Distraction osteogenesis in Pierre Robin sequence and related respiratory problems in children.
BACKGROUND
Sleep apnea is one of the most frequent manifestations of respiratory obstruction. Historically this clinical entity has stimulated the production of numerous valuable contributions with one purpose in mind: the improvement of airway permeability. A multi-disciplinary approach is required to define the problem in anatomic and functional terms to avoid a tracheostomy and prevent long-term sequels. We decided on an approach that focuses on improving the projection of the tongue in the posterior pharynx; by lengthening the mandible and bringing the muscular insertions of the floor of the mouth forward, the antero-posterior dimensions of the airway are increased.


OBJECTIVE
To evaluate mandibular distraction osteogenesis as a simple mandibular lengthening procedure useful as a definite treatment in patients with obstructive sleep apnea.


METHODS
The series consisted of 15 consecutive patients, divided in four groups. Patients with acute upper airway obstruction who required endotracheal intubation, patients with no acute upper airway obstruction but with severe respiratory distress, patients with milder degrees of airway obstruction, and patients with long-term tracheostomies. Therapeutic interventions were performed according to the findings of each group.


RESULTS
The patients were evaluated according to cephalometric analysis, polysomnograms, nasopharyngoscopy, and clinical data. Significant changes were seen in the cephalometric studies. There were no postoperative episodes of apnea; clinical improvement occurred in all patients and decannulation was possible in all patients.


CONCLUSIONS
Mandibular distraction is a safe and reliable procedure for treating patients with obstructive sleep apnea.
Monasterio
Fernando Ortiz
FO
Department of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez, Calzada de Tlalpan 4800 Colonia Toriello Guerra, México, D.F., C.P. 14000, Mexico City, Mexico.
Drucker
Mónica
M
Molina
Fernando
F
Ysunza
Antonio
A
D000293:Adolescent; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008334:Mandible / Q000601:surgery*; D019186:Mandibular Advancement / Q000379:methods*; D019857:Osteogenesis, Distraction; D010855:Pierre Robin Syndrome / Q000150:complications*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome