Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea

Abstract

Background:Obstructive sleep apnea (OSA) in individuals with craniofacial anomalies can compromise airway and is a serious life-threatening condition. In many cases, tracheostomy is carried out as the treatment of choice. Distraction osteogenesis of the mandible as a treatment modality for OSA is very useful and may spare the need for tracheostomy or allow decannulation, yet controlling the vector of distraction is still a major challenge. We present a method for controlling the vector of distraction.Materials and Methods:Eight patients with severe respiratory distress secondary to a micrognathic mandible were treated by mandibular distraction osteogenesis using either external or internal devices. Temporary anchorage devices (TADs) and orthodontic elastics were used to control the vector of distraction. Cephalometric X-rays, computed tomography, and polysomnographic sleep studies were used to analyze the results.Results:A mean distraction of 22 mm using the internal devices and a mean of 30 mm using the external devices were achieved. Increase in the pharyngeal airway and hyoid bone advancement was also observed. Anterior-posterior advancement of the mandible was noted with no clockwise rotation. Most importantly, clinical improvement in symptoms of OSA, respiratory distress, and feeding was noted.Conclusions:We describe a method for controlling the vector of distraction used as a treatment for OSA. In these cases, TADs were used as an anchorage unit to control the vector of distraction. Our results show excellent clinical and radiographical results. TADs are a simple and nonexpensive method to control the vector of distraction.

Classification of Subtypes of Apert Syndrome, Based on the Type of Vault Suture Synostosis

“…Meanwhile, the relative position, morphology, and structure of mandible may be another contributor to respiratory compromise. 24 In class I, the linear measurements with S as reference points, the distance from S to the middle and lower facial landmarks of class I patients, developed wide spread decreases. These proportionate reduced diameters of maxilla and mandible to the S indicate a mutual adaptation and displacement of them.…”

A New Orthodontic-Surgical Approach to Mandibular Retrognathia

“…Nonetheless, the main challenge of the intraoral distractors is controlling the vector direction; when improperly managed it can result in asymmetry or posterior rotation of the mandible [ 37 ]. The treatment plan should consider molar and canine final position in order to plan presurgical orthodontics with fixed appliances, with or without temporary anchorage devices, in order to eliminate dental interferences that may contribute to an unstable occlusion which in turn can alter the distraction vector [ 38 ]. More recently, the introduction of 3D technologies can improve the planning of mandibular osteogenic distractions.…”

Management of Severely Atrophic Maxilla in Ectrodactyly Ectodermal Dysplasia-cleft Syndrome

“…In our study, temporary anchorage devices were used as an alternative option in patients lacking the sufficient dentition for tooth borne elastics. 17 – 19 …”