Distraction Osteogenesis for Obstructive Apneas in Patients with Congenital Craniofacial Malformations

Abstract

Infants with congenital craniofacial malformations often have associated severe mandibular hypoplasia causing obstruction of the hypopharynx by retroposition of the base of the tongue into the posterior pharyngeal airway. Management depends on the severity of the airway obstruction. Most cases can be managed by prone positioning until the infant outgrows the problem at 3 to 6 months of age. In more critical cases, monitoring of oxygen saturation, temporary placement of a nasopharyngeal tube, and placement of an endotracheal tube will be useful procedures. Tracheotomy is an effective method for more severe cases, but longstanding tracheotomies result in high morbidity and occasional mortality. Mandibular distraction was performed in seven patients, ranging in age from 1 to 18 months, with critical obstructive apnea secondary to mandibular hypoplasia characterized by an apnea/hypopnea index greater than 20 apneas per hour and oxygen saturation below 80 percent. Two patients were tracheotomized previously. Mandibular lengthening, from 16 to 25 mm on the left side and from 10 to 22 mm on the right, was achieved in 21 to 25 days. Improvement of airway obstruction parameters was measured on polysomnograms and lateral cephalograms. Mandibular lengthening by gradual distraction is a successful method for young patients with severe mandibular hypoplasia causing critical obstructive apneas. Avoidance of tracheotomy or early decannulation in previously tracheotomized patients is a great advantage for patients with congenital craniofacial malformation.

Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

“…Malunion, malalignment and infection are infrequently observed in MDO due to the excellent vascularity of the craniofacial region [7,10,25]. In our case there was no noteworthy intra or post-operative complication.…”

“…It is shown to be effective in resolving upper airway obstruction and tracheostomy decanulation. It has also been used in respiratory distressed neonates and infants to avoid tracheostomy [6,7]. Troullis et al [8] described ultrasonography (USG) as an accurate non-invasive technique to assess mandibular DO.…”

Impact of Mandibular Distraction Osteogenesis on the Oropharyngeal Airway in Adult Patients with Obstructive Sleep Apnea Secondary to Retroglossal Airway Obstruction

“…This is secondary to disproportionate mandibular anatomy and mandibular advancement in such situations is shown to have 97.0 % of success in paediatric patients and 100 %, success rate in adult patients [3][4][5][6][7][8][9][10]. Mandibular advancement can be achieved by osteotomies or distraction and our choice of the latter was based on the magnitude of advancement required and its influence on post-operative stability [11,12].…”

Evaluation of airway volume changes in patients treated with distraction osteogenesis: a pilot study

“…Furthermore, the small size of the mandible and its retruded position, cause a corresponding retrodisplacement of the tongue and reduction in the OP airway. In such conditions mandibular DO has been proposed as a useful method to resolve OP airway obstruction 29,30,31 . The mean OP volume at T1 was aproximately 2.5 times the T0 time interval.…”