Mandibular Distraction for Micrognathia and Severe Upper Airway Obstruction

Abstract

To determine whether the use of mandibular distraction osteogenesis (DOG) can help to avoid tracheotomy or achieve decannulation in patients with mandibular hypoplasia and severe upper airway obstruction.Design: Retrospective medical record review (spanning a 27-month period).Setting: Tertiary care children's hospital. Subjects: Group A (n=8) was composed of infants with Pierre Robin sequence and no tracheotomy (mean age, 2.5 months); group B (n = 6), older nontracheotomized micrognathic children with obstructive sleep apnea (OSA) (mean age, 69 months); and group C (n = 12), tracheotomized children with complex congenital syndromes (mean age, 33 months).Intervention: Bilateral mandibular DOG with endoscopic (n = 24) and/or radiographic (n = 17) airway evaluation (mean follow-up, 16 months [range, 2-42 months]).Outcome Measures: Group A, tracheotomy avoidance; group B, resolution of OSA (clinically or on polysomnography); and group C, decannulation.Results: Group A, 7 patients (88%) successfully avoided tracheotomy; group B, 5 patients (83%) had resolution of OSA; and group C, 2 patients (17%) underwent decannulation.Conclusions: Mandibular DOG (1) allows tracheotomy avoidance in infants with isolated Pierre Robin sequence and (2) relieves OSA in older micrognathic children without tracheotomy. However, mandibular DOG does not frequently lead to decannulation in tracheotomized patients with complex congenital syndromes.

Impact of Mandibular Distraction Osteogenesis on the Oropharyngeal Airway in Adult Patients with Obstructive Sleep Apnea Secondary to Retroglossal Airway Obstruction

“…Micrognathia and retrognathia are common features seen in a number of congenital and acquired craniofacial anomalies including Treacher Collins syndrome, Hemifacial Microsomia, Nager syndrome, Pierre Robin sequence and TMJ ankylosis [7,8]. Abnormalities in the position or morphology of the skeletal tissues have a direct impact on the surrounding envelope of soft tissues of the upper airway, thereby indirectly influencing the airflow through it.…”

“…Numerous studies have been performed to assess the airway dimensions after mandibular advancements using lateral cephalograms [4,5,8,9] but these do not demonstrate the actual volumetric improvement at the pharyngeal inlet. Computed tomography provides valuable data regarding the 3 dimensional changes in the airway space and volume which gives us credible proof for the outcome of the surgical treatment [3,5,14].…”

“…This is secondary to disproportionate mandibular anatomy and mandibular advancement in such situations is shown to have 97.0 % of success in paediatric patients and 100 %, success rate in adult patients [3][4][5][6][7][8][9][10]. Mandibular advancement can be achieved by osteotomies or distraction and our choice of the latter was based on the magnitude of advancement required and its influence on post-operative stability [11,12].…”

“…Numerous studies have been performed to evaluate the structural oropharyngeal airway (OPA) changes in two [4,[7][8][9] and three dimensions [5,13,14]. Physiologic improvement of the same has been shown using polysomnography.…”

Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

“…Tracheostomy is considered the conventional alternative for management of upper airway obstruction in PRS; however, it is associated with high morbidity and mortality rates. The average age of decannulation for children with PRS is 3.1 years [4,5].…”