Sleep Apnea & Airway Obstruction
Many of the craniofacial syndromes we see and treat have obstructive sleep apnea which is caused by a blockage of the airway, most notably when sleeping. In Aperts and Crouzons Syndrome, upper airway obstruction can be caused by mid-face deficiency, mandibular deficiency, or both. In Pierre Robin Syndrome, Treacher Collins Syndrome, and other cases of micro- retrognathia, the mandible is recessed causing lower airway obstruction.
DescriptionThe Greek word apnea means without breath. Sleep apnea is a common disorder with significant adverse health consequences. Those with untreated sleep apnea stop breathing repeatedly throughout sleep which can lead to high blood pressure, cardiovascular disease, memory problems, weight gain, and headaches. Due to the lack of awareness among the public and healthcare professionals, many remain undiagnosed. The most common etiology of airway obstruction in children is enlarged tonsils and adenoid hypertrophy.
Evaluation and Treatment
The most common rationale for the indication of surgery is the need to alleviate the symptoms of excessive daytime sleepiness and minimize or eliminate the associated cardiovascular and metabolic complications associated with sleep disordered breathing. To determine the severity of sleep apnea, a presurgical evaluation must be completed with the following studies:
- Overnight sleep study
- Comprehensive head and neck physical exam
- 3D CT scan and modified Mueller maneuver
- Lateral cephalometric analysis
- Direct nasopharyngeal endoscopy
In children with obstructive sleep apnea and micrognathia (as in Pierre Robin Syndrome and Treacher Collins Syndrome) surgical treatment of the airway can be an emergency. Our goal is first to provide a stable airway and this may require a tracheostomy in some cases. However, in many cases a tracheostomy may be omitted if the mandible can be moved forward. Distraction osteogenesis of the mandible is a surgical technique that involves the use of internal or externally place devices that allow the team to slowly advance the bone without the need of bone grafting. This takes a period of time, often 2 weeks , and can be done at home. This is followed by a 2-2.5 month period of bone healing prior to the removal of the devices. Many cases have successfully been performed relieving the obstruction and returning the patient to a normal airway.