Shilo Dekel, Emodi Omri, Aizenbud Dror, Rachmiel Adi
Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.
Ruth and Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology, Haifa, Israel; Department of Orthodontics and Cleft Palate, School of Oral and Dental Surgery, Rambam Health Care Campus, Haifa, Israel.
Ann Maxillofac Surg. 2016 Jul-Dec;6(2):214-218. doi: 10.4103/2231-0746.200319.
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.
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.
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.
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.
颅面畸形患者的阻塞性睡眠呼吸暂停（OSA）会使气道受损，是一种严重的危及生命的病症。在许多情况下，气管造口术是首选的治疗方法。下颌骨牵张成骨术作为治疗OSA的一种方式非常有用，可能无需进行气管造口术或允许拔管，但控制牵张向量仍然是一项重大挑战。我们提出一种控制牵张向量的方法。
8例因小下颌导致严重呼吸窘迫的患者采用外部或内部装置进行下颌骨牵张成骨术治疗。使用临时锚固装置（TAD）和正畸弹力线来控制牵张向量。采用头影测量X线片、计算机断层扫描和多导睡眠图睡眠研究来分析结果。
使用内部装置平均牵张22毫米，使用外部装置平均牵张30毫米。还观察到咽部气道增加和舌骨前移。下颌骨前后移位，无顺时针旋转。最重要的是，OSA、呼吸窘迫和喂养症状有临床改善。
我们描述了一种控制牵张向量的方法，用于治疗OSA。在这些病例中，TAD被用作锚固单元来控制牵张向量。我们的结果显示出优异的临床和影像学结果。TAD是一种控制牵张向量的简单且廉价的方法。
