title: Reformatted 3D airway imaging in patients with airway obstruction and micrognathia.
abstract: OBJECTIVE
  Mandibular distraction osteogenesis (MDO) is an effective treatment for patients with micrognathia and severe recurrent airway obstruction (Denny, 2004; Denny and Amm, 2005; Denny, 2009; Cicchetti et al., 2012; Flores et al., 2014). However the efficacy of the procedure is based on selecting the appropriate patient. Presence of central apnea or airway obstruction anywhere other than the tongue base will make MDO futile. The availability of three dimensional reformatting of the airway has greatly improved the accuracy of correct patient selection, providing a powerful tool to further characterize the pathology in these patients.
  
  
  METHODS
  We conducted a retrospective review of the last thirty patients with micrognathia and severe recurrent airway obstruction seen in consult by the senior author for potential role of surgery in their management.
  
  
  RESULTS
  Twenty-one patients met our inclusion criteria, with fourteen treated appropriately with MDO. The remaining patients had findings on the 3D airway CT scans with other anatomic causes of obstruction making them inappropriate candidates for mandibular distraction osteogenesis.
  
  
  CONCLUSIONS
  The use of three dimensional formatting of the airway from CT scans obtained using low dose protocols has improved the accuracy of evaluation and treatment of Pierre Robin patients. Most valuable is the non-invasive identification of airway abnormalities that would make mandibular distraction osteogenesis ineffective in correcting the airway obstruction.
authors.affiliation: Penn State Hershey Medical Center Plastic Surgery, 500 University Drive, Mail Code HO71, Hershey, PA 17033, United States. Electronic address: chenry1@hmc.psu.edu.
authors.forename: Cathy R
authors.initials: CR
authors.lastname: Henry
authors.affiliation: Department of Plastic Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53225, United States. Electronic address: ADenny@chw.org.
authors.forename: Arlen D
authors.initials: AD
authors.lastname: Denny
mesh_terms: D000402:Airway Obstruction / Q000601:surgery*; D006801:Humans; D008334:Mandible / Q000601:surgery; D008844:Micrognathism / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods*; D010855:Pierre Robin Syndrome; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Airway obstruction/surgery; Finite element analysis; Imaging, Three-dimensional; Micrognathism/surgery; Osteogenesis, Distraction; Pierre Robin Sequence/surgery