Neonatal and infant mandibular distraction as an alternative to tracheostomy in severe obstructive sleep apnea.
BACKGROUND
Surgical management for severe obstructive sleep apnea has been tracheostomy, which has significant morbidity.


OBJECTIVE
To determine the efficacy of internal mandibular distraction in treating severe obstructive sleep apnea in infants and neonates.


METHODS
Retrospective review of medical records of 29 patients who underwent internal mandibular distraction for obstructive sleep apnea secondary to micrognathia.


METHODS
Nonprofit, academic, pediatric medical center.


METHODS
A total of 29 infants with obstructive sleep apnea were studied. Nine were included in the respiratory failure group requiring intubation prior to distraction surgery. The other 20 were included in the respiratory distress group and underwent preoperative polysomnography that assessed the severity of obstructive sleep apnea as measured by the apnea-hypopnea index. One patient expired following surgery; the remaining 28 underwent postoperative polysomnography determining their postoperative apnea-hypopnea index.


METHODS
Bilateral mandibular distraction with internal microdistractors.


METHODS
Improvement in the apnea-hypopnea index or extubation.


RESULTS
The nine respiratory failure patients avoided tracheostomy and were successfully extubated postdistraction. Eight in this group had postoperative polysomnographies showing a mean apnea-hypopnea index of 3.13 (range, 0 to 13.9). All 20 patients in the respiratory distress group underwent polysomnography and showed improved apnea-hypopnea indices (p < .001). The mean pre-op apnea-hypopnea index was 39.7 (range, 4.5 to 177), and the mean post-op apnea-hypopnea index was 5.8 (range, 0 to 34). Average improvement in the apnea-hypopnea index was 33.9. The mean follow-up period was 18.7 months (1.6 to 45.2 months).


CONCLUSIONS
Infants with micrognathia and obstructive sleep apnea may avoid tracheostomy and its inherent risks and complications by undergoing internal mandibular distraction, which is a viable alternative to tracheostomy.
Keck School of Medicine of University of Southern California, Children's Hospital Los Angeles, Plastic Surgery #96, Los Angeles, CA 90027, USA. JHammoudeh@chla.usc.edu
Jeffrey
J
Hammoudeh
Vijay K
VK
Bindingnavele
Brian
B
Davis
Sally L
SL
Davidson Ward
Pedro A
PA
Sanchez-Lara
Grant
G
Kleiber
Sheila S
SS
Nazarian Mobin
Cameron S
CS
Francis
Mark M
MM
Urata
D001999:Bronchoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008334:Mandible / Q000601:surgery*; D008844:Micrognathism / Q000150:complications / Q000601:surgery*; D019857:Osteogenesis, Distraction; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy; D016896:Treatment Outcome