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ORIGINAL ARTICLE RETROSPECTIVE STUDY
Year : 2016  |  Volume : 6  |  Issue : 2  |  Page : 214-218

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


1 Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
2 Ruth and Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology, Haifa; Department of Orthodontics and Cleft Palate, School of Oral and Dental Surgery, Rambam Health Care Campus, Haifa, Israel
3 Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa; Ruth and Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology, Haifa, Israel

Correspondence Address:
Dekel Shilo
Rambam Health Care Campus, 8 Ha'Aliyah Street, Haifa 35254
Israel
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DOI: 10.4103/2231-0746.200319

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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.


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