Purpose: The efficacy of distraction osteogenesis for purpose of decannulation in children who have had tracheostomy early in life is well known. However, usefulness of preventing tracheostomy with early mandibular distraction in infants specially using an internal device is not well documented . The purpose of this study was to evaluate mandibular distraction using an internal/external device as an alternative to tracheostomy . Also included in the study were children who had received tracheostomy prior to offering mandibular distraction .

Method: Since 2001 twelve children have been treated with varying degrees of upper airway obstruction. The pre-operative diagnoses included Pierre Robin syndrome (n=6), cerebral palsy (n=2), mixed group of craniofacial disorders (n=4). Age ranged between 4 weeks-15 years. Pre-operative evaluation included sleep study, lateral neck radiograph and cephalometric measurement and saturation recording. Three patients had tracheostomy prior to offering mandibular distraction . Nine patients had severe upper airway compromise and were considered candidates for tracheostomy .

Results; Tracheostomy was avoided in 100% of patients who were offered distraction osteogenesis .All patients who had existing tracheostomy were successfully decanulated after distraction. Average distraction rate was 1.29 mm per day. Average latency period was 4.75 days. Distraction distance ranged from 10.5-45 mm. Internal unidirectional device was used in six patients . Four patients received an internal bidirectional device and two had an external bidirectional device. Complications occurred in four out of twelve patients (33 %). Three patients had minor complication related to inadequate fixation . One patient had temporary neuropraxia of the marginal mandibular branch. There were no cases of non-union.

Conclusion:

Our study confirms the efficacy of mandible distraction as primary treatment of upper airway obstruction and obstructive airway sleep apnea in infants and young children and should be considered as an alternative to tracheostomy. It should also be considered a treatment of choice for early decannulation in children who have existing tracheostomy.
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