Mandibular distraction osteogenesis in infants younger than 3 months.
OBJECTIVE
To examine the long-term outcomes and complications in infants with upper airway obstruction and feeding difficulty who underwent bilateral mandibular distraction osteogenesis (MDO) within the first 3 months of life and to identify any preoperative characteristics that may predict the long-term outcome following early MDO intervention for airway obstruction.


METHODS
An institutional, retrospective medical chart review was performed. Inclusion criteria were bilateral MDO performed at an age younger than 3 months, with a minimum follow-up of 3 years. A quantitative outcome measures scale was developed, and patients were scored based on long-term postoperative complications as well as airway and feeding goals. Factors such as need for an additional surgical procedure were also considered.


RESULTS
Nineteen children were identified as having undergone MDO before 3 months of age and having more than 3 years of follow-up data. The mean age at distraction was 4.8 weeks (range, 5 days-12 weeks); the mean length of follow-up was 5.6 years (range, 37-122 months). Of these 19 patients, 14 had isolated Pierre Robin sequence (PRS) and 5 had syndromic PRS. All patients with isolated PRS had a good or intermediate long-term result. Infants with comorbidities such as developmental delay, seizures, or arthrogryposis had the poorest outcomes.


CONCLUSIONS
Bilateral MDO is a relatively safe and effective means of treating airway obstruction and feeding difficulty in infants with PRS. The effects of this procedure, which carries a relatively low morbidity, persist through early childhood in most patients.
Department of Otolaryngology-Head & Neck Surgery, Tufts University School of Medicine, PO Box 850, 800 Washington St, Boston, MA 02111, USA. ascott@tuftsmedicalcenter.org
Andrew R
AR
Scott
Robert J
RJ
Tibesar
Timothy A
TA
Lander
Daniel E
DE
Sampson
James D
JD
Sidman
D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008334:Mandible / Q000601:surgery*; D008844:Micrognathism / Q000150:complications / Q000601:surgery; D019857:Osteogenesis, Distraction; D010855:Pierre Robin Syndrome / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome