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[Obstructive sleep apnea in the child: an interdisciplinary treatment concept with special reference to craniofacial
Insights
Pediatric obstructive sleep-related breathing disturbances (SRBD) often stem from craniofacial issues, not obesity. Early, tailored interventions including conservative and surgical methods effectively treat infants, avoiding tracheotomies.
Area of Science:
- Pediatric Sleep Medicine
- Craniofacial Abnormalities
- Respiratory Disorders in Infants
Context:
- Obstructive sleep-related breathing disturbances (SRBD) in children differ significantly from adult presentations.
- Infantile SRBD is frequently linked to congenital craniofacial anomalies such as Pierre Robin and Goldenhar syndromes.
- Obesity plays a minor role in SRBD among infants, unlike in adult populations.
Purpose:
- To highlight the distinct etiology of SRBD in infants and newborns.
- To present a comprehensive overview of diagnostic and therapeutic strategies for pediatric SRBD.
- To emphasize the effectiveness of early and multimodal treatment approaches.
Summary:
- Over 30 infants with SRBD and craniofacial changes were successfully treated over two years.
- Therapeutic options range from immediate conservative measures (prone positioning, nasopharyngeal tubes) to surgical interventions (mandibular distraction osteogenesis, adenotonsillectomy).
- Conventional orthopedic/orthodontic treatments and surgical reconstructions address underlying anatomical defects, while adenotonsillectomy is highly effective in infants.
Impact:
- This refined treatment concept has successfully avoided the need for tracheotomies in pediatric patients.
- Early intervention positively influences facial growth and improves nasal breathing.
- Demonstrates the efficacy of tailored, multidisciplinary approaches for managing complex pediatric sleep-disordered breathing.
Abstract:
Diagnosis and therapy of obstructive sleep-related breathing disturbances SRBD in adults may not be applied without hesitation to children. SRBD in newborn and infants are often due to craniofacial disturbances (Pierre Robin syndrome, Goldenhars syndrome etc.), obesity is of minor importance. More than 30 infants with SRBD and craniofacial changes have been diagnosed and successfully treated over a 2-year period. Conservative therapy starts immediately after birth. The first step in newborn with Pierre Robin syndrome, for instance, is prone position for protrusion of tongue and mandible and mandibular growth stimulation. Intermediate nightly nasopharyngeal tubes are an alternative to nCPAP-/BiPAP treatment. Conventional orthopaedic/orthodontic treatment should not be neglected, even if it takes years to become effective. Surgical therapies are able to support, sometimes to replace or at least to shorten conservative methods. In rare cases when prone position in combination with palatal plates in cases of Robin syndrome, for instance, are not fully effective, mandibular extension is indicated. Aplasia or defects demand adequate surgical reconstruction, even if this does not necessarily mean abolishment of SRBD. In contrast to adults adenotonsillectomy is highly effective in infants and does not only reduce SRBD, but also improves nasal breathing and thus positively influences facial growth. A relatively new method is gradual mandibular distraction osteogenesis according to Ilizarov, which also enhances soft tissue growth. Maxillary and mandibular advancement osteotomies should not be considered before the termination of facial growth. Thanks to this refined treatment concept we were able to avoid tracheotomies in children during the past few years.