Infant Mandibular Distraction for Upper Airway Obstruction: A Clinical Audit
AuthorAdhikari, AN; Heggie, AAC; Shand, JM; Bordbar, P; Pellicano, A; Kilpatrick, N
Source TitlePlastic and Reconstructive Surgery Global Open
PublisherLIPPINCOTT WILLIAMS & WILKINS
Document TypeJournal Article
CitationsAdhikari, A. N., Heggie, A. A. C., Shand, J. M., Bordbar, P., Pellicano, A. & Kilpatrick, N. (2016). Infant Mandibular Distraction for Upper Airway Obstruction: A Clinical Audit. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN, 4 (7), https://doi.org/10.1097/GOX.0000000000000822.
Access StatusOpen Access
BACKGROUND: Mandibular distraction osteogenesis (MDO) is an effective method of treating upper airway obstruction (UAO) in micrognathic infants. The short-term outcomes include relief of UAO, avoidance of tracheostomy, and prompt discharge from hospital. However, it is a significant surgical procedure with potential associated morbidities. This study describes a cohort of infants managed using MDO over a twelve-year period. METHODS: A retrospective chart review was undertaken for children who had MDO before the age of 5 years between 2000 and 2012. This was followed by a clinical review of the same cohort specifically looking for dental anomalies, nerve injuries, and scar cosmesis. RESULTS: Seventy-three children underwent MDO at a mean age of 2 months [interquartile range (IQR), 1.7-4.2] for nonsyndromic infants and 3.3 months (IQR, 2.1-7.4) for those with syndromes. Infants were discharged from hospital, on average, 15 days after procedure. After MDO, of the 9 who were previously tracheostomy dependent, 5 (56%) were decannulated within 12 months and none of the nontracheostomy-dependent children required further airway assistance. The majority of children required supplemental feeding preoperatively but, 12 months postoperatively, 97% of the nonsyndromic infants fed orally. Thirty-nine children (53%) were reviewed clinically [median age, 5.1 y (IQR, 3.9-6.5)] with 18 being syndromic. Many of the mandibular first permanent and second primary molars had developmental defects, but there was a low rate of neurosensory deficit and good scar cosmesis. CONCLUSIONS: This study contributes further to the evidence base underpinning the management of micrognathic infants with UAO.
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