SKELETAL EXPANSION COMBINED WITH SOFT-TISSUE REDUCTION IN THE TREATMENT OF OBSTRUCTIVE SLEEP-APNEA IN CHILDREN - PHYSIOLOGICAL RESULTS

Twenty consecutive children, ranging in age from 6 days to 18 years, w ere treated with skeletal expansion, in addition to soft-tissue reduct ion, for medically refractory obstructive sleep apnea. The underlying diagnoses were craniofacial microsomia (n = 6), Down syndrome (n = 3), Pierre Robin syndrome (n = 3), cerebral palsy (n = 3), Nager's syndro me (n = 1), Treacher Collins syndrome (n = 1), cri du chat syndrome (n = 1), juvenile rheumatoid arthritis (n = 1), and temporomandibular jo int ankylosis (n = 1). Fourteen children had severe medically refracto ry sleep apnea and were tracheostomy candidates; in the remaining six, tracheostomies were placed shortly after birth and could not be decan nulated. Overnight, 12-channel polysomnography was obtained before and after surgery. The mean apnea index improved from 7.42 to 1.26, the m ean respiratory disturbance index improved from 25.24 to 1.72, and the mean lowest apnea-related oxygen saturation improved from 68% to 88%. Of the 14 children with medically refractory obstructive sleep apnea, two required tracheostomies. Of the six patients with tracheostomies, five have been decannulated at the time of this writing. Skeletal exp ansion in conjunction with soft-tissue reduction in the pediatric popu lation permits substantial increases in the volume of both the nasopha rynx and oropharynx. Creative use of conventional osteotomies and the application of distraction osteogenesis have enabled surgeons to apply maxillofacial and craniofacial techniques in treating children with o bstructive sleep apnea.