下颌骨牵引成骨术治疗儿童小下颌畸形伴阻塞性睡眠呼吸暂停综合征

Mandibular distraction osteogenesis in the treatment of obstructive sleep apnea syndrome in children with micrognathia

目的探讨和评价下颌骨牵引成骨技术在治疗儿童小下颌畸形伴阻塞性睡眠呼吸暂停综合征(obstructivesleepapneasyndrome,OSAS)中的应用价值。方法6例先天性小下颌发育不全畸形伴重度OSAS,年龄4个月至9岁。每例患者术前术后均行X射线头影测量及睡眠多导图仪检查。用牵引成骨技术牵引双侧下颌骨,带动舌和口底肌肉组织前移,使口咽腔通畅,达到治疗小下颌畸形患者OSAS的目的。结果6例12侧下颌骨牵引成骨,最大牵引延长距离为25mm,最小15mm,平均19.2mm。后气道间隙由平均4.5mm增至10.1mm。牵引时间最短10d,最长20d,平均14.5d。所有病例在截骨、牵引器固定过程中均未损伤下牙槽神经血管束。牵引过程顺利,牵引区成骨良好。随访2至11个月。1例需要进行继续治疗,5例均恢复正常呼吸,去除鼻咽导气管和气管切开导管。结论下颌骨牵引成骨术是治疗OSAS重要的有效治疗手段,能够有效地矫正口咽腔气道狭窄,改善呼吸,可在年幼儿童应用。随着应用例数的增多会更详尽阐明其所发挥的作用。

Objective To evaluate the treatment of obstructive sleep apnea syndrome(OSAS ) in children with congenital micrognathia using mandibular distraction osteogenesis and to discuss the advantages and disadvantages of this approach. Methods 6 patients (4 males, 2 females) had undergone mandibular distraction osteogenesis,12 distraction devices were placed through extroral incision for bilateral distraction. The mean age of treatment was 1 year and 9 months (range 4 months to 9 years). Every patient had been evaluated pre and postoperatively with cephalometry. The peroid of consolidation was 4～11 weeks. The period of follow-up was from 2 to 10 months. Results The average distraction distance was 19.2 mm (range 15 to 25 mm). The osteotomy and distraction processes were smooth in all the cases, the osteogenesis was good,without infection and other complications. The posterior airway space was increased from averaged 4.5 mm preoperatively to 10.1mm after surgery. Five children had normal respiration and sleep restored with naso-pharyngeal airway removal or tracheostomy decannulation. One patient is to receive a planned second stage of distraction with a horizontal vector. The results were stable without relapse during a follow-up period of 2 to 10 months. Conclusions Application of mandibular distraction osteogenesis is an important component and effective in the treatment of OSAS and permits mandibular advancement in the younger child. As more experience is gained with distraction osteogenesis in the treatment of children with OSAS, the role of distraction will become better defined.;