Mandibular distraction for micrognathia and severe upper airway obstruction

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Respiratory Medicine

Background:

• Severe upper airway obstruction in infants and children often necessitates tracheotomy.
• Mandibular hypoplasia is a common cause of airway obstruction, particularly in conditions like Pierre Robin sequence.
• Existing treatments for severe airway obstruction carry significant risks and morbidity.

Purpose of the Study:

• To evaluate the efficacy of mandibular distraction osteogenesis (DOG) in avoiding tracheotomy or achieving decannulation in pediatric patients with mandibular hypoplasia.
• To assess DOG's effectiveness across different patient groups: infants with Pierre Robin sequence, older children with obstructive sleep apnea (OSA), and tracheotomized children with complex syndromes.

Main Methods:

• Retrospective review of medical records from a tertiary care children's hospital over 27 months.
• Patients were categorized into three groups: infants with Pierre Robin sequence (Group A), older children with OSA (Group B), and tracheotomized children with complex congenital syndromes (Group C).
• All patients underwent bilateral mandibular DOG with endoscopic and/or radiographic airway evaluation, with a mean follow-up of 16 months.

Main Results:

• In Group A, 88% of infants successfully avoided tracheotomy.
• In Group B, 83% of older children experienced resolution of OSA.
• In Group C, only 17% of tracheotomized patients were successfully decannulated.

Conclusions:

• Mandibular DOG is effective in preventing the need for tracheotomy in infants with Pierre Robin sequence.
• Mandibular DOG can successfully relieve OSA in older micrognathic children not requiring prior tracheotomy.
• The success rate for decannulation in tracheotomized patients with complex congenital syndromes is low, suggesting DOG is primarily beneficial for airway management in less complex cases.