Early decannulation with bilateral mandibular distraction for tracheostomy-dependent patients

Obstructive sleep apnea in the neonatal period may originate from a hypopla stic mandibular framework causing retroposition of the base of the tongue a nd an inadequate hypopharyngeal space. A tracheotomy in childhood is an eff ective treatment for obstructive sleep apnea, but it is associated with inc reased morbidity, management problems, and difficulties in social interacti on. Tracheostomy-dependent pediatric patients Two underwent mandibular dist raction were reviewed to determine the effectiveness of this technique in a chieving decannulation. A clinical review was completed to determine the st atus of the tracheostomy after external, unidirectional distraction in trac heostomy-dependent patients. Expansion of the mandibular framework was anal yzed using traditional bony landmarks on predistraction and postdistraction lateral cephalograms. The area of the lower face was analyzed, and changes in the position of the hyoid bone were determined. Four patients with tracheostomies underwent an average of 21.3 mm and 20.8 mm of distraction on the left and right hemimandibles, respectively. The av erage age at the time of distraction was 2.7 years (range, 2.2 to 3.2 years ). All patients under-went successful decannulation at an average of 3.8 mo nths (range, 1.5 to 5.5 months) after completion of distraction. The area o f the lower face increased 26.9 percent (range, 12.2 to 53.5 percent) after distraction, and the hyoid bone advanced an average of 14.5 mm (range, 8 t o 25 mm). Bilateral mandibular distraction is an effective method of expanding the ma ndibular framework and concomitantly advancing the base of the tongue. The technique provides a tool for early intervention and decannulation in pedia tric patients with indwelling tracheostomies secondary to mandibular defici encies.