IADR Abstract Archives
Mandibular Distraction Osteogenesis (MDO) : a Role in the Management of Paediatric Airway Obstruction
Objectives: Distraction osteogenesis (DO) a process of gradual bone elongation has recognised indications in facial reconstruction. This report identifies a role for mandibular DO (MDO) in paediatric patients with airway obstruction.
Methods: This retrospective study reports seven paediatric patients undergoing MDO treating airway obstruction. The MDO protocol, degree of mandibular advancement outcomes for airway management and post-operative complications was assessed.
Results: The study population included seven patients (M 6, F 1), with severe mandibular retrognathism (MR) based on clinical and radiographic assessment. The diagnoses were as follows: Treacher Collins Syndrome, Kleinfelter Syndrome, Pierre Robin Syndrome, Marden Walker Syndrome, Subglottic Stenosis, Sleep Apnoea (OSA). Four patients were tracheostomy and three CPAP dependant. Mean age at distraction surgery was 72 (36-125) months. All patients underwent MDO under general anaesthesia using internal distractors via a submandibular approach with a bilateral mandibular angle osteotomy, a 5-day latency period, and bilateral MDO at 1 mm per day for 20 days. The activation arms were removed at distraction completion. The distractors were removed under general anaesthesia three months following the completion of distraction. The outcomes were as follows: Tracheostomy removed in 3 patients, OSA improved in 3 patients with CPAP discontinued. One patient with subglottic stenosis and autism failed decannulation, the same patient had a fracture of a mandibular distractor and required an iliac crest bone graft and placement of a bone plate. One patient has transient marginal mandibular branch VII weakness.
Conclusions: Airway obstruction secondary to MR can occur with displacement of the tongue into the pharyngeal airway. If severe, tracheostomy or the use of CPAP is necessary. This may result in delayed social and educational development, increased morbidity and family demands. MDO increases the upper airway volume and has a role in the management of paediatric patients with airway obstruction.
Methods: This retrospective study reports seven paediatric patients undergoing MDO treating airway obstruction. The MDO protocol, degree of mandibular advancement outcomes for airway management and post-operative complications was assessed.
Results: The study population included seven patients (M 6, F 1), with severe mandibular retrognathism (MR) based on clinical and radiographic assessment. The diagnoses were as follows: Treacher Collins Syndrome, Kleinfelter Syndrome, Pierre Robin Syndrome, Marden Walker Syndrome, Subglottic Stenosis, Sleep Apnoea (OSA). Four patients were tracheostomy and three CPAP dependant. Mean age at distraction surgery was 72 (36-125) months. All patients underwent MDO under general anaesthesia using internal distractors via a submandibular approach with a bilateral mandibular angle osteotomy, a 5-day latency period, and bilateral MDO at 1 mm per day for 20 days. The activation arms were removed at distraction completion. The distractors were removed under general anaesthesia three months following the completion of distraction. The outcomes were as follows: Tracheostomy removed in 3 patients, OSA improved in 3 patients with CPAP discontinued. One patient with subglottic stenosis and autism failed decannulation, the same patient had a fracture of a mandibular distractor and required an iliac crest bone graft and placement of a bone plate. One patient has transient marginal mandibular branch VII weakness.
Conclusions: Airway obstruction secondary to MR can occur with displacement of the tongue into the pharyngeal airway. If severe, tracheostomy or the use of CPAP is necessary. This may result in delayed social and educational development, increased morbidity and family demands. MDO increases the upper airway volume and has a role in the management of paediatric patients with airway obstruction.