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Management of obstructive sleep apnea in pediatric craniofacial anomalies
Adi Rachmiel1, Omri Emodi, Dror Aizenbud
1Department of Oral and Maxillofacial Surgery, Rambam Medical Centre, Haifa, Israel.
Insights
Mandibular distraction osteogenesis effectively treats pediatric obstructive sleep apnea (OSA) caused by craniofacial issues. This procedure expands the airway, resolving respiratory distress and eliminating the need for tracheostomies in many cases.
Area of Science:
- Craniofacial Surgery
- Pediatric Sleep Medicine
- Otolaryngology
Background:
- Obstructive sleep apnea (OSA) frequently co-occurs with congenital craniofacial malformations, leading to reduced pharyngeal airway size.
- Severe cases can necessitate tracheostomy or result in dependence, impacting pediatric patients with conditions like Pierre-Robin Syndrome.
Purpose of the Study:
- To evaluate the efficacy of mandibular distraction osteogenesis in treating pediatric OSA associated with craniofacial abnormalities.
- To compare outcomes between external and internal distraction devices in improving airway patency.
Main Methods:
- Twelve patients with severe respiratory distress and ten with tracheostomies underwent mandibular distraction osteogenesis.
- Both external and internal distraction devices were utilized, with mandibular framework expansion assessed via cephalometric analysis and CT scans.
Main Results:
- Significant mandibular elongation was achieved (average 29 mm with external, 22 mm with internal devices), increasing mandibular volume and pharyngeal airway.
- Patients with tracheostomies were successfully decannulated, and those with respiratory distress showed improved airway function and resolution of OSA symptoms, including oxygen requirement elimination.
Conclusions:
- Mandibular distraction osteogenesis is a valuable treatment for pediatric OSA secondary to craniofacial malformations, effectively widening the pharyngeal airway.
- External devices offer greater distraction but are less comfortable; internal devices are more comfortable but provide less distraction and require removal surgery.
Introduction:
Obstructive sleep apnea (OSA) is often associated with congenital craniofacial malformations such as Pierre-Robin Syndrome, Hemifacial Microsomia, Treacher Collins Syndrome resulting in decreased pharyngeal airway, which, in severe cases, leads to tracheostomy dependence. Some pediatric patients had tracheostomies done and others with severe respiratory distress were considered tracheostomy candidates.
Materials And Methods:
Twelve patients with severe respiratory distress without tracheostomy and ten patients with tracheostomy were treated by mandibular distraction osteogenesis using either external or internal devices. The expansion of mandibular framework was analyzed using bony cephalometric landmarks and computed tomography (CT).
Results:
The results demonstrated average mandibular elongation of 29 mm on each side using the external devices and 22 mm using the internal devices, and an increase in mandibular volume and pharyngeal airway. The group of patients with tracheostomies were decannulated and in the patients with respiratory distress there was improved airway with improvement of signs and symptoms of OSA with elimination of oxygen requirement.
Conclusions:
Mandibular distraction is a useful method in younger children with OSA expanding the mandible and concomitantly advancing the base of tongue and hyoid bone increasing the pharyngeal airway. The external devices permit greater distraction length, the removal is simple but the devices are uncomfortable for the patients. On the other hand, the internal devices are more comfortable for patients but permit shorter distraction length and require a second operation for removal.
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