Mandibular advancement by distraction osteogenesis for tracheostomy-dependent children with severe micrognathia.
OBJECTIVE
The purpose of this study was to evaluate mandibular lengthening by distraction osteogenesis (DO) to achieve decannulation of micrognathic children with "permanent" tracheostomies.


METHODS
Using a retrospective chart review, patients were included who had 1 ) airway compromise/tracheostomy, 2 ) micrognathia, 3 ) polysomnography-documented obstructive apnea, and 4 ) mandibular advancement using DO. Excluded were 1 ) adults, 2 ) neonates without tracheostomy, and 3 ) patients with central apnea. Patient age, past medical history, age at tracheostomy, and distraction protocol were documented. Oxygen saturation, posterior airway space (in millimeters), and sella-nasion-B point (SNB) angle were recorded. The distraction protocol consisted of a latency of 48 hours and a rate of 1 mm/day.


RESULTS
There were 5 children, aged 2 to 14 years, who received a tracheostomy between ages 2 and 36 months for airway obstruction. All patients underwent bilateral mandibular distraction using semiburied, unidirectional devices. The average latency was 58 hours, the rate was 1 mm/day, the duration of fixation was 40 to 60 days, and the magnitude of advancement was 23 mm. Healing was evaluated by clinical, radiologic, and ultrasound examinations. No complications were experienced. Mean follow-up was 3.2 years. Postdistraction sleep studies demonstrated no obstructive apneic events and a mean oxygen saturation of 98% (preoperative, 76%, P < .005). Cephalometric values improved: posterior airway space 4 to 14 mm; SNB 66 degrees to 72 degrees ( P < .005 for both variables). Four of the 5 patients have been successfully decannulated to date.


CONCLUSIONS
The results of this preliminary study indicate that mandibular advancement by DO is a potentially viable treatment option for tracheostomy-dependent children with upper airway obstruction secondary to micrognathia.
Steinbacher
Derek M
DM
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02112, USA.
Kaban
Leonard B
LB
Troulis
Maria J
MJ
D000293:Adolescent; D000402:Airway Obstruction / Q000601:surgery; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D019186:Mandibular Advancement / Q000379:methods*; D008844:Micrognathism / Q000601:surgery*; D009666:Nose / Q000473:pathology; D019857:Osteogenesis, Distraction / Q000379:methods*; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D014139:Tracheostomy; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
D010100:Oxygen