title: Incidence of concomitant airway anomalies when using the university of California, Los Angeles, protocol for neonatal mandibular distraction.
abstract: BACKGROUND
  In newborns with micrognathia and severe upper airway obstruction, understanding potential airway lesions is important for determining appropriate treatment: observation, mandibular distraction, or tracheostomy. When concomitant airway anomalies are present, mandibular distraction is often unsuccessful at alleviating causes of obstruction, mandating the need for tracheostomy. The first part of this study evaluates 10-year results using the University of California, Los Angeles, algorithm for surgical candidacy to identify patients who will benefit from neonatal mandibular distraction. The second part describes the concomitant airway abnormalities found at the time of diagnostic laryngoscopy/bronchoscopy and how these anomalies affect neonatal distraction candidacy of these patients.
  
  
  METHODS
  Newborns admitted to the neonatal intensive care unit with micrognathia and upper airway obstruction (n = 133) were subjected to a decision tree model protocol formulated by a multidisciplinary team at the University of California, Los Angeles, to decide on appropriate treatment. Concomitant airway abnormalities were recorded and outcomes were documented for the first 5 years of life.
  
  
  RESULTS
  Fifty-five percent of patients underwent internal mandibular distraction with 97 percent success. Home observation with a nasopharyngeal tube was chosen in 11 percent of patients, and 34 percent had tracheostomies. On endoscopic examination, 51.7 percent of the nondistracted patients had concomitant airway anomalies: laryngomalacia (53.3 percent), tracheal web (20.0 percent), vocal cord paralysis (13.3 percent), epiglottal collapse (6.7 percent), and infraglottal narrowing (6.7 percent).
  
  
  CONCLUSIONS
  For the management of neonatal upper airway obstruction with micrognathia, a decision tree algorithm is useful to determine candidates for mandibular distraction. Diagnostic laryngoscopy/bronchoscopy is an important component of this algorithm because a multitude of airway anomalies may be present.
  
  
  METHODS
  : Therapeutic, IV.
authors: Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles.
authors: Brian T
authors: BT
authors: Andrews
authors: Kenneth L
authors: KL
authors: Fan
authors: Jason
authors: J
authors: Roostaeian
authors: Christina
authors: C
authors: Federico
authors: James P
authors: JP
authors: Bradley
mesh_terms: D000402:Airway Obstruction / Q000453:epidemiology* / Q000601:surgery*; D000465:Algorithms; D001999:Bronchoscopy; D003663:Decision Trees; D004825:Epiglottis / Q000002:abnormalities / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods; D007828:Laryngoscopy; D008297:Male; D008334:Mandible / Q000002:abnormalities / Q000601:surgery*; D008844:Micrognathism / Q000453:epidemiology* / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods*; D014132:Trachea / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery
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