OSAS in infants: how to prevent or remove tracheostomy

Objective: Obstruction of the upper airway consequent to mandibular hypoplasia is one of the most common causes of neonatal and infant obstructive sleep apnea syndrome (OSAS). Often a tracheotomy in infant or newborn babies is an effective treatment to prevent an acute respiratory distress, but it is associated to severe problems such as tracheomalacia, tracheal and language development. Fur there more tracheostomy is not always a life saving procedure. This paper reports our experience about the treatment of OSAS with mandibular distraction osteogenesis in infant and newborns. Methods: 6 patients (2 males, 4 females) have undergone seven procedures of bilateral mandibular distraction osteogenesis. One patients was affected by Franceschetti Sindrome, two by Nager Syndrome and three by Pierre Robin Sequence. Three patients were intubated and three were tracheostomised. The average age at distraction was 18 months and the age range went from 7 days to 7 years. The surgical protocol included complete corticotomy, placement of the distraction devices, a latency period of 3−5 days and a distraction rate of 1 mm/day. The stabilization time was 90 days. Results: Expansion of the mandibular framework was analyzed using superimposition of pre and post distraction X Ray cephalogram. The average of mandibular length increment was 23 mm. Conclusions: All patients removed tracheostomy and OT intubation without respiratory distress episodes. The Franceschetti’s patient needed a secondary procedure after 22 months.