Improvement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia

Zanaty, Ola M.; Metainy, Shahira El; Alia, Doaa Abo; Medra, Ahmed

doi:10.1111/pan.12869

Cited by 26 publications

(14 citation statements)

References 16 publications

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“…Our results show that 43% children (26/60) improved laryngeal exposure and decrease intubation difficulty under direct laryngoscopy during the secondstage operation. These results are consistent with those of previous studies that mandibular distraction osteogenesis could improve the laryngeal view, increase the airway volume and mandibular volume [14][15][16]. However, some complications can occur after surgical correction, such as infection and ankylosis of the temporomandibular joint, which can cause intubation to be more difficult.…”

Section: Discussionsupporting

confidence: 92%

Airway management in children with hemifacial microsomia: a restropective study of 311 cases

Deng

Yan

2020

BMC Anesthesiol

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Background: Hemifacial microsomia (HFM) is a congenital craniofacial malformation which is associated with difficult airway. Anesthesiologists may experience difficult intubation in children with HFM. Mandibular distraction could increase the length of the mandible. Theoretically, it should be advantageous to laryngeal view during tracheal intubation. This study reviewed airway management in children with HFM, assessed the efficiency of direct laryngoscopy versus airway-visualizing equipment during the tracheal intubation and determined whether mandibular distraction could improve the laryngoscopic view in children with HFM. Methods: A retrospective review of cases involving children with HFM aged 5 to 17 years old underwent anesthesia from December 2016 to April 2019 at a single center was performed. The demographic data, preoperative airway assessments, procedure type, anesthetic technique, method of airway management, anesthetists' comments on mask ventilation, laryngoscopy and intubation parameters were collected. Results: At last, 136 HFM children entered this study, a total of 311 anesthesia procedures were completed during the study period. Face mask ventilation was possible for most of children except 1 child (bilateral involvement) required two practitioners. The success rates of intubation for the primary video laryngoscopy and fibroscopy were both 100%, but 79.5% for direct laryngoscopy (P < 0.001). 95 (38.9%) children who had difficult laryngoscopic view (DLV) were significantly correlated with failed direct laryngoscopy (P < 0.001). Airway-visualizing equipment (video laryngoscope and Fiberscope) was the primary airway technique in 3 (75%) bilaterally involved children. 60 children underwent both mandibular distraction osteogenesis and the removal of distractor. The laryngoscopic views improved in 26 (43%) children after treatment with mandibular distraction (P < 0.001). Conclusions: Airway-visualizing equipment can be effectively utilized for intubation in HFM children with DLV. Mandibular distraction could improve the laryngeal view effectively.

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Section: Discussionsupporting

confidence: 92%

Airway management in children with hemifacial microsomia: a restropective study of 311 cases

Deng

Yan

2020

BMC Anesthesiol

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“…In another study, Zanaty O and colleagues have concluded that DO of mandible results in marked improved in apnea-hypopnea index in patients of obstructive sleep apnea. 6 It has been shown that DO can also result in avoidance of need of tracheostomy in infants and young patients with severe airway obstruction due to mandibular micrognathia. 7 TMJ ankylosis and associated dentofacial deformities can be surgically managed by single-stage or multistage treatment protocols.…”

Section: Discussionmentioning

confidence: 99%

Management Of Obstructive Sleep Apnea Syndrome Associated With Severe Micrognathia

Khan

Asim

Shah

2018

J Coll Physicians Surg Pak

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Obstructive sleep apnea syndrome (OSAS), commonly associated with mandibular micrognathia, is a serious condition that can lead to various devastating cardiovascular and neurocognitive consequences. Patients of OSAS with micrognathia present with many functional and esthetic problems. Therefore, comprehensive management of these patients requires multiple surgeries and frequent follow-up. Several surgical and non-surgical treatment options have been proposed for the treatment of OSAS. Distraction osteogenesis (DO) in maxillofacial region, although a newer treatment modality, is being increasingly favoured by many surgeons because of its many advantages over other treatment methods. We present comprehensive management of a case of OSAS associated with post temporomandibular joint ankylosis severe micrognathia. Various surgical treatment methods including DO and conventional orthognathic surgical procedures were employed in management of this patient of obstructive sleep apnea. Both functional and esthetic complaints of the patient were addressed, and we achieved exceptional results at the end of treatment.

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“…In this case, the narrow area of the upper airway was the retroglossal section rather than the retropalatal area, owing to the small mandible and the normal maxilla (SNA angle within the normal range). Therefore, the third treatment option was rejected because a small retroglossal area can be entirely corrected by mandibular DO with sliding genioplasty, as previously reported [ 4 – 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mandibular distraction osteogenesis (DO), which has now been proposed as an alternative to bilateral sagittal split osteotomy (BSSO), is an effective method for expanding the pharyngeal airways of pediatric [ 4 ] and adult patients [ 5 , 6 ]. It has been shown that mandibular DO results in significant changes in pharyngeal airway volume [ 6 ] and the apnea-hypopnea index (AHI) [ 5 , 7 ] because more than half of upper pharyngeal airway obstructions occur at the base of the tongue [ 8 ]. Mandibular DO, which induces gradual movement of skeletal bone and slow stretching of the soft tissue, is considered to reduce the risk of relapse.…”

Section: Introductionmentioning

confidence: 99%

Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report

et al. 2017

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BackgroundWe describe the case of a 16-year-old female patient with micrognathia, temporomandibular joint (TMJ) ankylosis, and obstructive sleep apnea, who was treated with mandibular distraction osteogenesis (DO) combined with sliding genioplasty, using skeletal anchorage.Case presentationWe first performed interpositional arthroplasty, in which an interposition of fascia temporalis and surrounding fat tissue was inserted into the defect after bilateral condylectomy, increasing the maximum mouth opening from 5.0 to 32.0 mm. Subsequently, orthodontic treatment and advancement of the mandible were carried out by mandibular DO, using miniscrews and miniplates. Finally, sliding genioplasty was performed to bring the tip of the mandible forward. The total amount of mandibular advancement at the menton was 16.0 mm. An improved facial appearance and good occlusion were eventually achieved, and the apnea-hypopnea index decreased from 37.1 to 8.7. There was no obvious bone resorption or pain in the temporomandibular region, limited mouth opening (maximum mouth opening: 33.0 mm), myofascial pain or headache, downward rotation of the mandible, or lateral shift of mandibular position evident at 5 years and 6 months after mandibular DO.ConclusionMandibular DO using skeletal anchorage with intermaxillary elastics is useful for preventing extrusion of the upper and lower anterior teeth, thereby preventing rotation of the mandible. In addition, mandibular DO combined with sliding genioplasty is effective at improving both dentofacial deformities and impaired respiratory function.

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Improvement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia

Abstract: Mandibular distraction osteogenesis improved laryngeal view. Distraction osteogenesis can be successfully used for the treatment of obstructive sleep apnea in mandibular hypoplasia patients.

Cited by 26 publications

References 16 publications

Airway management in children with hemifacial microsomia: a restropective study of 311 cases

Airway management in children with hemifacial microsomia: a restropective study of 311 cases

Management Of Obstructive Sleep Apnea Syndrome Associated With Severe Micrognathia

Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report

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