Relief of upper airway obstruction with mandibular distraction surgery: Long-term quantitative results in young children

Abstract

Objective: To evaluate the long-term benefits of mandibular distraction on sleep-related upper airway obstruction in young children with mandibular hypoplasia.

Design: Cross-sectional study. Subjects were examined for sleep-disordered breathing using medical history, physical examination results, and a written questionnaire. Subjects underwent standard overnight polysomnography, during which measures of sleep-disordered breathing were collected.

Setting: Tertiary care hospital.

Patients: Five children with upper airway obstruction from craniofacial anomalies treated with mandibular distraction, with a minimum follow-up of 12 months.

Main outcome measures: Apnea-hypopnea index, oxygen saturation nadir, and peak end-tidal carbon dioxide value.

Results: Of the 5 children, 3 were cured of upper airway obstruction as documented by polysomnography, with an apnea-hypopnea index of less than 1.5 and no snoring. The fourth child had primary snoring without apnea. The fifth child had severe obstructive sleep apnea, with an apnea-hypopnea index of 20.2.

Conclusions: Most children who undergo mandibular distraction for upper airway obstruction associated with mandibular hypoplasia demonstrate significant clinical improvement of obstructive sleep apnea. However, those children who continue to have symptoms of sleep-disordered breathing after surgery should undergo polysomnography for evaluation of persistent obstructive sleep apnea.