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Reply: The Effectiveness of Mandibular Distraction in Improving Airway Obstruction The Florentine Center Experience

Tahiri, Youssef M.D., C.M., M.Sc.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 487e
doi: 10.1097/PRS.0000000000000435

Riley Hospital for Children, Indiana University, Indianapolis, Ind.,

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I am glad to read and learn the details given by our Italian colleagues in their thoughtful letter. I thank Dr. Agostini and his team for their comments on the role and effectiveness of mandibular distraction osteogenesis for the treatment of airway obstruction in syndromic pediatric patients suffering respiratory insufficiency.

Children born with congenital craniofacial abnormalities face a host of complex challenges with regard to airway management.1 Diagnoses such as Pierre Robin sequence and Treacher Collins syndrome can be associated with significant retrognathia and glossoptosis, resulting in airway obstruction. In their letter, Dr. Agostini et al. present their experience with mandibular distraction osteogenesis performed on three patients with Crouzon syndrome, one with Goldenhar syndrome, one with “complex craniofacial malformation,” and two patients with isolated Pierre Robin sequence, and reported an 85.7 percent success rate at relieving respiratory insufficiency (either decannulation or prevention of tracheostomy). I would like to congratulate them on the results they obtained. Their findings further reinforce the important and growing role of mandibular distraction osteogenesis in the treatment of airway obstruction in nonsyndromic and syndromic patients.

Airway and subsequent respiratory compromise is common in patients with craniofacial syndromes. Causes may be various and include structural problems such as mandibular hypoplasia, midface hypoplasia and retrusion, choanal atresia, and tracheal/laryngeal abnormalities, but also central apnea, gastroesophageal reflux, reactive airway disease, and others.1,2 Although it is clear that mandibular distraction osteogenesis is a powerful tool available to the craniofacial surgeon to address upper airway obstruction in the pediatric population, one should keep in mind that it should be considered in selected patients with mandibular hypoplasia and upper airway obstruction who have failed conservative airway management efforts before proceeding to tracheostomy. Proper patient selection and workup to rule out associated lower airway anomalies is key to high success rates.

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The author has no financial interest to declare in relation to the content of this communication.

Youssef Tahiri, M.D., C.M., M.Sc.

Riley Hospital for Children

Indiana University

Indianapolis, Ind.

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1. Forrest CR, Hopper RA. Craniofacial syndromes and surgery. Plast Reconstr Surg. 2013;131:86e–109e
2. Hardin KA. Syndromic craniosynostosis: Complicated airway obstruction calls for progressive strategies in surgical management. Expert Rev Respir Med. 2010;4:315–319
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