Discussion: Childhood Temporomandibular Joint Fracture Leading to Obstructive Sleep Apnea Syndrome

Abstract

This is a very intriguing case presentation that clearly demonstrates the medical complications of maxillofacial trauma. Mandibular facture may be viewed as the principle factor in the etiology of this patient’s obstructive sleep apnea (OSA), including the comorbidity of daytime fatigue, hypertension, congestive heart failure, stroke, and early death. The acquired micrognathic mandible appears to impinge on the posterior airway space by the retro position of the tongue base. 1 Bettega G. Pepin J.L. Levy P. et al. Surgical treatment of a patient with obstructive sleep apnea syndrome associated with temporomandibular joint destruction by rheumatoid arthritis. Plast Reconstr Surg. 1998; 101: 1045 Crossref PubMed Scopus (14) Google Scholar Base of tongue obstruction is a well-recognized and clinically obvious cause of OSA. 2 Davies S.F. Iber C. Obstructive sleep apnea associated with adult-acquired micrognathia from rheumatoid arthritis. Am Rev Respir Dis. 1983; 127: 245 PubMed Google Scholar , 3 Pepin J.L. et al. Evaluation of the upper airway in sleep apnea syndrome. Sleep. 1992; 15: S50 PubMed Google Scholar From a teaching standpoint, many aspects are worthy of discussion, beginning with pediatric treatment of condylar fractures and extending through delayed orthognathic/prosthetic reconstruction, temporomandibular joint (TMJ) reconstruction, and management of OSA.