Neonatal and Infant Mandibular Distraction as an Alternative to Tracheostomy in Severe Obstructive Sleep Apnea

Abstract

Context 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. Design Retrospective review of medical records of 29 patients who underwent internal mandibular distraction for obstructive sleep apnea secondary to micrognathia. Setting Nonprofit, academic, pediatric medical center. Patients 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. Interventions Bilateral mandibular distraction with internal microdistractors. Main Outcome Measure 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.