title: Infant Mandibular Distraction for Upper Airway Obstruction: A Clinical Audit.
abstract: BACKGROUND
  Mandibular distraction osteogenesis (MDO) is an effective method of treating upper airway obstruction (UAO) in micrognathic infants. The short-term outcomes include relief of UAO, avoidance of tracheostomy, and prompt discharge from hospital. However, it is a significant surgical procedure with potential associated morbidities. This study describes a cohort of infants managed using MDO over a twelve-year period.
  
  
  METHODS
  A retrospective chart review was undertaken for children who had MDO before the age of 5 years between 2000 and 2012. This was followed by a clinical review of the same cohort specifically looking for dental anomalies, nerve injuries, and scar cosmesis.
  
  
  RESULTS
  Seventy-three children underwent MDO at a mean age of 2 months [interquartile range (IQR), 1.7-4.2] for nonsyndromic infants and 3.3 months (IQR, 2.1-7.4) for those with syndromes. Infants were discharged from hospital, on average, 15 days after procedure. After MDO, of the 9 who were previously tracheostomy dependent, 5 (56%) were decannulated within 12 months and none of the nontracheostomy-dependent children required further airway assistance. The majority of children required supplemental feeding preoperatively but, 12 months postoperatively, 97% of the nonsyndromic infants fed orally. Thirty-nine children (53%) were reviewed clinically [median age, 5.1 y (IQR, 3.9-6.5)] with 18 being syndromic. Many of the mandibular first permanent and second primary molars had developmental defects, but there was a low rate of neurosensory deficit and good scar cosmesis.
  
  
  CONCLUSIONS
  This study contributes further to the evidence base underpinning the management of micrognathic infants with UAO.
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Head, Oral & Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, the Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia; and Plastic Surgery Research, Murdoch Childrens Research Institute, the Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Ashim N
authors.initials: AN
authors.lastname: Adhikari
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Head, Oral & Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, the Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia; and Plastic Surgery Research, Murdoch Childrens Research Institute, the Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew A C
authors.initials: AA
authors.lastname: Heggie
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Head, Oral & Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, the Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia; and Plastic Surgery Research, Murdoch Childrens Research Institute, the Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Shand
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Head, Oral & Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, the Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia; and Plastic Surgery Research, Murdoch Childrens Research Institute, the Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Patrishia
authors.initials: P
authors.lastname: Bordbar
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Head, Oral & Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, the Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia; and Plastic Surgery Research, Murdoch Childrens Research Institute, the Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pellicano
authors.affiliation: Faculty of Medicine, Dentistry and Health Sciences and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Head, Oral & Maxillofacial Surgery Unit, Department of Plastic and Maxillofacial Surgery, the Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia; and Plastic Surgery Research, Murdoch Childrens Research Institute, the Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Nicky
authors.initials: N
authors.lastname: Kilpatrick