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Early decannulation with bilateral mandibular distraction for tracheostomy-dependent patients
J K Williams1, D Maull, B H Grayson
1Variety Center of Craniofacial Rehabilitation, the Institute of Reconstructive Plastic Surgery, New York University Hospital, NY 10016, USA.
Plastic and Reconstructive Surgery
|January 23, 1999
Summary
Mandibular distraction surgery effectively treats obstructive sleep apnea in children dependent on tracheostomies. This procedure expands the jaw, allowing for successful decannulation and improved quality of life.
Area of Science:
- Craniofacial Surgery
- Pediatric Sleep Medicine
- Otolaryngology
Background:
- Neonatal obstructive sleep apnea can stem from a small mandible, leading to tongue base retroposition and airway narrowing.
- Tracheotomy is an effective treatment for pediatric obstructive sleep apnea but carries significant risks and social challenges.
Purpose of the Study:
- To evaluate the efficacy of mandibular distraction in achieving decannulation for tracheostomy-dependent pediatric patients.
- To assess changes in mandibular structure and hyoid bone position following distraction.
Main Methods:
- A clinical review of tracheostomy-dependent pediatric patients who underwent external, unidirectional mandibular distraction.
- Analysis of lateral cephalograms to measure mandibular expansion and hyoid bone advancement.
- Tracking decannulation status post-distraction.
Main Results:
- Four patients underwent bilateral mandibular distraction, averaging 21.3 mm (right) and 20.8 mm (left) expansion.
- All patients were successfully decannulated within 1.5 to 5.5 months post-procedure.
- Lower facial area increased by 26.9% and the hyoid bone advanced by an average of 14.5 mm.
Conclusions:
- Bilateral mandibular distraction effectively expands the mandibular framework and advances the tongue base.
- This technique offers a viable option for early intervention and decannulation in pediatric patients with mandibular deficiencies causing airway obstruction.