Distraction Osteogenesis: When Other Ways Fail
Introduction: The distraction osteogenesis of mandible (DOM) is characterized as a dynamic process, which consists in the elongation of the mandible and adjacent soft tissues, obtained by gradual traction applied to both osteotomized bone surfaces with a mechanical device called a “distractor.” The DOM represents an alternative method to traditional management of the upper airways of patients with micrognathia, especially those with Robin sequence (RS). The RS consists of micrognathia, glossoptosis, and consequent respiratory distress. High prevalence of Obstructive Sleep Apnea Syndrome (OSAS) is observed in these cases.
Objectives: The study aims to present a case of severe OSAS in a child due to a craniofacial anomaly, satisfactorily treated with bone-lengthening jaw.
Report: A3-year-old male patient, with clinical OSAS confirmed by polysomnography (Apnea-Hypopnea Index [AHI]: 14.1) consequent to RS. Endoscopic evaluation showed severe glossoptosis not associated with other abnormalities. Bilateral osteotomy of the body of the mandible and adaptation of external distractors were performed. The distraction was made to correct micrognathia, forward displacement of the tongue, and clinical improvement of OSAS and of polysomnographic parameters (AHI: 0.7).
Conclusion: The best indication for DOM is reserved for cases in which glossoptosis is identified as a cause of airway obstruction in patients with RS, which do not respond to the various clinical measures employed, thus avoiding a tracheostomy.
Keywords: mandibular distraction, Robin sequence, obstructive sleep apnea, micrognathia, glossoptosis.