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Long term outcome of mandibular distraction for airway obstruction
Majed Maalouf M.D., James Lehman M.D.
Summa health system ,akron Ohio
2010-03-29
Presenter: Majed Maalouf
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Newborns with Pierre Robin Sequence (PRS) may require oro-tracheal intubation or tracheostomy at birth for airway obstruction. Elongation of the mandible will relief airway obstruction. At present, there is no series reporting on the long term outcomes of mandibular distraction in this patient population.
we report the outcome analysis of children's who underwent bilateral mandibular distraction for airway obstruction and evaluate the maintenance of mandibular growth.
It is a retrospective review of a single surgeon's series including office charts, photos and cephalometric x-rays .
From 1995 till date, 23 patients underwent bilateral mandibular distraction for severe airway obstruction. One patient had Treacher Collins syndrome, one patient had isolated micrognathia and 21 patients had PRS. 9 (41%) patients had a tracheostomy before distraction.6 patients (27%) were distracted shortly after birth for severe airway obstruction at a median of 20 days.6 patients (27%) had a less severe airway obstruction and were distracted at a median of 6.5 months .The median age at distraction was 5.8 months. All airway obstructions resolved after distraction. The median follow up was 64 m (4-145).7 patients (30%) had cephalometric xrays . Their median follow up was 11 years (7.5-12). 3(42%) patients had an ANB angle between 0º and 4º. Analysis of the facial contour angle revealed that 50% of patients had an angle between 8º and 16º.
Distraction osteogenesis is an efficient and effective way to manage severe airway obstruction resulting from micrognathia. Fifty percent of patients will maintain proportionate facial symmetry on long term follow up.
