is associated with midface hypoplasia. (C) 2020 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.