Mandibular reconstruction in children with obstructive sleep apnea due to micrognathia

Obstructive sleep apnea in children with micrognathia may be severe enough to necessitate permanent airway maintenance. Affected children form a small, but important, group of patients because early reconstructive surgery to the mandible may permit decannulation. A policy of early and aggressive surgical management has been pursued for the past 15 years, and an audit of outcome was undertaken to confirm whether or not this policy has been justified. The records of 25 patients so treated between 1980 and 1994 were analyzed by an independent clinician. Decannulation was achieved in 20 of the children (80 percent). The conditions that were most amenable to successful treatment (100 percent) were hemifacial microsomia, temporomandibular ankylosis, and the Pierre Robin sequence. The outcome for children with Treacher Collins syndrome and Nager syndrome was less successful (75 and 60 percent, respectively). The worst outcome occurred in a mixed group of three children with other syndromes, two of whom failed decannulation. Surgery was most successful when carried out before the age of 2 years (87 percent) and after the age of 4 years (90 percent).