MANDIBULAR DISTRACTION OSTEOGENESIS IN THE TREATMENT OF UPPER AIRWAY-OBSTRUCTION IN CHILDREN WITH CRANIOFACIAL DEFORMITIES

Over the past 3 years, 16 patients (12 males, 4 females) have undergon e mandibular distraction osteogenesis in conjunction with soft-tissue procedures to treat medically refractory obstructive sleep apnea. Thir ty distraction devices were placed for bilateral distraction in 14 chi ldren and unilateral distraction in 2. The mean age of treatment was 4 years and 8 months (range 14 weeks to 12 years and 8 months). Eight o f the patients had failed conventional medical and surgical treatment of obstructive sleep apnea and were considered tracheostomy candidates , whereas the remaining eight had tracheostomies placed shortly after birth for upper airway obstruction. These eight children could not be decannulated by standard protocols. The average distraction distance w as 25 mm (range 18 to 35 mm). To date, seven of the eight patients wit h tracheostomies hare been decannulated, and one is still in progress. Clinical improvement in the signs and symptoms of sleep apnea and red uction or elimination of preoperative oxygen requirements occurred in seven of the eight children with medically refractory sleep apnea. Twe lve-channel polysomnograms were obtained preoperatively and postoperat ively in each of the eight patients without tracheostomies. Respirator y disturbance index decreased from a mean of 7.1 to 1.7 after surgery. Lowest oxygen saturation rose from a mean of 0.70 to 0.89 after surge ry. Application of mandibular distraction osteogenesis is an important component in the treatment of obstructive sleep apnea and permits man dibular advancement in the younger child. As more experience is gained with distraction osteogenesis in the treatment of children with obstr uctive sleep apnea, the role of distraction will become better defined .