External versus Internal Distraction Devices in Treatment of Obstructive Sleep Apnea in Craniofacial Anomalies

Abstract

Background:Obstructive sleep apnea is often associated with congenital craniofacial malformations due to hypoplastic mandible and decreased pharyngeal airway. In this study, we will compare external and internal distraction devices for mandibular lengthening in terms of effectiveness, results, patient comfort, and complications.Methods:Thirty-seven patients were treated by bilateral mandibular distraction osteogenesis for obstructive sleep apnea: 20 with external and 17 with internal distraction devices.Results:Lengthening of the mandible and increase of the pharyngeal airway were obtained in all patients. Using the external devices, the average mandibular elongation was 30 mm versus 22 mm with the internal devices; however, after 1 year, the results were more stable with internal devices. External devices carried greater risk for pin tract infection than the internal devices (27.5% vs 5.88%). In addition, pin loosening in 22.5% required pin replacement or led to reduced retention period. Internal devices had a precise and predictable vector of lengthening and left less visible scars at the submandibular area but carried the disadvantage of requiring a second operation for device removal. In very young children with severe micrognathia, it was impossible to place internal devices, and external devices were used.Conclusions:Internal devices should be the first choice because they are more comfortable to the patients, more predictable vector of lengthening, are less vulnerable to dislodgement, and leave reduced scarring, with the great disadvantage of second operation for removal. However, external devices still should be considered mainly in severely hypoplastic cases, and the surgeon should be prepared for both options.

Improvement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia

“…The therapeutic process must correct the ankylosis and relieve the narrowing of the posterior airway space . Previous studies examined the use of distraction osteogenesis (DO) to correct the disorder, being considered the most effective method for the treatment of this complicated disorder . Mandibular distraction has been shown to reduce upper airway obstruction, but the changes in anesthetic airway difficulty have not been documented.…”

Síndrome Da Apneia E Hipopneia Obstrutiva Do Sono Na Infância: Aspectos Odontológicos

“…De forma geral, a terapêutica da SAHOS varia de acordo com a sua gravidade entre seguimento clínico, tratamento medicamentoso (corticosteróide), cirúrgico (adenoidectomia-tonsilectomia) ou mecânico (ventilação por pressão positiva do ar -CPAP) (PATER et al, 2014;RACHMIEL et al, 2014;MITCHELL et al, 2015).…”

European Guideline Craniofacial Microsomia

“…Bilateral mandibular distraction osteogenesis (MDO) is a preferred method for treatment of respiratory distress / obstructive sleep apnoea in patients (<18 years) with mandibular hypoplasia who are unresponsive to non-surgical treatment. Rachmiel et al (2014) included 37 patients who underwent MDO for the treatment of OSA over a period of nine year. Fourteen of these patients had CFM, fifteen patients had Pierre Robin sequence and eight patients Treacher Collins.…”