Purpose: The objective of the study was to assess the effectiveness of neonatal mandibular distraction in treatment of obstructive sleep apnea in the postnatal period in preventing tracheotomy. Methods: This was a prospective evaluation of 15 patients at two centers who were born with severe micrognathia with obstructive apnea(OA) refractory to conservative therapy. Prior to surgery each infant underwent a 3D CAT scan and polygraphic study. After ruling out other causes airway obstruction each infant underwent bilateral mandibular osteotomy with distraction. Age at surgery varied from 5-120 days. Distraction was performed at a rate of 2 mm/day. Callus consolidation allowed for 4-6 weeks and the device removed. Each child underwent a 3 D CAT scan 3 months following surgery. Results: Of the 15 patients, 14 successfully underwent extubation and demonstrated significant improvement in the obstructive sleep apnea. 5 patients had both pre and post-operative 3D CT Scan information available. Postoperative horizontal ramus length increased to 34.8 mm from 23.3 mm preoperatively. Mean maxillary mandibular discrepancy was 8.28 mm pre-operatively, and 2.2 mm post-operatively. In 6 infants pre and postoperative polygraphic studies showed improvement in OA (per hour) by 79%, O2 saturation by 33% and sleep efficiency by 5%. In the 5 infants who had only post surgery evaluation, these results were also comparable. 1 patient required a tracheotomy. Conclusion: Neonatal distraction is an effective treatment of micrognathia with obstructive sleep apnea in the postnatal period in preventing a tracheotomy.

View Synopsis (.doc format, 21.0 kb)