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Jaw Surgery for Obstructive Sleep Apnea (OSA) at North Austin Campus

Conditions

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Obstructive Sleep Apnea (OSA) occurs when something is blocking the airway above the vocal cords and causing either problems with healthy sleeping, with getting enough oxygen while sleeping, or both. OSA occurs in 1% to 5% of all children including babies, infants, toddlers, children, and adolescents. It is most common between the ages of 2 and 6 years old. In most cases of OSA in otherwise healthy children, the cause of the obstruction is from enlargement of their tonsils. Our ENT / Otolaryngology surgeons in North Austin are experts in treating tonsil enlargement. 

In certain genetic conditions, like Down syndrome or cerebral palsy, changes in muscle tone at night cause the tissue to come closer together and block the airway. In some craniofacial conditions such as Treacher Collins syndrome, Apert syndrome, Pfeiffer syndrome, Craniofacial Microsomia, and Crouzon syndrome, the chance of having OSA is much higher and can be very severe. Some cases of severe OSA require specialized jaw surgery to treat.

Our craniofacial team at Texas Children’s North Austin Campus specializes in severe obstructive sleep apnea associated with craniofacial conditions. We have introduced innovative surgeries that successfully treat severe OSA when other techniques have failed. In many cases, the patients referred to us have needed to have a breathing tube inserted in their neck (tracheostomy) to breathe since birth. In most cases, our techniques can open these children’s airway, so the tracheostomy is no longer needed. The surgical technique we use will depend on your child’s age, diagnosis, and site of airway obstruction. 

While it is most common for a child to experience mild symptoms of sleep apnea such as heavy snoring or restless sleep, untreated sleep apnea can be dangerous to a child’s health and lead to the following complications:

  • Developmental challenges
  • Heart and Lung conditions
  • Loss of bladder control
  • Attention-deficit / Hyperactivity disorder (ADHD)
  • Changes in behavior, emotions and school performance

Symptoms of OSA that occur during sleeping include:

  • Mouth breathing, loud breathing or snoring
  • Gasping or brief moments when breathing stops
  • Coughing or choking
  • Tossing and turning (restless sleep)
  • Night sweats
  • Sleepwalking or sleep talking
  • Prolonged bedwetting

In addition, children with OSA may have fatigue and headaches during the day.

The first step for determining if your child has sleep apnea is for them to meet with one of our airway specialists in otolaryngology (Ears, Nose, Throat Specialist) or our Sleep Specialists (Sleep Pulmonologists). If your child is first seen in our craniofacial clinic, we will consult these specialists to participate in your child’s care. We will start with learning more about your child’s symptoms and asking questions about their sleep behavior. We will also perform a physical examination and take a complete medical history. 

If our specialists suspect your child does have sleep apnea, we may recommend some of the following tests:

  • Imaging of the upper airway: This may start with a normal x-ray to see the airway shadow from a side (profile) view. If we suspect the position of the jaws is causing the obstructive sleep apnea, we will recommend a CT scan to look at the position of the bones. 
  • Upper airway examination: Depending on the age of your child, our ENT airway specialists can use a small thin flexible camera (endoscope) to examine your child’s airway in clinic while they are awake (nasopharyngoscopy). If OSA is strongly suspected, a more detailed camera examination is performed in the operating room while they are asleep (sleep endoscopy) to determine the level of obstruction.
  • Sleep study (polysomnography): This test monitors your child as they sleep using different monitors that attach to your child’s skin and finger. The sleep study is done in the sleep lab in North Austin where you and your child will sleep overnight. The sleep study will let our sleep specialists measure your child’s brain activity, heart rate, amount of airflow through their mouth and nose, oxygen and carbon dioxide content in their blood, muscle activity, chest and abdominal wall movement, and sleep interruptions. It gives our sleep specialists a lot of data to determine what type of sleep apnea your child may have, and how severe it is. 

Treatment of obstructive sleep apnea will depend on what is blocking your child’s airway based on the tests we perform. Treatments recommended by our sleep specialists and craniofacial team may include:

  • Tonsillectomy and adenoidectomy: Surgery may be necessary to remove enlarged tonsils or adenoids or repair abnormalities in the structure of your child’s airway to create more room.
  • Medications: Some medications can help open your child’s airways to help their breathing. These medications are recommended by our sleep and ENT specialists based on their examination. 
  • Continuous positive airway pressure (CPAP): CPAP uses a small mask over your child’s nose to help them while they sleep at home. The mask attaches to a small machine that blows air through the nostrils and into their airway. The air pressure keeps your child’s airway open so they can breathe normally during sleep. In some cases, the mask may cover both your child’s nose and mouth. The CPAP machine and pressure setting is ordered by our sleep specialists after they determine what settings your child needs during a sleep study. 
  • Jaw Surgery: In cases of severe obstructive sleep apnea associated with a craniofacial condition, we may recommend surgery on your child’s upper, lower, or both jaws, depending on where the obstruction is located. Our craniofacial surgeons, craniofacial orthodontist, ENT airway specialists, and sleep specialists in North Austin work together to design a surgical plan that will meet your child’s specific needs. If the OSA is mostly caused by the tongue blocking the airway, we may recommend orthognathic (jaw) surgery if your child is an older teenager, or mandible distraction osteogenesis if they are younger. In severe cases of OSA, the obstruction is at multiple levels, and we need to include upper jaw surgeries such as C3DO, LF2ZR, or Le Fort 3 Midface distraction.