The Safety and Efficacy of Mandibular Distraction Osteogenesis Among Infants Less Than 3 kg

Taufique, Zahrah; Ebert, Bridget; Smith, E.; Zavala, Hanan; Scott, Andrew R.; Roby, Brianne Barnett

doi:10.1002/lary.29877

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…Distraction was performed at a mean age of 35 days, and tracheostomy was necessary in two cases. 8 Analysis of 117 infants with PRS and early mandibular distraction at an average age of 71 days revealed an enlarged upper airway cross section, 9 which was also shown in our case (Fig. 4 ).…”

Section: Discussionsupporting

confidence: 83%

Early MDO with a Virtually Planned Distractor in a Neonate with Pierre Robin Sequence

Lutz

Olmos

Schmidt

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Pierre Robin sequence (PRS) is characterized by mandibular micrognathia, glossoptosis, and airway obstruction. We report a case of a female infant with PRS in combination with deletion of chromosome 4q and cardiac insufficiency due to an atrioventricular septum defect. The child was transferred to our center from a peripheral hospital with respiratory insufficiency. Initially, respiration was ensured using a continuous positive airway pressure (CPAP) device because a Tuebingen plate was not tolerated. After a pediatric cardiac surgery intervention, CPAP ventilation proved to be insufficient, and the young patient had to be resuscitated and endotracheal intubation was required for recurrent severe respiratory failure. To avoid tracheostomy, an interdisciplinary decision was made to perform an early mandibular distraction. In the fifth week of life, two patient-specific internal distractors were implanted after prior virtual surgery planning. This approach allows for shorter surgical time through preoperative vector planning and fabrication of a patient-specific distractor, in combination with reduced morbidity through maximum protection of adjacent structures such as the tooth follicles and inferior alveolar nerves. An advancement of the mandible by 15 mm could be achieved within 2 weeks. Thereafter, the small patient could be extubated successfully, and there was no further episode of major respiratory insufficiency. We demonstrate that mandibular early distraction with a patient-specific distractor is a successful method to treat severe respiratory insufficiency in PRS, and it can prevent the necessity for tracheostomy with the resulting disadvantages. We provide details concerning our therapeutic algorithm, metric analyses, and a discussion of relevant literature.

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Section: Discussionsupporting

confidence: 83%

Early MDO with a Virtually Planned Distractor in a Neonate with Pierre Robin Sequence

Lutz

Olmos

Schmidt

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Approximately 20% of the patients were less than 3 kg at the time of surgery. Logistic regression showed no relationship between the weight at the time of surgery and the presence of a complication or unfavourable outcome [5 ▪▪ ].…”

Section: Surgical Considerationsmentioning

confidence: 86%

Paediatric mandibular distraction: optimizing outcomes

Discolo

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewThe purpose of this review is to summarize current evidence surrounding the use of mandibular distraction osteogenesis in children and to highlight recent advances in our knowledge of this subject.Recent findingsDistraction osteogenesis of the mandible has gained in popularity since its initial description about 30 years ago. Its efficacy and safety have been well described. More recently, proper patient selection, technique modifications and long-term outcomes have been the subject of much discussion around this revolutionary technique.SummaryDistraction osteogenesis of the mandible is a powerful tool for surgeons. Technological advances and high-quality research have allowed for optimization of this technique within the field of craniomaxillofacial surgery.

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“…The complications included device failure, premature ossification, fibrous nonunion, and abscess, but this did not assess feeding outcomes. When specifically evaluating feeding outcomes, Taufique et al 23 found no significant difference in postoperative G-tube rates when comparing infants above and below 3 kg. Alternatively, the results from our institution suggest there may be better G-tube outcomes if infants can reach 3 kg before the time of operation, but definitive interpretation of these results are limited by inability to perform multivariate analysis of our data to assess for the impact of confounding comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Pre-Operative Characteristics Helping to Avoid Gastrostomy Tube After Mandibular Distraction in Neonates With Pierre-Robin Sequence: A Institutional Case-Series and Review of the Literature

Mace,

Krishnapura,

Golinko

et al. 2024

Ann Otol Rhinol Laryngol

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Objective: to investigate the ability of mandibular distraction osteogenesis (MDO) to avoid gastrostomy tube (G-tube). Data Sources: PubMed, EBSCOhost, Cochrane, and Embase. Review Methods: We retrospectively reviewed the number of MDO cases performed at our institution for patients with Robin Sequence (RS) over the past 10 years. In our institutional review, patients were excluded if they had a G-tube already placed at the time of surgery. We also performed a systematic review of the literature. Articles were excluded if they did not detail feeding outcomes after MDO, or if MDO was performed on patients that did not have RS. Results: In our systematic review, 12 articles were included that comprised a total of 209 neonates with RS that underwent MDO. A total of 174 (83.3%) patients avoided a G-tube once MDO was performed. A total of 14 patients met the inclusion criteria at our institution. Of the 14 RS patients, 9 (64%) avoided having a G-tube placed and all (14/14) avoided tracheostomy. The average birth weight of patients avoiding a G-tube was 3.11 kg compared to 2.25 kg ( P = .045) in the group requiring a G-tube. In the group avoiding a G-tube, the average weight at time of operation was 3.46 kg compared to 2.83 kg ( P = .037) in the group requiring a G-tube. Conclusion: MDO may be considered as a surgical option to prevent G-tube placement for neonates with non-syndromic RS who have difficulty with PO feeding but whose airway obstruction is not severe enough to require respiratory support. Based on our institutional experience, a minimum weight of 3.00 kg correlated with higher success rates of PO intake and avoiding a G-tube.

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The Safety and Efficacy of Mandibular Distraction Osteogenesis Among Infants Less Than 3 kg

Cited by 5 publications

References 23 publications

Early MDO with a Virtually Planned Distractor in a Neonate with Pierre Robin Sequence

Early MDO with a Virtually Planned Distractor in a Neonate with Pierre Robin Sequence

Paediatric mandibular distraction: optimizing outcomes

Pre-Operative Characteristics Helping to Avoid Gastrostomy Tube After Mandibular Distraction in Neonates With Pierre-Robin Sequence: A Institutional Case-Series and Review of the Literature

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