What is the impact of distraction osteogenesis on the upper airway of hemifacial microsomia patient with obstructive sleep apnea: a case report

Rongyang Wang,Ruimei Yang,Shixing Xu

doi:10.1186/s40001-021-00547-1

Abstract

BackgroundCurrent research about hemifacial microsomia (HFM) patients after distraction osteogenesis (DO) most emphasize the morphologic changes. This case report shows the outcome of DO on the upper airway of a HFM patient with obstructive sleep apnea (OSA) based on the use of computational fluid dynamics (CFD).Case presentationAn 11-year-old boy was diagnosed as HFM with OSA, and underwent unilateral DO. Polysomnography and CT scans were performed before and 6 months after treatment. After DO, lowest blood oxygen saturation increased from 81% to 95% and apnea and hypopnea index decreased from 6.4 events/hour to 1.2 events/hour. The oropharynx and nasopharynx were obviously expanded. We observed apparently increased average pressure, decreased average velocity and pressure drop in all cross-sections, and largely decreased airflow resistance and maximum velocity entirely in the airway.ConclusionsThe results suggest that DO might be effective for the treatment of OSA by expanding the upper airway and reducing the resistance of inspiration.

Highlights

Current research about hemifacial microsomia (HFM) patients after distraction osteogenesis (DO) most emphasize the morphologic changes
The results suggest that DO might be effective for the treatment of obstructive sleep apnea (OSA) by expanding the upper airway and reducing the resistance of inspiration
This report was aimed to show the outcome of DO on the upper airway of a HFM patient with OSA based on the use of computational fluid dynamics (CFD), which may help to explore the therapeutic mechanism of DO for OSA

Summary

Introduction

Current research about hemifacial microsomia (HFM) patients after distraction osteogenesis (DO) most emphasize the morphologic changes. This case report shows the outcome of DO on the upper airway of a HFM patient with obstructive sleep apnea (OSA) based on the use of computational fluid dynamics (CFD). Case presentation: An 11-year-old boy was diagnosed as HFM with OSA, and underwent unilateral DO. We observed apparently increased average pressure, decreased average velocity and pressure drop in all cross-sections, and largely decreased airflow resistance and maximum velocity entirely in the airway. Because of the impaired development of the affected side, the mandible progressively shortens and narrows, leading to concomitant reduction of the pharyngeal airway in HFM patients. The pathophysiological process of OSA is greatly affected by the flow field inner the airway.

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