title: Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) in individuals with craniofacial anomalies can compromise airway and is a serious life-threatening condition. In many cases, tracheostomy is carried out as the treatment of choice. Distraction osteogenesis of the mandible as a treatment modality for OSA is very useful and may spare the need for tracheostomy or allow decannulation, yet controlling the vector of distraction is still a major challenge. We present a method for controlling the vector of distraction.
  
  
  METHODS
  Eight patients with severe respiratory distress secondary to a micrognathic mandible were treated by mandibular distraction osteogenesis using either external or internal devices. Temporary anchorage devices (TADs) and orthodontic elastics were used to control the vector of distraction. Cephalometric X-rays, computed tomography, and polysomnographic sleep studies were used to analyze the results.
  
  
  RESULTS
  A mean distraction of 22 mm using the internal devices and a mean of 30 mm using the external devices were achieved. Increase in the pharyngeal airway and hyoid bone advancement was also observed. Anterior-posterior advancement of the mandible was noted with no clockwise rotation. Most importantly, clinical improvement in symptoms of OSA, respiratory distress, and feeding was noted.
  
  
  CONCLUSIONS
  We describe a method for controlling the vector of distraction used as a treatment for OSA. In these cases, TADs were used as an anchorage unit to control the vector of distraction. Our results show excellent clinical and radiographical results. TADs are a simple and nonexpensive method to control the vector of distraction.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Dekel
authors.initials: D
authors.lastname: Shilo
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Omri
authors.initials: O
authors.lastname: Emodi
authors.affiliation: Ruth and Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology, Haifa, Israel; Department of Orthodontics and Cleft Palate, School of Oral and Dental Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Aizenbud
authors.affiliation: Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Rachmiel
keywords: Control; distraction osteogenesis; obstructive sleep apnea; temporary anchorage devices; vector