Posted by: @gingahsnap

Has anyone actually seen improvement in diagnosed sleep apnea with any of these devices in a young child? Is there anything that actually serves to bring the high vault down when it is not especially narrow?

I suppose you are writing about a specific child. how old is he/she? Is there an overbite as well? Are there any nasal problems? Have you taken him/her to a paediatric ENT and to an orthodontist? and to a oromyofunctional therapist?

Would it be possible that you post some photos and xrays? some coronal slices from a CBCT maybe?

As a rule of thumb, a high vault is not high, it looks high because it is narrow. And doing a real skeletal expansion will always work better than only a dentoalveolar one.

@sergio-oms

I found these before and after casts of upper and lower ALFs. Do these look dentoalveolar or skeletal? Or are dental casts alone not enough to determine between the two?  

They look dentoalveolar, but it is  a nice dentoalveolar effect, I must admit.

The orthodontist that works at my surgery has used ALF in a relative of his. He explained to me that a some skeletal effect can be achieved in young children, but it is mainly dentoalveolar.

A good combination could be MSE in the upper (depending on how young is the child, if not MSE then a U Penn expander) and ALF or braces in the lower. And braces afterwards.

@sergio-oms

5.5 years. Adenoidectomy/partial turbinectomy at 4.5 years. Frenectomy at 5 years and 4 months of OMT. Residual OSA. 

Have been to 3 different well known providers in the U.S. who all proclaimed their appliance was the only way to go. I have yet to meet a provider who is proficient with multiple devices who could offer objectivity. I also have not seen anything case study wise regarding apnea treatment other than an RME, and obviously even that is not promised. 

With a child that young I don't see why this should be difficult with any appliance. Children usually use basic palatal expanders of all kinds because they're still growing. The debate over all these different appliances is usually with adults.   Are you sure that narrow palate is the cause of the sleep apnea? Could there be other factors as well?

Posted by: @gingahsnap

@sergio-oms

5.5 years. Adenoidectomy/partial turbinectomy at 4.5 years. Frenectomy at 5 years and 4 months of OMT. Residual OSA. 

Have been to 3 different well known providers in the U.S. who all proclaimed their appliance was the only way to go. I have yet to meet a provider who is proficient with multiple devices who could offer objectivity. I also have not seen anything case study wise regarding apnea treatment other than an RME, and obviously even that is not promised. 

Expansion works in children, anyway. The more skeletal, the better. 

NOTE: I wrote a previous message that was totally wrong, as I understood a totally different thing. Just in case you have read it.