Airway Analysis

Looby, Joseph F.; Schendel, Stephen A.; Lorenz, H. Peter; Hopkins, Elena; Aizenbud, Dror

doi:10.1097/scs.0b013e3181ae4139

Cited by 47 publications

(9 citation statements)

References 37 publications

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“…PRS infants who have undergone MDO have shown clinical improvement and significant increases in distance from pharyngeal wall to tongue base, cross sectional airway and hypopharyngeal airway volumes on CT (102, 103). A published meta-analysis has shown that MDO is effective in preventing tracheostomies in 91.3% of infants, and in relieving symptoms of OSA in 97% of the affected children (104).…”

Section: Treatment Of Osa In Children With Pierre Robin Sequencementioning

confidence: 99%

Craniofacial syndromes and sleep-related breathing disorders

Tan

Kheirandish‐Gozal

Abel

et al. 2016

Sleep Medicine Reviews

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Summary Children with craniofacial syndromes are at risk of sleep disordered breathing, the most common being obstructive sleep apnea. Midface hypoplasia in children with craniosynostosis and glossoptosis in children with Pierre Robin syndrome are well recognized risk factors, but the etiology is often multifactorial and many children have multilevel airway obstruction. We examine the published evidence and explore the current management strategies in these complex patients. Some treatment modalities are similar to those used in otherwise healthy children such as as adenotonsillectomy, positive pressure ventilation and in the refractory cases, tracheostomy. However, there are some distinct approaches such as nasopharyngeal airways, tongue lip adhesion, mandibular distraction osteogenesis in children with Pierre Robin sequence, and midface advancement in children with craniosynostoses. Clinicians should have a low threshold for referral for evaluation of sleep-disordered-breathing in these patients.

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Section: Treatment Of Osa In Children With Pierre Robin Sequencementioning

confidence: 99%

Craniofacial syndromes and sleep-related breathing disorders

Tan

Kheirandish‐Gozal

Abel

et al. 2016

Sleep Medicine Reviews

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“…Twelve articles fulfilled the 5 criteria and entered the final round of critical appraisal. [ 45 , 64 , 75 , 77 , 79 , 85 , 87 , 95 , 96 , 100 , 101 , 124 ] All the 12 articles passed the appraisal and were included in the final review. The study selection process was shown in flow diagram in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies mentioned the need for postoperative monitoring or delayed extubation in the intensive care unit for several days (1–11.4 days) until the postsurgical swelling subsided or until the desired amount of distraction was achieved. [ 64 , 75 , 77 , 79 , 87 , 101 , 124 ] The mean reported follow-up period ranged from 6 to 37 months.…”

Section: Resultsmentioning

confidence: 99%

“…Wang et al [ 64 ] reported a mean increase of PAS from 4.6 to 12.5 mm after MDO in the adult group. Looby et al [ 77 ] showed a mean increase of 209% in retroglossal area from 41.5 to 127.8 mm 2 in the children group. Rachmiel et al [ 101 ] in another study demonstrated a 71.9% increase in airway volume based on 3-dimensional CT measurement in a group of child patients.…”

Section: Resultsmentioning

confidence: 99%

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Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome

et al. 2016

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Background:To conduct a systematic review to answer the clinical question “What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?”.Methods:A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed.Results:Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances.Conclusion:This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular advancement surgery for OSAS patients and to provide a better evidence on the success and complication rates of the techniques.

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“…The degree of osseous elements hypoplasia and deformity, the facial abnormal growth potential of the affected and adjacent skeleton, the soft tissue, and nervous system impairment are factors that need taking into consideration 14 . MDO is an excellent assist to address the above concerns very well 8,16,17 . MDO not only lengthens the affected skeleton but also extends the associated soft-tissue envelope, therefore, improving the airway and facial appearance of patients 1,8 .…”

Section: Discussionmentioning

confidence: 99%

Mandibular Distraction Osteogenesis First for Children With Severe Unilateral Hemifacial Microsomia: Treatment Strategy and Outcomes

Liu

Zhao

et al. 2021

Journal of Craniofacial Surgery

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The treatment for severe hemifacial microsomia (HFM), especially type III case, is extremely difficult. Mandibular distraction osteogenesis (MDO) was rarely used as the primary choice in the treatment of severe type cases. The authors sought to observe the short-term therapeutic outcomes of patients with severe unilateral HFM who underwent MDO first.A retrospective study of children underwent MDO or later received costochondral graft (CCG) for severe unilateral HFM from 2009 to 2019 was conducted. Cephalometric measurements and clinical variables were analyzed to evaluate the effectiveness of MDO first strategy for severe cases and compare disparity between Pruzansky–Kaban classification type IIb and type III groups.Thirty-six patients (23 males and 13 females) underwent MDO first for severe HFM were included for analysis in the present study. The average age at MDO was 8.33 ± 2.03 years. At the last follow-up, MDO acquired significant improvement in mandibular height, maxillary cant, chin deviation, lip commissural line tilt, and clinical chin deviation (P < 0.05). Distraction results were stable during the short-term follow-up in terms of the mandibular height ratio and maxillary cant (P > 0.05).MDO is a proper primary method for suitable type IIb and type III HFM cases. MDO can immediately and significantly improve the facial skeleton deficiency, extend the associated soft tissue at the same time, and lay foundation for secondary surgery. MDO can achieve the downgrade of HFM deficiency severity. MDO followed by costochondral graft can get satisfactory esthetic and structural consequence for type III patients.

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Airway Analysis

Abstract: Mandibular distraction is effective at relieving anatomic airway obstruction in infants with micrognathia and obstructive sleep apnea while avoiding some previously reported associated complications.

Cited by 47 publications

References 37 publications

Craniofacial syndromes and sleep-related breathing disorders

Craniofacial syndromes and sleep-related breathing disorders

Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome

Mandibular Distraction Osteogenesis First for Children With Severe Unilateral Hemifacial Microsomia: Treatment Strategy and Outcomes

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