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Immediate Mandibular Distraction in Mandibular Hypoplasia and Upper Airway Obstruction

Schoemann, Mark B. MD*; Burstein, Fernando D. MD, FACS*†; Bakthavachalam, Sivi MD; Williams, Joseph K. MD, FACS*†§

Journal of Craniofacial Surgery:
doi: 10.1097/SCS.0b013e31825a64d9
Original Articles
Abstract

Abstract: Distraction osteogenesis of the mandible has become an alternative to tracheostomy in infants and children who present with upper airway obstruction due to micrognathia. To avoid prolonged intubation during distraction, we have implemented a protocol of immediate distraction at the time of distractor placement, which results in acute airway improvement. Over 2 years, 22 patients with micrognathia and severe airway obstruction have undergone mandibular distractor placement. Indications for surgery were apnea and desaturations with feeding. Resorbable distraction devices were placed bilaterally and activated to 5 to 8 mm. Recombinant human bone morphogenetic protein 2 was placed in the gap. Distraction was implemented at postoperative day 2 at 2 mm/d. Forty-four distraction devices were placed in 22 patients (68% male, 32% female) with a mean age of 24.1 months (range, 3 days to 5.5 years). The average distance of distraction performed in the operating room was 5 mm. The average total distraction was 24 mm performed over 12 days. Overall, 89% of patients were extubated after distractor placement in the operating room. Two patients with difficult intubations were extubated 7 days later in the operating room with otolaryngology. Of the 4 tracheostomy patients, 1 patient was decannulated, whereas 3 patients are pending postoperative sleep studies. One patient had a minor wound complication. Tracheostomy and prolonged intubation in patients with mandibular hypoplasia have significant morbidity and mortality. We have implemented a successful protocol of immediate distraction in the operating room with placement of bone morphogenetic protein. Immediate distraction appears to be an effective method of avoiding postoperative intubation and tracheostomy.

Author Information

From the *Center for Craniofacial Disorders, Children’s Healthcare of Atlanta; †Division of Plastic and Reconstructive Surgery, Emory University; ‡Pediatric Ear, Nose & Throat of Atlanta, P.C.; and §Department of Pediatrics, Emory University, Atlanta, GA.

Received February 29, 2012.

Accepted for publication April 10, 2012.

Address correspondence and reprint requests to Fernando D. Burstein, MD, FACS, 975 Johnson Ferry Rd, Suite 100, Atlanta, GA 30342; E-mail: fburstein@aol.com

F.D.B. and J.K.W. have consulted to Biomet. The other authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD