Outcomes of Mandibular Distraction Osteogenesis in the Treatment of Severe Micrognathia

Abstract

Mandibular distraction osteogenesis has a high rate of success in avoiding tracheotomy. Patients who required a tracheotomy before MDO had a lower success rate in achieving decannulation and a higher rate of complications. However, these patients also had a higher rate of syndromic diagnoses and associated comorbidities. Patients with Goldenhar syndrome have a decreased likelihood of surgical success.

Defining failure and its predictors in mandibular distraction for Robin sequence

“…To construct these standardized care plans, a consistent means of assessing surgical outcomes needs to be defined. The current literature demonstrates varying definitions of 'failure' of MDO including: the clinical presence of apnea; an objective drop in AHI; the need for tracheostomy, redistraction, or other airway procedures; and death (Dauria and Marsh, 2008;Paes et al, 2013;Papoff et al, 2013;Flores et al, 2014;Lam et al, 2014;Tahiri et al, 2014). Agreement on the definition of failure is critical to assessing differing patient variables associated with successful and unsuccessful distraction and is ultimately required to create definitive treatment protocols.…”

“…Critical appraisal of the literature demonstrates that the definition of successful distraction varies across studies (Denny et al, 2001;Denny and Kalantarian, 2002;Monasterio et al, 2002;Denny, 2004;Mandell et al, 2004;Wittenborn et al, 2004;Burstein and Williams, 2005;Dauria and Marsh, 2008;Paes et al, 2013;Flores et al, 2014;Lam et al, 2014;Murage et al, 2014;Rachmiel et al, 2014;Runyan et al, 2014;Tahiri et al, 2014) and can include resolution of apnea by clinical exam or polysomnogram (PSG) improvement; avoidance of tracheostomy; changes in airway obstruction patterns; or mortality. Unfortunately, this variation in definitions creates a confounder in determining patient characteristics leading to favorable or unfavorable results and is problematic to formulating definitive treatment protocols of care.…”

Paediatric oral & maxillofacial surgery

“…In the severely retrognathic mandible, the tongue base is posteriorly positioned (glossoptosis) and this results in narrowing of the oro‐pharyngeal airway at this level. Distraction osteogenesis has been effectively used to advance the mandible and tongue base and to alleviate the obstruction and the technigue of internal distraction was pioneered in Australasia by our service …”

Neonatal mandibular distraction osteogenesis

“…These patients either avoid tracheotomy altogether or are able to be decannulated after MDO. 13 Similarly, these babies are usually able to regain the ability to feed by mouth, and they either avoid gastrostomy tube placement or are able to be weaned off supplemental enteral feeds. 14 The long-term benefits are not as clearly defined, but early data suggest that patients who undergo neonatal MDO maintain similar airway and feeding benefits well into early childhood ( Figure 4).…”