Mandibular distraction to relieve airway obstruction in children with cerebral palsy

Objective: To determine the effectiveness of distraction osteogenesis of the mandible for relief of airway obstruction in neurologically impaired children. Design: Prospective pilot study. Setting: Tertiary care children's hospital. Patients: Five children with upper airway obstruction secondary to hypotonia were identified by airway endoscopy, pulse oximetry, and polysomnography. Four children were tracheotomy-dependent because of upper airway obstruction, and 1 was being considered for tracheotomy because of progressive airway obstruction. Interventions: All patients underwent distraction osteogenesis of the mandible for relief of their airway obstruction. Main Outcome Measures: Treatment success was determined by endoscopy, continuous pulse oximetry, and polysomnography. Results: Four of the 5 children underwent distraction osteogenesis of the mandible with successful resolution of airway obstruction or tracheotomy decannulation. One child did not show adequate improvement of upper airway obstruction and remained tracheotomy-dependent. Follow-up was 2 to 40 months. Conclusions: Children with cerebral palsy and hypotonia of the upper airway may achieve relief of their chronic airway obstruction following distraction osteogenesis of the mandible. Appropriate selection criteria must be adhered to, including demonstration of tongue base obstruction on flexible laryngoscopy.