Mandibular Distraction Osteogenesis for the Treatment of Neonatal Tongue-Based Airway Obstruction

Abstract

Early postnatal tracheostomy for airway compromise is associated with high morbidity and cost. In certain patients with tongue-base airway obstruction (TBAO), mandibular distraction osteogenesis may be preferred. We present a comprehensive analysis of surgical, airway, and cephalometric outcomes in a large series of neonatal patients with TBAO. A retrospective review was performed of patients with laryngoscopically proven TBAO who underwent mandibular distraction osteogenesis before 1 year of age at our institution. Demographic, operative, postoperative, polysomnographic, and radiographic data were analyzed with the appropriate statistical test. Between 2010 and 2013, 28 patients younger than 1 year underwent mandibular distraction for TBAO. Distraction was performed for documented TBAO and failure to thrive at an average age of 58 days (range, 11-312) days with distractor removal after an average of 90 days. Preoperative polysomnograms were obtained on 20 patients with an average apnea-hypopnea index of 39.3 ± 22.0/h; the apnea-hypopnea index on postoperative polysomnograms obtained after distraction completion was significantly reduced in all 14 patients in whom it was measured (mean, 3.0 ± 1.5/h; P < 0.0001). Twenty patients transitioned to oral feeding, and cephalometric and airway diameters were improved (P < 0.0001). Distraction was successful in all but 4 patients including all patients with GILLS scores of 2 or less and 66% of patients with GILLS scores of 3 or greater. Neonatal mandibular distraction is a powerful tool to treat critical obstructive apnea in patients with TBAO. Appropriate patient selection remains a challenge; however, mandibular distraction represents a compelling treatment modality.

Surgical Management and Outcomes of Pierre Robin Sequence: A Comparison of Mandibular Distraction Osteogenesis and Tongue-Lip Adhesion

“…Regardless of the intervention, careful patient selection is necessary to anticipate potential complications and achieve optimal outcomes. In both MDO 53,60,61,77 and TLA 36,48,78 syndromic patients tended to have poorer airway and feeding outcomes. Subjects who still required gastrostomy after either MDO or TLA often had an associated syndrome 43,53,56,60 .…”

“…Additional studies are required to identify risk factors for MDO perioperative complications. Of particular interest would be whether syndromic PRS subjects are more prone to perioperative complications, given that several studies have shown they have poorer feeding and airway outcomes 39,53,60,61,77 . Expanded knowledge of risk factors and continued advances in operative technique can help to reduce complications, increasing the benefit to risk ratio of MDO over TLA.…”

Obstructive sleep apnoea and the role of tongue reduction surgery in children with Beckwith-Wiedemann syndrome

“…Surgical procedures such as mandibular distraction osteogenesis can increase the size of the retroglossal airway relative to the tongue, effectively treating OSA. 4 Similarly, in patients with Down syndrome, tongue size is one risk factor for OSA. In a study using upper airway magnetic resonance imaging (MRI), Guimaraes and colleagues showed that patients with Down syndrome had relative macroglossia compared to healthy controls.…”

Precise osteotomies for mandibular distraction in infants with Robin sequence using virtual surgical planning

“…Mandibular distraction osteogenesis (MDO) has become the first-line operation in many centers for infants with airway obstruction associated with (Pierre) Robin sequence (RS) who have failed non-invasive management 1 . This procedure boasts high rates for successful resolution of obstructive sleep apnea (OSA) and avoid-ance of tracheostomy [2][3][4][5][6][7][8][9][10][11][12] . Long-term complications associated with the position of the osteotomies, such as injury to developing teeth and the inferior alveolar nerve, however, are common 1,[13][14][15] .…”