+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Mandibular distraction osteogenesis in very young patients to correct airway obstruction

Mandibular distraction osteogenesis in very young patients to correct airway obstruction

Plastic and Reconstructive Surgery 108(2): 302-311

The purpose of this study was to measure changes in the airway cross-sectional area of pediatric patients with micrognathia and obstructive airway symptoms after treatment by mandibular distraction. The measurements obtained were correlated with the clinical outcomes.Ten patients, ranging in age from 3 months to 8 years, underwent measurement and distraction. Eight patients were under 30 months of age. Six were diagnosed with Pierre Robin sequence, two with Treacher Collins syndrome, and two with Nager syndrome. All patients had retrognathia of greater than 8 mm and obstructive airway symptoms while awake that had resulted in tracheostomy (3), repeated apnea monitor triggering (5), or abnormal sleep study (2). Cephalometric analysis was performed pretreatment and posttreatment by distraction. The effective airway space was defined with the following boundaries: a horizontal line from the tip of the odontoid to the velum, the uvula tip to the tongue base along the shortest line, the tongue base down to the base of the epiglottis, and the horizontal line to the posterior pharynx. These lines were traced for each cephalogram, the outline was digitized, and the area was calculated by computer. An analysis of the square area change was done by paired t test. The range of distraction was 8 to 22 mm; the mean effective airway increase was 67.5 percent, with a range of 26 to 120 percent. Measurable airway increase occurred in all patients who underwent distraction, and all patients showed clinical improvement. Six patients with Pierre Robin sequence became asymptomatic, with normal sleep, feeding, and weight gain. Two patients with Nager syndrome and tracheostomies were decannulated and were asymptomatic postdistraction. One patient with Treacher Collins syndrome without tracheostomy became asymptomatic after mandibular distraction; one patient failed to distract because of premature consolidation and continued to require a cannula. Mandibular distraction seems to provide a consistent change in tongue base position that improves obstructive airway symptoms by increasing measured effective airway space. The potential for mandibular distraction exceeds the simple correction of malocclusion also by eliminating soft-tissue obstruction of the micrognathic airway. Airway improvement is independent of the syndrome diagnosed. Mandibular distraction osteogenesis may be useful to avoid or decannulate existing tracheostomy in infants with micrognathia.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 046619746

Download citation: RISBibTeXText

PMID: 11496167

DOI: 10.1097/00006534-200108000-00004

Related references

Impact of mandibular distraction osteogenesis on the oropharyngeal airway in adult patients with obstructive sleep apnea secondary to retroglossal airway obstruction. Journal of Maxillofacial and Oral Surgery 13(2): 92-98, 2014

Poster 29: Mandibular Distraction Osteogenesis in Pediatric Patients for Relief of Upper Airway Obstruction. Journal of Oral and Maxillofacial Surgery 67(9-Supp-S): 84-85, 2009

Mandibular distraction osteogenesis for neonatal airway obstruction. Operative Techniques in Otolaryngology-Head and Neck Surgery 16(3): 187-193, 2005

Mandibular distraction osteogenesis used to treat upper airway obstruction. Archives of Facial Plastic Surgery 12(1): 11-15, 2010

Correction of airway obstruction in congenital micrognathia by mandibular distraction osteogenesis. Journal of the College of Physicians and Surgeons--Pakistan 21(7): 423-425, 2011

Mandibular distraction osteogenesis to relieve Pierre Robin airway obstruction. American Journal of Otolaryngology 27(6): 436-439, 2006

Correction of upper airway obstruction in the newborn with internal mandibular distraction osteogenesis. Journal of Craniofacial Surgery 14(4): 493-499, 2003

Mandibular distraction osteogenesis for neonates with Pierre Robin sequence and airway obstruction. Journal of Maternal-Fetal and Neonatal Medicine 25(Suppl. 4): 141-143, 2012

Mandibular distraction osteogenesis for the treatment of neonatal tongue-based airway obstruction. Journal of Craniofacial Surgery 26(3): 634-641, 2015

Treatment of upper airway obstruction in infants with micrognathia using mandibular distraction osteogenesis. Facial Plastic Surgery 23(2): 107-112, 2007

Treatment of airway obstruction with mandibular distraction osteogenesis in Pierre Robin syndrome. Zhonghua Zheng Xing Wai Ke Za Zhi 26(1): 4-7, 2010

"Mandibular distraction osteogenesis for severe airway obstruction in Robin Sequence. Case report". Journal of Cranio-Maxillo-Facial Surgery 38(6): 431-435, 2010

Mandibular distraction osteogenesis in the treatment of upper airway obstruction in children with craniofacial deformities. Plastic and Reconstructive Surgery 101(2): 312-318, 1998

Mandibular distraction osteogenesis for the management of upper airway obstruction in children with micrognathia: a systematic review. International Journal of Oral and Maxillofacial Surgery 45(6): 769-782, 2016

The effect of mandibular distraction osteogenesis on airway obstruction and polysomnographic parameters in children with Robin sequence. Journal of Cranio-Maxillo-Facial Surgery 46(8): 1343-1347, 2018