Airway analysis: with bilateral distraction of the infant mandible.
BACKGROUND
Mandibular distraction was proven to be a valuable tool for lengthening the hypoplastic mandible and relieving airway obstruction in infants. However, analysis of presurgical and postsurgical three-dimensional computed tomography and polysomnogram studies is lacking. The aim of this study was to describe the effect of distraction on the airway by evaluating the clinical, three-dimensional radiographic and polysomnogram studies before and after distraction.


METHODS
Seventeen infants with micrognathia who underwent internal curvilinear mandibular distraction from April 2005 through April 2008 at Lucile Packard Children's Hospital were included. Preoperative and postoperative computed tomography, polysomnograms, and feeding evaluations were obtained and compared after distraction.


RESULTS
The mean patient age before surgery was 105 days. All patients tolerated the distraction process with a mean mandibular advancement of 18.1 mm. One patient experienced a temporary marginal mandibular nerve palsy that resolved, and 1 postoperative wound infection was encountered. Preoperatively, the mean retroglossal oropharyngeal cross-sectional area was 41.53 mm. This was associated with a mean preoperative apnea-hypopnea index (AHI) of 10.57 and a minimum oxygen desaturation of 83%. After distraction, the mean airway increased to 127.77 mm. All patients had clinical improvement of their respiratory status; the mean postoperative AHI was 2.21, and the minimum oxygen desaturation was 90%. The result was a 209% cross-sectional airway increase. All patients progressed to oral feeds by 3.5 months postoperatively.


CONCLUSIONS
Mandibular distraction is effective at relieving anatomic airway obstruction in infants with micrognathia and obstructive sleep apnea while avoiding some previously reported associated complications.
Looby
Joseph F
JF
Division of Plastic Surgery, Stanford University Medical Center, Palo Alto, CA, USA. josephloobydo@yahoo.com
Schendel
Stephen A
SA
Lorenz
Herman Peter
HP
Hopkins
Elena M
EM
Aizenbud
Dror
D
D000402:Airway Obstruction / Q000601:surgery; D019412:Anatomy, Cross-Sectional; D003389:Cranial Nerve Diseases / Q000209:etiology; D003679:Deglutition / Q000502:physiology; D004435:Eating / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D008334:Mandible / Q000002:abnormalities / Q000601:surgery*; D008340:Mandibular Nerve / Q000503:physiopathology; D008844:Micrognathism / Q000601:surgery*; D009960:Oropharynx / Q000473:pathology; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010243:Paralysis / Q000209:etiology; D017286:Polysomnography; D012119:Respiration; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D010100:Oxygen