Treatment of obstructive sleep apnea by mandibular distraction

Obstructive sleep apnea (OSA) due to congenital malformations was treated by mandibular distraction osteogenesis. The mean age was five years old, ranging from 1 to 8 years. Six patients had tracheostomics placed and eight patients had various complaints of OSA as noisy breathing during sleep, waking episodes, pauses in respiration, daytime somnolence and were considered tracheostomy candidates. Mandibular distraction osteogenesis was performed bilaterally in the mandibular body using an extraoral distraction device. Cephalometric landmarks and computer assisted tomography (CT) were used to analyze the skeletal changes. The size of the pharyngeal airway preopeatively and post-treatment by distraction was evaluated by measurements of lateral (sagittal) and axial width. All patients had polysonmography before and after the treatment. The results suggest increase in mandibular framework. The average mandibular distraction length was 32mm. There was increase of pharyngeal airway measured on the lateral. and axial CT (level vertebra C2). To date, all six tracheostomized patients are decannulated, improved airway with improvement of signs and symptoms of OSA and elimination of oxygen requirement was observed in the other eight patients. Conclusion: Bilateral mandibular distraction is effective in younger children with OSA. Expanding the mandible and concomitantly advancing the base of tongue increases the pharyngeal airway.