title: Endoscopic changes in the upper airway after mandibular distraction osteogenesis.
abstract: BACKGROUND
  Children with micrognathia secondary to craniofacial disorders can experience significant airway and feeding difficulties. Mandibular distraction osteogenesis (MDO) is one treatment of severe micrognathia. We examined endoscopic images for upper airway (UA) soft tissue changes after MDO. We hypothesized that MDO produces consistent changes in UA soft tissue, which correlate with symptom resolution.
  
  
  METHODS
  This retrospective chart review included 16 patients undergoing MDO from 2002 to 2007. Demographic data, symptom information, and preoperative and early and late postoperative endoscopic images were collected. Blinded randomized images of UA soft tissues were quantitatively analyzed using ImageJ. To compare nonstandardized images, ratios of UA dimensions were made. Preoperative and early and late postoperative ratios were statistically analyzed with Student's t-test.
  
  
  RESULTS
  Sixteen patients with a mean age of 237 days were included. Mean distance distracted was 12 mm. There were significant changes in relative dimensions of the supraglottic space in the early postoperative period, which were not maintained in the late postoperative period. Nevertheless, all experienced complete relief of airway obstruction.
  
  
  CONCLUSIONS
  Our study showed a significant increase in supraglottic space dimensions after MDO that was not maintained over time. This is likely because of the limitation of images and measurement methods. Despite this, significant clinical improvement was seen in all patients, with resolution of airway obstruction. This suggests supraglottic changes as well as tongue base alterations are related to clinical improvement. Further investigation of alterations in UA after MDO is needed to continue characterizing these changes.
authors.affiliation: Division of General Surgery, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
authors.forename: Terrah Paul
authors.initials: TP
authors.lastname: Olson
authors.forename: J Scott
authors.initials: JS
authors.lastname: McMurray
authors.forename: Delora L
authors.initials: DL
authors.lastname: Mount
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008334:Mandible / Q000601:surgery*; D019857:Osteogenesis, Distraction; D010855:Pierre Robin Syndrome / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome