Thus, micrognathia and retrognathia, while providing similar facial profiles, are produced by different primary developmental processes, and each may integrate differently with tongue and palatal development. Micrognathia describes a mandible that is absolutely reduced in size, indicating that the mandible is primarily affected, while retrognathia refers to a normally sized mandible that is placed posteriorly relative to the upper jaw. Micro- and retrognathia are the most common terms used to describe mandibular phenotypes in mandibulofacial dysostosis, yet the current lack of precision in usage of these terms in diagnoses of mandibular dysmorphology does not critically consider the potentially distinct etiology of these phenotypes and their influence on the possible sequelae of anomalies. Since being named for the physician who provided an early description, it was variously defined as a set of anomalies that can include micro- or retrognathia, glossoptosis, respiratory obstruction, and cleft palate (CP), and termed Pierre Robin syndrome, sequence, anomalad, or complex. Internal distractors increase patient comfort, increase device stability during the treatment and provide better bone quality over those of external devices 10.Pierre Robin is an ill-defined disorder with specific mandibulofacial involvement that continues to defy a consistent definition. We were unable to perform orthognathic surgery in this patient. Therefore, we chose an intraoral distractor device. However, we deferred the use of this device in our patient, because we believed that she would be bothered by the device, potentially compromising the treatment. We considered an extraoral multi-vector distractor. In this study, we performed distraction osteogenesis using internal devices in the treatment of obstructive sleep apnea. These devices have reduced retention period and an increased relapse incidence compared to those of internal devices 16. However, external devices also create aesthetic, social problems and produce scars. External devices are advantageous because of their ease of use, manipulation and versatility. Mandibular advancement for the treatment of OSAS was initially performed using bilateral external distracters 10. The patient was doing well at her one-year follow-up examination.( Fig. She was able to position her tongue in her mouth, and could sleep comfortably. After distraction osteogenesis, the patient’s respiratory problems resolved. 5), the distractors were removed through the same incision site under general anesthesia. A 15-mm expansion was provided in the mandible using internal bilateral distractors. After one week, the distraction was performed to provide 1 mm expansion per day. The patient was treated with cefamezin (500 mg, twice a day) and intramuscular diclofenac sodium (once a day) for one week. There were no surgical or neurological complications encountered during the operation. The same procedure was performed on both sides of the mandible. 4), and the wound was closed primarily with resorbable sutures. An osteotomy was then completed using chisels. 3) A monocortical incision was made in the section corresponding to the mandibular canal in order to protect the inferior alveolar nerve. An osteotomy was performed with piezo surgery from the front of the ramus to be perpendicular to the mandibular corpus.( Fig. The mandibular corpus was revealed by blunt dissection. A submandibular incision was performed under general anesthesia. 2), mandibular distraction osteogenesis was planned. Keywords: Distraction osteogenesis, Obstructive sleep apnea, Treacher Collins syndrome, Mandibulofacial dysostosisĪfter a radiological examination ( Fig. Distraction osteogenesis was an effective method of advancing the mandible, increasing the upper airway space and ultimately preventing obstructive sleep apnea syndrome in patients with Treacher Collins syndrome. After distraction osteogenesis, the patient’s respiratory problems resolved, and she was able to sleep comfortably. The mandible was expanded by 15 mm using internal bilateral distractors. The patient underwent mandibular distraction osteogenesis under general anesthesia. The patient was referred to a sleep laboratory where she was diagnosed with obstructive sleep apnea, which was a consequence of her Treacher Collins syndrome. A 10-year-old girl with a past history of Treacher Collins syndrome presented to our clinic with her parents for respiratory distress and insomnia. In this study, we present the surgical treatment of obstructive sleep apnea in a child with Treacher Collins syndrome.
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