Mandibular distraction for micrognathia and severe upper airway obstruction.
OBJECTIVE
To determine whether the use of mandibular distraction osteogenesis (DOG) can help to avoid tracheotomy or achieve decannulation in patients with mandibular hypoplasia and severe upper airway obstruction.


METHODS
Retrospective medical record review (spanning a 27-month period).


METHODS
Tertiary care children's hospital.


METHODS
Group A (n=8) was composed of infants with Pierre Robin sequence and no tracheotomy (mean age, 2.5 months); group B (n=6), older nontracheotomized micrognathic children with obstructive sleep apnea (OSA) (mean age, 69 months); and group C (n=12), tracheotomized children with complex congenital syndromes (mean age, 33 months).


METHODS
Bilateral mandibular DOG with endoscopic (n=24) and/or radiographic (n=17) airway evaluation (mean follow-up, 16 months [range, 2-42 months]).


METHODS
Group A, tracheotomy avoidance; group B, resolution of OSA (clinically or on polysomnography); and group C, decannulation.


RESULTS
Group A, 7 patients (88%) successfully avoided tracheotomy; group B, 5 patients (83%) had resolution of OSA; and group C, 2 patients (17%) underwent decannulation.


CONCLUSIONS
Mandibular DOG (1) allows tracheotomy avoidance in infants with isolated Pierre Robin sequence and (2) relieves OSA in older micrognathic children without tracheotomy. However, mandibular DOG does not frequently lead to decannulation in tracheotomized patients with complex congenital syndromes.
Mandell
David L
DL
Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA. david.mandell@chp.edu
Yellon
Robert F
RF
Bradley
James P
JP
Izadi
Keyoumars
K
Gordon
Christopher B
CB
D016022:Case-Control Studies; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008844:Micrognathism / Q000601:surgery*; D019857:Osteogenesis, Distraction; D010855:Pierre Robin Syndrome / Q000601:surgery; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014140:Tracheotomy