Mandibular Hypoplasia refers to a jaw that is underdeveloped and small. When a mandible is too small, the teeth may not line up well and lead to an underbite or underjet. This may have important consequences for eating and even speech when significant during development. When the jaw underdevelopment, or retrognathia (or posterior-placed position of the jaw) is severe enough, it may lead to tongue-based airway obstruction causing sleep apnea (OSA).
OSA is when the airway is blocked temporarily during sleep (in this case by the tongue) leading to intermittent low oxygen levels (hypoxia), pauses in breathing (apnea) and frequent interruptions in sleep. Other causes of OSA may be enlarged tonsils, midface hypoplasia, and certain medications.
A child who is suffering from sleep apnea may show signs of:
- Frequent snoring
- Waking up suddenly or gasping for air
- Daytime somnolence (sleepiness or fatigue)
- Trouble concentrating at school
- Irritability, headaches, restlessness
- Trouble getting up in morning
- Night sweats
Untreated OSA has significant morbidity including:
- Growth disturbance
- Failure to thrive
- Acid Reflux
- Brain damage
- Feeding difficulties
- Carbon dioxide retention
- High blood pressure
- Pulmonary hypertension
- Cardiac heart failure
- Cardiac arrhythmia (irregular beats)
- Sudden Death
Nonsurgical approaches for sleep apnea often include weight loss or positive pressure therapy (Bi-PAP or CPAP). When conservative approaches are not improving the obstruction, surgery may be warranted.
Please contact your pediatrician or craniofacial surgeon if your neonate has a small jaw and any of the above symptoms. A sleep study may be required to determine what level of obstruction is occurring and if it is due to the small jaw and tongue position or not.