Compression-distraction devices in the treatment of congenital disorders in children. Case series

Abstract

Relevance. In many cases, Pierre Robin sequence and congenital micrognathia lead to respiratory failure, obstructive sleep apnea, and aspiration of food due to swallowing problems. Compression-distraction osteogenesis method allowed for the effective achievement of a stable clinical result with the minimum losses for the child's body. Purpose. The study aimed to conduct a retrospective analysis of various types of compression-distraction devices based on the Department of Maxillofacial Surgery of the Republican Children's Clinical Hospital. Material and Methods. Since 2010, 36 children aged three months to 13 years have been operated, 20 boys and 16 girls. Four children were operated using an multi-vector external compression-distraction device. Two children with Pierre Robin sequence had surgery with a Conmet intraoral compression-distraction device, 27 children – with a KLS Martin bone-borne compression-distraction device, of which 15 had Pierre Robin sequence, and 12 had congenital lower micrognathia. Seven children had tracheostomy, which had been placed due to permanent sleep apnea. Results . Three (8.33%) children were operated using external compression-distraction devices. From three months to one year. A patient with Pierre Robin sequence, tracheostomy, and cannula. A tracheostomy was installed at the age of 15 days due to persistent apnea. At three months of age, bilateral osteotomy of the mandible with the installation of an external compression-distraction device was performed. Compression was for three days; then, they began distraction of one mm/day for 15 days. Five months later, the child began to breathe freely through the natural respiratory tract; under mask anesthesia, the compression-distraction device was removed. Four children (11.11%) aged 8 to 12 months were operated using multi-vector external compression-distraction device. A patient aged one year with Pierre Robin sequence, tracheostomy, and cannula. The external compression-distraction device was installed at the age of eight months. The distraction period was 12 days. The consolidation period was three months. The treatment result was independent breathing through the natural respiratory tract. The tracheostomy cannula was removed. Twenty-nine children 2 (5.56%) were operated using intraoral bone-borne compressiondistraction devices. A child aged 14 months, diagnosed with Pierre Robin sequence, complained of periodic sleep apnea with signs of acrocyanosis. Moderate to severe obstructive sleep apnea was detected. A bilateral osteotomy of the mandible was performed, and a bone-borne compression-distraction device was installed. Compression was for three days, then the distraction of 0.5 mm twice a day – for 14 days. Distraction was performed at 14 mm. After five months, the bone-borne CDD was removed, and polysomnography was repeated. The apnea-hypopnea index (AHI) was <5. Respiratory function was fully restored. Conclusion . Thus, 24 children showed successful results with the use of compression-distraction device (an orthognathic occlusion was formed, glossoptosis was eliminated, natural breathing and feeding were restored); 11 children did not have a satisfactory result (due to distraction interruption, it was not possible to achieve a physiological bite, there was postoperative wound suppuration with wound dehiscence). There was one negative result due to trauma: the child fell on his chin at home during the consolidation period, and the compression-distraction device broke, which resulted in disocclusion.