Maxillary deformity following CPAP treatment in myasthenia gravis

Abstract Objective: Patients with Myasthenia gravis (MG) are characterized by muscle weakness that may cause obstructive sleep apnea (OSA). The use of a continuous positive airway pressure (CPAP) device is often needed in order to maintain free breathing during the night and sometimes even during the day. Clinical Presentation: A 29-year-old MG patient is presented who used a CPAP continuously since the age of 12. Tight fitting of a nasal mask applied enough force to cause severe maxillary deformity. Clinical Relevance: Masks with additional forehead and chin support or a regular full face mask are recommended for patients with muscle weakness, in order to spread forces more evenly.

[1]  Ki Beom Kim How has our interest in the airway changed over 100 years? , 2015, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[2]  C. Cingi,et al.  Obstructive sleep apnoea syndrome does not negatively affect oral and dental health , 2015, The Journal of Laryngology & Otology.

[3]  Bruno Eymard,et al.  Diagnostic and clinical classification of autoimmune myasthenia gravis. , 2014, Journal of autoimmunity.

[4]  P. Major,et al.  Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis. , 2013, Journal of the American Dental Association.

[5]  A. Lowe,et al.  Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea. , 2010, Chest.

[6]  U. Tolonen,et al.  Dental arch morphology in children with sleep-disordered breathing. , 2009, European journal of orthodontics.

[7]  Charles George,et al.  Sleep apnea in patients with myasthenia gravis , 2006, Neurology.

[8]  K. Ferguson,et al.  Oral appliances for snoring and obstructive sleep apnea: a review. , 2006, Sleep.

[9]  P. Boelle,et al.  Facial side effects during noninvasive positive pressure ventilation in children , 2005, Intensive Care Medicine.

[10]  V. Flanary Long‐term effect of adenotonsillectomy on quality of life in pediatric patients , 2003, The Laryngoscope.

[11]  M. Villa,et al.  Mid-face hypoplasia after long-term nasal ventilation. , 2002, American journal of respiratory and critical care medicine.

[12]  T. Young,et al.  Epidemiology of obstructive sleep apnea: a population health perspective. , 2002, American journal of respiratory and critical care medicine.

[13]  C. Guilleminault,et al.  An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia. , 2000, Chest.

[14]  Y. Anavi,et al.  Orthognathic surgery in patients with congenital myasthenia gravis. , 1996, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[15]  C. Marcus,et al.  Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. , 1995, The Journal of pediatrics.

[16]  M. Sadeh,et al.  Congenital myasthenia associated with facial malformations in Iraqi and Iranian Jews. A new genetic syndrome. , 1990, Brain : a journal of neurology.

[17]  ColinE. Sullivan,et al.  REVERSAL OF OBSTRUCTIVE SLEEP APNOEA BY CONTINUOUS POSITIVE AIRWAY PRESSURE APPLIED THROUGH THE NARES , 1981, The Lancet.

[18]  G. Chierici,et al.  Primate experiments on oral sensation and dental malocclusions. , 1973, American journal of orthodontics.