Treatment of pediatric obstructive sleep apnea by mandibular distraction

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Obstructive sleep apnea (OSA) in pediatric populations is often associated with congenital craniofacial malformations, as Pierre Robin syndrome, hemifacial microsomia, resulting in decreased pharyngeal airway, which, in severe cases, leads to tracheostomy dependence. A total of fourteen children were treated, six patients had tracheostomies placed and another eight patients were considered tracheostomy candidates. The mean age of the patients was four years old, ranging from 9 months to 7 years. The patients that are without tracheostomy are respiratory distressed and have various complaints of OSA, as noisy breathing during sleep, waking episodes, pauses in respiration, daytime somnolence and are considered tracheostomy candidates. OSA, due to congenital malformations, was treated by mandibular distraction osteogenesis. Mandibular distraction osteogenesis was performed bilaterally in the mandibular body using two extraoral distraction devices. After a latency period of four days, a gradual distraction in a rate of 1 mm/day was performed followed by consolidation period of eight weeks. The expansion of mandibular framework was analyzed using bony cephalometric landmarks and 3D CT. The size of the pharyngeal airway preoperatively and post-treatment was evaluated by measurements of lateral (sagittal) and axial width and by 3D CT. The results demonstrate average mandibular elongation of 34mm on each side, and an increase in mandibular volume and pharyngeal airway. To date, all six patients are decannulated and in the other eight patients there is improved airway with improvement of signs and symptoms of OSA and elimination of oxygen requirement. Then, continuous treatment of the palate and the velopharyngeal sphincter was possible without impairing the airway.