The Effectiveness of Mandibular Distraction in Improving Airway Obstruction in the Pediatric Population
- 1 March 2014
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 133 (3), 352e-359e
- https://doi.org/10.1097/01.prs.0000438049.29258.a8
Abstract
Distraction osteogenesis is an effective technique for elongating the deficient mandible. The authors specifically evaluated its effectiveness in the treatment of airway obstruction in pediatric patients with mandibular hypoplasia. A comprehensive literature review of the National Library of Medicine (PubMed) database was performed. English-language studies involving isolated distraction of the pediatric mandible (younger than 18 years) with descriptive reporting of airway changes were included. Extracted data included demographics, initial diagnosis, distractor type, distraction protocol, predistraction and postdistraction airway status, and complications. Seventy-four articles met the inclusion criteria, resulting in 711 patients with craniofacial abnormalities who underwent mandibular distraction osteogenesis. Mean age at the time of distraction was 18.1 months. The most common diagnoses were isolated Pierre Robin sequence (52.9 percent), syndromic Pierre Robin sequence (7 percent), and Treacher Collins syndrome (6.8 percent). Mandibular distraction osteogenesis successfully treated airway obstruction in 89.3 percent of cases. Success was defined as either decannulation of tracheostomy, avoidance of tracheostomy or continuous positive airway pressure, or alleviation or significant improvement of obstructive sleep apnea symptoms. One hundred seventy-one (84.2 percent) of the 203 tracheostomy-dependent patients were successfully decannulated. Among the 181 patients with obstructive sleep apnea, mandibular distraction osteogenesis successfully allowed for either complete resolution or significant improvement of symptoms in 95.6 percent. A 23.8 percent overall complication rate was noted. The mean follow-up time was 28.7 months. In addition to its positive effect on facial appearance, mandibular distraction osteogenesis is an effective procedure for the treatment of airway obstruction associated with congenital craniofacial defects involving mandibular hypoplasia in appropriately selected patients.Keywords
This publication has 67 references indexed in Scilit:
- Feeding and mandibular distraction osteogenesis in children with Pierre Robin sequence: A case series of functional outcomesInternational Journal of Pediatric Otorhinolaryngology, 2012
- Mandibular distraction in neonates: indications, technique, resultsItalian Journal of Pediatrics, 2012
- Early InterventionOtolaryngology -- Head and Neck Surgery, 2011
- Tracheostomy-dependent child with temporomandibular ankylosis and severe micrognathia treated by piezosurgery and distraction osteogenesis: case reportBritish Journal of Oral and Maxillofacial Surgery, 2011
- A new way to anchor the external device in mandibular distraction: three case reports with a Pierre Robin sequenceInternational Journal of Oral & Maxillofacial Surgery, 2011
- Distraction osteogenesis and glossopexy for Robin sequence with airway obstructionAnz Journal of Surgery, 2010
- Mandibular Distraction Using Bone Morphogenic Protein and Rapid Distraction in Neonates With Pierre Robin SyndromeThe Journal of Craniofacial Surgery, 2010
- Mandibular distraction osteogenesis for treatment of extreme mandibular hypoplasiaAmerican Journal of Orthodontics and Dentofacial Orthopedics, 2007
- Infant Mandibular Distraction With an Internal Curvilinear DeviceThe Journal of Craniofacial Surgery, 2007
- New Technique for Airway Correction in Neonates with Severe Pierre Robin SequenceThe Journal of Pediatrics, 2005