Surgical strategies in the treatment of complex obstructive sleep apnoea in children.

Complex OSA in children is a challenging problem that requires careful team management. Evaluation includes history, physical examination and appropriate radiological and endoscopic studies. Twelve-channel polysomnography, with or without a pH probe, is mandatory in children with OSA to determine the severity and to document the efficacy of treatment. A variety of individual problems and nuances arise and will continue to do so. Clinical experience and a high degree of suspicion in the craniofacial population is necessary to rule out the existence of OSA in a given patient. Newer treatment modalities, such as distraction osteogenesis of the mandible and midface, have revolutionised treatment of OSA during childhood. Although still the gold standard of care, tracheostomy is not a benign procedure and the toll on both the patient and family can be devastating.