title: Mandibular distraction osteogenesis for the management of upper airway obstruction in children with micrognathia: a systematic review.
abstract: Mandibular distraction osteogenesis (MDO) is increasingly used for neonates and infants with upper airway obstruction secondary to micrognathia. This systematic review was conducted to determine the effectiveness of MDO in the treatment of airway obstruction. The databases searched included PubMed, Embase, Scopus, and grey literature sources. The inclusion criteria were applied to identify studies in children with clinical evidence of micrognathia/Pierre Robin sequence (PRS) who had failed conservative treatments, including both syndromic and non-syndromic patients. Overall 66 studies were included in this review. Primary MDO for the relief of upper airway obstruction was found to be successful at preventing tracheostomy in 95% of cases. Syndromic patients were found to have a four times greater odds of failure compared to those with isolated PRS. The most common causes of failure were previously undiagnosed lower airway obstruction, central apnoea, undiagnosed neurological abnormalities, and the presence of additional cardiovascular co-morbidities. MDO was less effective (81% success rate) at facilitating decannulation of tracheostomy-dependent children (P<0.0001). Failure in these patients was most commonly due to severe preoperative gastro-oesophageal reflux disease, swallowing dysfunction, and tracheostomy-related complications. The failure rate was higher when MDO was performed at an age of ≥24 months. More studies are needed to evaluate the long-term implications of MDO on facial development and long-term complications.
authors: Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Joanna Briggs Institute, School of Translational Science, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: Omar.breik@gmail.com.
authors: O
authors: O
authors: Breik
authors: Joanna Briggs Institute, School of Translational Science, University of Adelaide, Adelaide, South Australia, Australia.
authors: D
authors: D
authors: Tivey
authors: Joanna Briggs Institute, School of Translational Science, University of Adelaide, Adelaide, South Australia, Australia.
authors: K
authors: K
authors: Umapathysivam
authors: Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia; Oral and Maxillofacial Surgery Unit, Universiti Sains Malaysia, Kota Bharu, Malaysia.
authors: P
authors: P
authors: Anderson
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D002648:Child; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008334:Mandible / Q000601:surgery*; D008844:Micrognathism / Q000150:complications / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods*; D010855:Pierre Robin Syndrome; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Pierre Robin sequence; decannulation; mandibular distraction; tracheostomy; upper airway obstruction