title: Mandibular distraction for micrognathia and severe upper airway obstruction.
abstract: 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.
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA. david.mandell@chp.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Mandell
authors.forename: Robert F
authors.initials: RF
authors.lastname: Yellon
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
authors.forename: Keyoumars
authors.initials: K
authors.lastname: Izadi
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Gordon
mesh_terms: 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