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Li HW, Zou MJ, Zhang ZY, Tang XJ, Xu X, Ma LK, Feng S, Liu W. 3D-CT measurements of facial symmetry in severe CFM patients: A comparative study between mandibular ascending ramus distraction osteogenesis and bone grafting. J Craniomaxillofac Surg 2024; 52:222-227. [PMID: 38195299 DOI: 10.1016/j.jcms.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024] Open
Abstract
This study aims to compare the effects of mandibular distraction osteogenesis (MDO) and bone grafting on the facial symmetry of children with Pruzansky-Kaban type IIB and III craniofacial microsomia (CFM). Medical records and three-dimensional computed tomography (3D-CT) data of CFM patients who had primarily undergone MDO and bone grafting were collected. A retrospective analysis of pre-and post-operative 3D imaging data was conducted to compare the improvement rate in facial symmetry between the two groups based on occlusal cant, affected/unaffected ramus height ratio and chin point deviation. The data were tested for normality using the Shapiro-Wilk test. When the data followed a normal distribution, a paired sample t-test was employed for the comparison between preoperative and postoperative data. When the data did not follow a normal distribution, the Wilcoxon signed-rank test for paired samples was used for preoperative and postoperative comparison. The study included 18 children with type IIB and III CFM, 11 in the MDO group and 7 in the bone grafting group. In the MDO group, postoperative Gn-FH and Gn-Cor distances increased significantly, whereas the postoperative Gn-Mid distance decreased significantly. Occlusal cant decreased significantly and ramus height affected/unaffected ratio increased significantly after MDO. In the bone graft group, there was no statistically significant difference in the postoperative ratios of chin deviation, occlusal cant, and ramus height affected/unaffected compared to the preoperative values. Compared to bone grafting, MDO can significantly enhance ramus height ratio, level occlusal plane, and centralize the chin point among patients with CFM. Furthermore, MDO achieves superior enhancements in facial symmetry.
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Affiliation(s)
- Hong-Wen Li
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Meng-Jia Zou
- Department of Gastrointestinal Surgery, Ningbo Municipal Hospital of T.C.M, China
| | - Zhi-Yong Zhang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Xiao-Jun Tang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Xi Xu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Lun-Kun Ma
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Shi Feng
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Wei Liu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China.
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THOM DANGHOANG, LAM VUNGOC, SON TRANTHIET. The Outcome of Mandibular Distraction Osteogenesis in Infants with Severe Pierre Robin Sequence in Vietnam. Kobe J Med Sci 2023; 69:E115-E121. [PMID: 38018223 PMCID: PMC10695094 DOI: 10.24546/0100485260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/02/2023] [Indexed: 11/30/2023]
Abstract
The purpose of this study was to provide the experience of a single center with mandibular distraction osteogenesis (MDO) in Pierre Robin Sequence (PRS) patients. A longitudinal research analysis was conducted to identify PRS patients who underwent MDO at Vietnam National Children's Hospital between 2019 and 2021. The following criteria were used to determine inclusion: 1) those pediatric patients with PRS who were not well handled with conservative therapy, 2) those who received MDO with internal mandibular distractors, and 3) no previous treatment elsewhere. Demographic data, postoperative complications, and surgical results were all evaluated. The inclusion criteria were met by 73 patients. There were no difficulties associated with our distraction strategy. The majority of individuals with tracheostomies were successfully decannulated, and the remainder were able to avoid tracheostomies. Using MDO in PRS is an effective technique to avoid future airway issues. The success rate was lower and the complication rate higher for patients who had a tracheotomy before distraction and for those who underwent distraction at an age older than 2 months. The presence of laryngomalacia, gastric reflux disease, cardiac abnormalities, and GI anomalies did not increase the likelihood of MDO failure in PRS patients.
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Affiliation(s)
- DANG HOANG THOM
- Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Children’s Hospital, Hanoi, Vietnam
| | - VU NGOC LAM
- 108 Military Central Hospital, Hanoi, Vietnam
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Thom DH, Lam VN, Son TT. The Impact of Mandibular Distraction Osteogenesis on Cephalometric Measurements in Infants with Pierre Robin Sequence. Kobe J Med Sci 2023; 69:E106-E114. [PMID: 38018222 PMCID: PMC10695098 DOI: 10.24546/0100485259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND The obstruction of the upper airway (UAO) in infants diagnosed with Robin Sequence (RS) is caused by micrognathia, and in severe cases, it can result in obstructive sleep apnea (OSA). Mandibular distraction osteogenesis (MDO) is a secure and efficient remedy for significant UAO. However, there is insufficient data on the related cephalometric changes. Therefore, this study meticulously analyzes the mandibular cephalometric changes in infants with RS who have undergone MDO using internal devices. The aim is to gain a more comprehensive understanding of the short- and long-term impacts of distraction on the mandible. METHODS The study examined 73 consecutive cases of mandibular distraction osteogenesis (MDO) performed by a single surgeon. Preoperative and postoperative lateral cephalograms, as well as CT scans of the mandible, were utilized to assess population averages for both time points. A two-sample T-Test with equal variance was used for this analysis. RESULTS After the MDO procedure, 19 out of 21 cephalometric parameters exhibited significant morphological changes. On average, there were notable improvements of 20.3 mm (60.7%) in length, 9.8 mm (49.7%) in height, 12.6 mm (36.1%) in width, and 211% in airway parameters. However, most parameters showed only mild regression at the time of device removal and 6 to 12 months post-MDO. Nonetheless, the cephalometric parameters remained significantly improved compared to the preoperative measurements. CONCLUSIONS The use of cephalometric measurement is a potent approach that provides a clear and measurable understanding of how MDO influences both immediate and long-term growth of the mandible. This quantitative assessment of the effects of mandibular distraction allows for the refinement of surgical techniques and the optimization of outcomes. Therefore, incorporating cephalometric measurements in the evaluation of patients undergoing MDO can lead to better surgical planning and more favorable results.
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Affiliation(s)
- Dang Hoang Thom
- Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Vu Ngoc Lam
- 108 Military Central Hospital, Hanoi, Vietnam
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Shu KY, Liu W, Zhao JL, Zhang ZY, Shan BG, Li XY, Ma LK. Condylar resorption post mandibular distraction osteogenesis in craniofacial microsomia: A retrospective study. J Craniomaxillofac Surg 2023; 51:675-681. [PMID: 37852887 DOI: 10.1016/j.jcms.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
The aim of this study was to investigate the characteristics of condylar resorption in craniofacial microsomia (CFM) patients following mandibular distraction osteogenesis (MDO). Patients with unilateral type-IIa and type-IIb CFM, who had completed MDO and mandibular distractor extraction (MDE), were recruited. The height and volume of the condyle were measured on three-dimension models created by the analysis of computed tomography (CT) data. Normality analysis was performed using the Shapiro-Wilk test. Data for the affected and unaffected sides were compared using the paired t-test or Wilcoxon signed-rank test. Data for both type-IIa and type-IIb CFM were compared using the independent-samples t-test or Mann-Whitney U test. The Pearson or Spearman correlation was used to determine the correlations of condylar resorption rate with related measurements. In total, 48 type-IIa and 48 type-IIb CFM patients were included. The condylar resorption rate in type-IIa CFM (0.35 ± 0.32) was significantly associated with the height of the condyle (r = 0.776, p < 0.001) and distraction distance (r = 0.447, p = 0.001), while the condylar resorption rate in type-IIb CFM (0.49 ± 0.46) was significantly associated with the height of the condyle (r = 0.924, p < 0.001). However, there was no significant difference in condylar resorption rate between type-IIa and type-IIb CFM (p = 0.075). In addition to occlusal changes, no other negative symptoms of the TMJ were observed with condylar resorption. Condylar resorption was evident in CFM patients following mandibular distraction osteogenesis, and the condylar resorption rate showed a relationship with distraction distance and condylar height.
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Affiliation(s)
- Kai-Yi Shu
- Department of Medical Cosmetology and Plastic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Wei Liu
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiu-Li Zhao
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Yong Zhang
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ba-Ga Shan
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Yuan Li
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lun-Kun Ma
- Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Xu D, Guo Y, Qi Z, Hao C, Yu G. An infant with congenital micrognathia and upper airway obstruction was diagnosed as Hutchinson-Gilford progeria syndrome caused by a novel LMNA mutation: Case report and literature review. Heliyon 2023; 9:e20857. [PMID: 37916118 PMCID: PMC10616127 DOI: 10.1016/j.heliyon.2023.e20857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare disease characterized by appearance of premature aging, including the skin, bones, heart, and blood vessels caused by LMNA mutation. In this study, the patient presented with congenital micrognathia and progressively aggravated upper airway obstruction as the initial symptom, which required bilateral mandibular distraction osteogenesis (MDO) surgery intervention. This was not commonly described in the literature, and the primary clinical diagnosis of Pierre Robin sequence (PRS) was made. However, other clinical features included sclerotic skin, dry skin, growth failure, lipoatrophy, joint stiffness, prominent scalp veins, small ear lobes, hair loss, and craniofacial disproportion gradually emerged, the diagnosis of HGPS was preferred when the patient was 5 months old. The genetic testing result with a novel and de novo LMNA mutation (c.1968 + 3_1968+6delGAGT) further confirmed the diagnosis and expanded the clinical and mutational spectrum of HGPS. During the 12-month follow-up period after surgery, the patient no longer suffered dyspnea. Complications of other organs and systems have not happened at the moment. In addition, the pathogenesis, the role of LMNA gene mutation, the progress in clinical treatment, and breakthrough studies about genetic treatment in animals of HGPS are described in the literature review.
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Affiliation(s)
- Duojiao Xu
- Department of Stomatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yujiao Guo
- Department of Stomatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhan Qi
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Rare Disease Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Chanjuan Hao
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, MOE Key Laboratory of Major Diseases in Children, Rare Disease Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Guoxia Yu
- Department of Stomatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Ma LK, Zhang ZY, Tang XJ, Xu X, Feng S, Zhao SB, Shu KY, Liu BY, Zang TY, Liu W. Respiratory outcome of mandibular distraction osteogenesis on obstructive sleep apnea in craniofacial microsomia: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00079-3. [PMID: 37355371 DOI: 10.1016/j.jcms.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/09/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
This study aimed to evaluate the effect of mandibular distraction osteogenesis (MDO) on respiratory function in CFM patients with obstructive sleep apnea (OSA) according to polysomnography (PSG). This study retrospectively analyzed patients with CFM who underwent PSG before surgery and after completion of mandible distraction. Patients who met the inclusion criteria were selected. The Pediatric Sleep Questionnaire (PSQ) was used to assess patients' signs and symptoms related to OSA. The obstructive apnea-hypopnea index (OAHI) and lowest oxygen saturation (LSaO2) were imported into SPSS version 26.0. The Wilcoxon signed-rank test was used to assess the differences in PSG before and after MDO. Other data were described using descriptive statistics. A P-value less than 0.05 was considered statistically significant. A total of 25 unilateral CFM patients were included in this study. Most patients (72%) had mild OSA; moderate and severe OSA were 12% and 16%, respectively. Snoring (52%) was the most common symptom among these patients. After completion of mandibular distraction, snoring and other OSA-related symptoms were significantly improved. Twelve patients had normalized PSG and the severity of OSA improved significantly in 3 patients. The total effective rate of MDO for OSA was 60%. The statistical results showed that OAHI (P = 0.045) decreased and LSaO2 (P = 0.009) increased significantly compared to preoperative values. MDO can improve OSA-related symptoms in CFM patients. In addition, respiratory function was improved in most patients after MDO, based on PSG. CFM patients, especially those with OSA, can benefit from MDO.
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Affiliation(s)
- Lun-Kun Ma
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Zhi-Yong Zhang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Xiao-Jun Tang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Xi Xu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Shi Feng
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Shan-Baga Zhao
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Kai-Yi Shu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Bing-Yang Liu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Tian-Ying Zang
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China
| | - Wei Liu
- Department of Cranio-Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China.
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Zaballa K, Singh J, Waters K. The management of upper airway obstruction in Pierre Robin Sequence. Paediatr Respir Rev 2023; 45:11-5. [PMID: 35987882 DOI: 10.1016/j.prrv.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022]
Abstract
Pierre Robin Sequence (PRS) is defined by a constellation of characteristics including micrognathia, glossoptosis and airway obstruction. PRS can occur in isolation or can be associated with syndromes and another anomalies. Airway obstruction and feeding difficulties are the major presenting issues, and the severity of the condition ranges from mild, with minimal to no symptoms, to severe, with overt obstruction resulting in apnoeas, severe respiratory distress and cyanosis. The presence of airway obstruction can result in obstructive sleep apnoea and abnormalities in gas exchange, as well as exacerbation of already present feeding difficulties and failure to thrive, secondary to mismatch of caloric intake to energy usage associated with increased effort of breathing. Management of airway obstruction for infants with PRS varies between centres. This paper explores the surgical and non-surgical management options available, their effectiveness and pitfalls in children with PRS. Despite the pros and cons of each management option, it is evident that resource availability and multidisciplinary clinical support are key factors to successful management.
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Wang B, Liu W, Li Z, Qian J, Wang Y, Liu T, Zhang Q, Zhang Z. A new treatment strategy for hemifacial microsomia: Auricular reconstruction with an expanded two-flap method and simultaneous mandibular distraction osteogenesis. J Plast Reconstr Aesthet Surg 2022; 75:1950-7. [PMID: 35183465 DOI: 10.1016/j.bjps.2022.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Owing to the complex clinical manifestations of hemifacial microsomia (HFM), multidisciplinary cooperation is required to achieve better therapeutic effects in terms of function and aesthetics. This study aimed to explore the efficacy of the expanded two-flap auricular reconstruction combined with mandibular distraction osteogenesis in the treatment of HFM. METHODS This surgical strategy was performed in three stages. In the first stage, the retroauricular skin was expanded with a tissue expander and a mandibular distraction device was installed. In the second stage, the traditional expanded two-flap method for auricular reconstruction was adapted, and the framework was fabricated with costal cartilage and wrapped with the expanded skin flap, retroauricular fascia flap, and full-thickness skin graft. In the final stage, the tragus and lobule were rebuilt, the concha cavity deepened, and the mandibular distraction device removed. RESULTS From January 2014 to November 2018, 166 HFM patients underwent auricular reconstruction with the expanded two-flap method and simultaneous mandibular extension in our hospital. The median follow-up period was 9.3 months. Of the 166 patients, 154 patients and their families were satisfied with the results, and only 16 patients experienced complications. CONCLUSIONS This three-stage technique of simultaneous auricular reconstruction and mandibular distraction osteogenesis is safe and effective in achieving facial symmetry, improving occlusal contact, shortening treatment course, and relieving patient's suffering, especially for HFM patients.
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van der Plas PPJM, Joosten KFM, Wolvius EB, Koudstaal MJ, Mathijssen IMJ, van Dooren MF, Pullens B. Mandibular distraction to correct severe non-isolated mandibular hypoplasia: The role of drug-induced sleep endoscopy (DISE) in decision making. Int J Pediatr Otorhinolaryngol 2022; 152:110968. [PMID: 34861552 DOI: 10.1016/j.ijporl.2021.110968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In patients with mandibular hypoplasia, mandibular distraction osteogenesis (MDO) aims to relieve tongue-based airway obstruction. Drug-induced sleep endoscopy (DISE) provides a dynamic assessment of the upper airway and visualizes anatomical site and cause of airway obstruction. The aim of this study was to evaluate the effect of MDO on tongue-based airway obstruction found by DISE within a non-isolated patient population with severe upper airway obstruction (UAO). Furthermore, we aimed to assess the additional value of DISE in clinical decision making by correlating DISE findings to functional airway outcomes after MDO. METHODS Findings on DISE in children who underwent MDO were retrospectively gathered and evaluated. According to DISE findings, severity of tongue-based obstruction was scored using a 4-step classification similar to the one that is used by Bravo et al.. Intubation conditions were scored according to the Cormack Lehane score (CLS). Pre-and postoperative DISE findings were compared and correlated with functional airway outcomes following MDO. RESULTS In 19 out of 28 MDO procedures, both a pre-and postoperative DISE was available. Tongue-based obstruction scores improved in 13 procedures, which correlated to a functional improvement in seven. Postoperative tongue-based obstruction differed significantly between patients with successful MDO and patients treated unsuccessfully (2.00 ((Interquartile range (IQR) 1.00-2.00) vs. 3.00 (IQR 2.00-4.00), p = 0.028), whereas this difference was not significant for the CLS (1.00 (IQR 1.00-1.50) vs. 2.00 (IQR 1.00-4.00), p = 0.066). If no improvement of tongue-based obstruction was seen, MDO is very unlikely to be successful on the functional airway. CONCLUSIONS DISE provides information on the site and nature of airway obstruction and can visualize the effect of MDO on the severity of tongue-based airway obstruction. Therefore, it can be of additional value in understanding the differences in functional airway outcomes after MDO and aids in deciding appropriate and targeted treatment. Hence, standardized use of DISE, in addition to the clinical assessment of mandibular position and a polysomnography, during MDO management is highly recommended.
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Affiliation(s)
- Pleun P J M van der Plas
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Koen F M Joosten
- Department of Pediatric Intensive Care, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Marieke F van Dooren
- Department of Clinical Genetics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Bas Pullens
- Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
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Niño-Sandoval TC, Rodrigues EDR, Vasconcelos BC. Latency phase in mandibular distraction osteogenesis: a systematic review in animal models. Br J Oral Maxillofac Surg 2021; 59:993-1004. [PMID: 34531073 DOI: 10.1016/j.bjoms.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/10/2020] [Indexed: 12/09/2022]
Abstract
The aim of the present study was to perform a systematic review of the need for the latency period in distraction osteogenesis to obtain adequate bone formation. Searches were performed in the Web of Science, Pubmed/MEDLINE, Scopus, and Cochrane electronic databases. Nine articles were selected for qualitative analysis. Quality assessment was performed using the 10-item SYRCLE tool. Clinical stability was evaluated in two articles, histology was analysed in seven, histomorphometry was analysed in three, and mechanical testing was used in two. The results favoured the five-day latency group in two studies and the seven-day latency group in one. No differences were found between latency and no-latency groups in six studies. A latency period greater than seven days did not provide any additional benefit. Important risks of bias were found in all articles. Some of the results were influenced by uncontrolled intervening factors, such as consolidation time. The need for a latency period for distraction osteogenesis in animal models is not yet clear. Caution must be exercised when extrapolating the results of animal protocols to applications with humans in the clinical setting.
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Affiliation(s)
- T C Niño-Sandoval
- Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, CEP: 50.100-130, Brazil.
| | - E D R Rodrigues
- Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, CEP: 50.100-130, Brazil.
| | - B C Vasconcelos
- Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, CEP: 50.100-130, Brazil.
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Abstract
Treacher Collins syndrome (TCS) is a genetic disorder that presents with a variety of craniofacial deformities. One classic feature of TCS is a steep, counterclockwise rotation of the occlusal plane, and microretrognathia with bony deficiencies in both the body and ramus of the mandible. This morphology commonly necessitates reconstruction by the craniofacial surgeon. This article discusses strategies and considerations for surgically correcting the mandibular deformity associated with TCS using mandibular distraction osteogenesis and other related techniques. The proper implementation of these techniques can yield excellent results that greatly improve quality of life in this challenging patient population.
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Swanson D, Ba'th F, Zavala H, Chinnadurai S, Roby BB. Incidence of mandibular distraction osteogenesis in Stickler Syndrome: Variation due to COL2A1 and COL11A1. Int J Pediatr Otorhinolaryngol 2021; 146:110749. [PMID: 34004386 DOI: 10.1016/j.ijporl.2021.110749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether the two most common genetic mutations seen in Stickler Syndrome (SS) (COL2A1 and COL11A1) affect the incidence of mandibular distraction osteogenesis (MDO) and what impact Robin sequence (RS) has on diagnosis. SS is an autosomal dominant connective tissue disorder characterized by almost complete penetrance. COL2A1 and COL11A1 are the two most common mutations seen in SS patients. SS often presents at birth with RS, which is characterized by the triad of micrognathia, glossoptosis, and tongue-based airway obstruction. MDO is one surgical intervention that has been shown to be successful in relieving tongue base obstruction and is the surgical intervention of choice for this condition. METHODS A retrospective chart review was performed on all patients with a diagnosis of SS at a tertiary pediatric hospital between January 1, 2003 and December 31, 2018. The included patient charts were reviewed for demographic information, SS mutation, and history of MDO. Forty-six patients had a clinical diagnosis of SS. Of those, 31 met inclusion criteria which involved having a molecular diagnosis of SS and sufficient follow up information to determine if MDO was indicated or performed. Twenty-two of the 31 included patients had a diagnosis of RS (70.96%). Thirteen of the 31 patients (41.94%) included in this study required MDO as a neonate. RESULTS Fifty-percent of patients with type I (COL2A1) required MDO as a neonate compared to only 31% of patients with type II (COL11A1), though the difference between the two groups was not statistically significant. CONCLUSION The findings of this study suggest that patients with type I mutation may have a higher incidence of MDO than patients with a type II mutation, though further research with larger sample sizes is needed. This information is helpful in counseling those with SS or family history of SS about what they can expect related to RS and need for MDO based on genetic findings. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Dan Swanson
- Georgetown University School of Medicine, Washington, D.C, USA
| | - Fadlullah Ba'th
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Hanan Zavala
- Children's Minnesota ENT and Facial Plastic Surgery, Minneapolis, MN, USA
| | - Siva Chinnadurai
- Children's Minnesota ENT and Facial Plastic Surgery, Minneapolis, MN, USA
| | - Brianne Barnett Roby
- Children's Minnesota ENT and Facial Plastic Surgery, Minneapolis, MN, USA; University of Minnesota Department of Otolaryngology-Head and Neck Surgery, Minneapolis, MN, USA.
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13
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Abstract
Pierre Robin sequence is defined by the clinical triad: mandibular hypoplasia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) is a standard treatment of Robin sequence associated with severe airway obstruction and is the only intervention that directly corrects the underlying anatomic pathologic condition. Compared with tongue-lip adhesion, MDO has demonstrated more success in treating airway obstruction in infants with Pierre Robin sequence, including patients with syndromic diagnoses and concomitant anomalies. This article provides a current, comprehensive review of neonatal mandibular distraction and offers treatment guidelines based on a combined surgical experience of more than 400 patients.
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Affiliation(s)
- Kerry A Morrison
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 222 East 41st Street, New York, NY, 10017, USA
| | - Marcus V Collares
- Rio Grande do Sul Federal University Medical School, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul Federal University, Rua Hilário Ribeiro 202, cj 406, Porto Alegre, Brazil
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, Cleft and Craniofacial Surgery, NYU Langone Health, 222 East 41st Street, 22nd floor, New York, NY, 10017, USA.
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14
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Abstract
Phenotypic severity dictates the timing and type of surgical intervention required. Mandibular distraction in children without respiratory and feeding difficulties remains controversial with regard to long-term mandibular growth outcomes and reducing surgical burden. Early mandibular distraction does not obviate secondary orthognathic surgery at skeletal maturity; it provides improved functional, aesthetic, and psychosocial outcomes, at least in the short term. Costochondral rib grafting for Pruzansky type IIB and III mandibles can produce reliable results, especially when combined with subsequent mandibular distraction. Secondary 2-jaw orthognathic surgery plus genioplasty at skeletal maturity benefits from improved bone volume from prior mandibular distraction.
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Affiliation(s)
- Sameer Shakir
- Division of Plastic Surgery, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, South Pavilion, 14th Fl, Philadelphia, PA 19104, USA
| | - Scott P Bartlett
- Division of Plastic Surgery, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19014, USA.
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Reighard CL, Powell AR, Zurawski TY, Rooney DM, Keilin CA, Zopf DA. Development of a novel mandibular distraction osteogenesis simulator using Computer Aided Design and 3D printing. Int J Pediatr Otorhinolaryngol 2021; 142:110616. [PMID: 33444961 DOI: 10.1016/j.ijporl.2021.110616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Micrognathia, a component of Robin Sequence, can cause glossoptosis, failure of palatal fusion, and critical obstruction of the airway. Mandibular distraction osteogenesis (MDO) is at times offered to anteriorly translate the mandible and tongue, relieving airway obstruction. MDO is an intricate reconstructive procedure that may be ideal for teaching using a high-fidelity educational simulator, allowing early hands-on experience in a zero-risk environment. OBJECTIVES To design a novel, low-cost, high-fidelity neonatal MDO simulator that can be used for trainee education and refinement of surgical technique. METHODS A novel MDO simulator was developed using additive manufacturing techniques. Three experts in MDO surgery completed a 20-item survey, rating the simulator's physical attributes, the realism of experience, the simulator's value, its relevance to practice and the surgeon's ability to perform tasks on a 4-point Likert scale. RESULTS Computer Aided Design (CAD) and 3D printing allowed for the production of a realistic surgical simulator that emulates important aspects of MDO surgery. This preliminary evaluation indicated adequate means across the five domains relevant to the simulator's fidelity and usability (M = 3.33 to 3.75) out of a maximum of 4 points. Lowest rated items were consistent with expert comments allowing future refinement on subsequent iterations. Consumable material costs per model were $9.39 USD. CONCLUSIONS The MDO model demonstrated adequate fidelity and holds promise as a skill-development tool for surgeons in training. Further studies are planned to determine its utility as a training and assessment tool.
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Belcher RH, Phillips JD. Total facial nerve injury during mandibular distraction osteogenesis. Int J Pediatr Otorhinolaryngol 2020; 136:110182. [PMID: 32563840 DOI: 10.1016/j.ijporl.2020.110182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Over the last 10-15 years, usage of internal mandibular distraction systems has increased in the pediatric population, particularly for craniofacial syndromes. Mandibular distraction osteogenesis (MDO) has been shown to be effective in avoiding tracheostomy or achieving early decannulation in patients with micro-retrognathic mandibles in hemifacial microsomia or Pierre Robin sequence. As the frequency of the application of MDO has increased, so has the awareness and management of subsequent complications from the procedure. In this study, we discuss a complication involving paresis and eventual recovery of cranial nerve (CN) VII after the application of an MDO internal device at our institution in two cases. We also review the literature and propose multiple anatomic considerations that can impact more than just the marginal branch of CN VII. METHOD This study is a retrospective case study from our institution and a review of the literature. Pubmed was queried for terms singularly and in combination including "mandibular distraction osteogenesis", "facial nerve", "cranial nerve", "complications", "micrognathia", "retrognathia". After reviewing the results, studies discussing complications of MDO that involved CN VII were reviewed and included. RESULTS In the literature review and our retrospective review, CN VII injuries from MDO vary in their length and timing of onset. Management of this complication depended on the timing of onset and ranged from conservative management to removal of the distraction device. Majority (7/9) of the cases resolved to an eventual House-Brackmann of 0/6 with conservative measures. CONCLUSION Total facial nerve injury in association with MDO, has been scarcely reported, though the facial nerve is at great risk given its intimate location near the mandible particularly in neonates. It is encouraging that though it could be a devastating complication, out of all the cases reported, the large majority resolve with a combination of time and steroids.
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Affiliation(s)
- Ryan H Belcher
- Pediatric Otolaryngology, Head and Neck Surgery at Vanderbilt Children's Hospital, Vanderbilt Cleft and Craniofacial Team, United States.
| | - James D Phillips
- Pediatric Otolaryngology, Head and Neck Surgery at Vanderbilt Children's Hospital, Vanderbilt Cleft and Craniofacial Team, United States.
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Chen X, Yang X, Gu S, Li H, Zin MA, Mooi WJ, Han W, Zhang Y, Chai G. Early hemi-mandibular lengthening by distraction osteogenesis contributes to compensatory maxillary growth. J Craniomaxillofac Surg 2020; 48:357-364. [PMID: 32164998 DOI: 10.1016/j.jcms.2020.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022] Open
Abstract
Mandibular distraction osteogenesis at an early age is the standard hemifacial microsomia treatment. Nevertheless, the recurrence rate remains high and the definition of early age is controversial. We explored the optimal timing for mandibular distraction, when the surrounding skeleton, such as maxilla, can grow compensatory, to reduce recurrence. Hemifacial microsomia patients were prospectively divided into Groups A (1-3 years old) and B (4-6 years old), according to maxillary and mandibular growth curves. Computed tomography scans were obtained before distractor implantation and after removal surgery. Maxillary volume increase percentage was the main outcome indicator; other indicators (maxillary symmetry and complications) were secondary outcomes. Fifty-eight patients were enrolled and all but one patient in Group A (failed distraction) completed the study. Two patients had facial nerve injury and another two had mouth-opening limitation, which was relieved after coracoid resection. The difference in percentage increase in maxillary volume between the affected and unaffected sides was 5.06 ± 2.73% and 3.18 ± 1.99% in Groups A and B, respectively, suggesting better compensatory growth in younger patients (P = 0.004). Maxillary symmetry was apparently elevated after mandibular distraction. Mandibular distraction osteogenesis was confirmed to be feasible and safe at age <4 years.
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Affiliation(s)
- Xiaojun Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China
| | - Xianxian Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China
| | - Shuo Gu
- Department of Pediatrics, Shanghai Children's Medical Center, 1678 Dongfang Road, Shanghai, People's Republic of China
| | - Hao Li
- Department of Pediatrics, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, People's Republic of China
| | - Mar Aung Zin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China
| | - Wei Jun Mooi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China
| | - Wenqing Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China
| | - Yan Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China.
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China.
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Tomonari H, Takada H, Hamada T, Kwon S, Sugiura T, Miyawaki S. Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report. Head Face Med 2017; 13:20. [PMID: 29126455 PMCID: PMC5681793 DOI: 10.1186/s13005-017-0150-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/12/2017] [Indexed: 12/01/2022] Open
Abstract
Background We 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 presentation We 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. Conclusion Mandibular 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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Affiliation(s)
- Hiroshi Tomonari
- Department of Orthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroko Takada
- Department of Orthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomofumi Hamada
- Department of Oral surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Sangho Kwon
- Department of Orthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tsuyoshi Sugiura
- Department of Oral surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shouichi Miyawaki
- Department of Orthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Bianchi A, Betti E, Badiali G, Ricotta F, Marchetti C, Tarsitano A. 3D computed tomographic evaluation of the upper airway space of patients undergoing mandibular distraction osteogenesis for micrognathia. Acta Otorhinolaryngol Ital 2017; 35:350-4. [PMID: 26824918 PMCID: PMC4720923 DOI: 10.14639/0392-100x-546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mandibular distraction osteogenesis (MDO) is currently an accepted method of treatment for patients requiring reconstruction of hypoplastic mandibles. To date one of the unsolved problems is how to assess the quantitative increase of mandible length needed to achieve a significant change in the volume of the posterior airway space (PAS) in children with mandibular micrognathia following distraction osteogenesis. The purpose of this study is to present quantitative volumetric evaluation of PAS in young patients having distraction osteogenesis for micrognathia using 3D-CT data sets and compare it with pre-operative situation. In this observational retrospective study, we report our experience in five consecutive patients who underwent MDO in an attempt to relieve severe upper airway obstruction. Each patient was evaluated before treatment (T0) and at the end of distraction procedure (T1) with computer tomography (CT) in axial, coronal, and sagittal planes and three-dimensional CT of the facial bones and upper airway. Using parameters to extract only data within anatomic constraints, a digital set of the edited upper airway volume was obtained. The volume determination was used for volumetric qualification of upper airway. The computed tomographic digital data were used to evaluate the upper airway volumes both pre-distraction and post-distraction. The mean length of distraction was 23 mm. Quantitative assessment of upper airway volume before and after distraction demonstrated increased volumes ranging from 84% to 3,087% with a mean of 536%. In conclusion, our study seems to show that DO can significantly increase the volume of the PAS in patients with upper airway obstruction following micrognathia, by an average of 5 times. Furthermore, the worse is the starting volume, the greater the increase in PAS to equal distraction.
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Affiliation(s)
- A Bianchi
- Maxillofacial Surgery Unit, Policlinico "S. Orsola-Malpighi", University of Bologna, Italy
| | - E Betti
- Maxillofacial Surgery Unit, Policlinico "S. Orsola-Malpighi", University of Bologna, Italy
| | - G Badiali
- Maxillofacial Surgery Unit, Policlinico "S. Orsola-Malpighi", University of Bologna, Italy
| | - F Ricotta
- Maxillofacial Surgery Unit, Policlinico "S. Orsola-Malpighi", University of Bologna, Italy
| | - C Marchetti
- Maxillofacial Surgery Unit, Policlinico "S. Orsola-Malpighi", University of Bologna, Italy
| | - A Tarsitano
- Maxillofacial Surgery Unit, Policlinico "S. Orsola-Malpighi", University of Bologna, Italy
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20
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Ângelo DSF, Rosa B, Santos R, Matos CD. The role of curvilinear distraction system in pediatric obstructive sleep apnea: A case report. Cranio 2017; 36:65-69. [PMID: 28198643 DOI: 10.1080/08869634.2017.1290927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The authors present a case of obstructive sleep apnea associated with severe mandibular micrognathia treated by mandibular bone distraction with curvilinear system planned under computer assistance. CLINICAL PRESENTATION A 15-year-old child with limited compliance to continuous positive airway therapy was referred to the authors' department. Observation revealed severe mandibular micrognathia as the major cause for obstructive sleep apnea syndrome. The first polysomnography study revealed 14 obstructive apneas, 16 obstructive hypopneas, and 4.6/h apnea-hypopnea index. CONCLUSION Mandibular distraction osteogenesis can be a successful technique in alleviating upper airway obstruction secondary to micrognathia, while also improving the patient's appearance. Surgical planning under computer assistance is a useful tool to predict bone movements, and curvilinear distraction could be considered valuable in mandibular distraction.
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Affiliation(s)
| | - Bruno Rosa
- b Plastic Surgery Department , Centro Hospitalar Lisboa Norte , Lisboa , Portugal
| | - Rogério Santos
- b Plastic Surgery Department , Centro Hospitalar Lisboa Norte , Lisboa , Portugal
| | - Carlos Diogo Matos
- a Stomatology Department , Centro Hospitalar de Setúbal , Setúbal , Portugal
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Bangiyev JN, Traboulsi H, Abdulhamid I, Rozzelle A, Thottam PJ. Sleep architecture in Pierre-Robin sequence: The effect of mandibular distraction osteogenesis. Int J Pediatr Otorhinolaryngol 2016; 89:72-5. [PMID: 27619032 DOI: 10.1016/j.ijporl.2016.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pierre-Robin Sequence (PRS), a triad of micro/retrognathia, glossoptosis, and upper airway obstruction, usually in conjunction with a cleft palate is frequently associated with significant morbidity. Mandibular distraction osteogenesis (MDO) is an effective treatment modality to address retroglossal upper airway obstruction by increasing the anterior-posterior diameter of the infant airway. Although MDO has been shown to improve the apnea-hypopnea index (AHI) in children with PRS, the consequences of MDO on other aspects of infant sleep, including hypercapnea, hypoxia, the REM to Non-REM ratio, as well as its effect on central and mixed apneas has not been investigated with an adequate sample size. OBJECTIVE To characterize the effect of MDO on key components of sleep architecture in infants with PRS. METHODS Charts from 32 infants with PRS that were addressed with MDO at our tertiary-care children's hospital were retrospectively reviewed. Of these, 26 infants (57.7% male; mean age = 4.1 weeks, SD = 5.0) had pre- and post-operative polysomnograms (PSG). Paired samples t-tests were used to compare pre- and post- MDO sleep architecture mean score differences. RESULTS Among the 26 infants, 73.1% demonstrated severe pre-MDO sleep apnea (AHI > 10). Several aspects of sleep architecture were found to improve post-operatively. Significant improvements were found in AHI (30.3 vs. 8.7; t = 4.1, p < 0.001), obstructive apneas (79.3 vs. 5.8; t = 4.0, p < 0.001), hypopneas (48.1 vs. 22.1; t = 2.2, p = 0.040), time spent below 90% SpO2 (3.9% vs. 0.7%; t = 3.3, p = 0.003), and lowest SpO2 nadir (75.4% vs. 82.9%; 3.4, p = 0.002). In addition, a marginally significant improvement was found for mixed apnea (6.3 vs. 1.6; t = 1.99, p = 0.058). CONCLUSION MDO improves several sleep architecture parameters in this sample of infants with PRS. Statistically significant improvement was seen in obstructive apneas, hypopneas, AHI, obstructive AHI, and several indicators of hypoxia during sleep.
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Affiliation(s)
- J N Bangiyev
- Detroit Medical Center Department of Otolaryngology-HNS, Detroit, MI, USA; Children's Hospital of Michigan, Department of Pediatric Otolaryngology, Detroit, MI, USA.
| | - H Traboulsi
- Children's Hospital of Michigan, Department of Pediatric Otolaryngology, Detroit, MI, USA
| | - I Abdulhamid
- Children's Hospital of Michigan, Department of Pediatric Pulmonology and Sleep Medicine, Detroit, MI, USA
| | - A Rozzelle
- Children's Hospital of Michigan, Department of Plastic Reconstructive Surgery, Detroit, MI, USA
| | - P J Thottam
- Children's Hospital of Michigan, Department of Pediatric Otolaryngology, Detroit, MI, USA; MPENTA, Michigan Pediatric ENT Associates, Detroit, MI, USA; Department of Pediatric Otolaryngology, Beaumont Children's Hospital, Detroit, MI, USA
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Lee JJ, Thottam PJ, Ford MD, Jabbour N. Characteristics of sleep apnea in infants with Pierre-Robin sequence: Is there improvement with advancing age? Int J Pediatr Otorhinolaryngol 2015; 79:2059-67. [PMID: 26429600 DOI: 10.1016/j.ijporl.2015.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/09/2015] [Accepted: 09/13/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate changes in obstructive sleep apnea (OSA) and central sleep apnea (CSA) in infants with Pierre-Robin sequence (PRS) with advancing age and after mandibular distraction osteogenesis (MDO). METHODS Charts from 141 infants with PRS that presented to our tertiary-care children's hospital between 2005 and 2015 were retrospectively reviewed. Forty-five patients received a polysomnogram (PSG) prior to surgical intervention. Linear regression was utilized to compare age at pre-operative PSG with apnea-hypopnea index (AHI), obstructive apnea-hypopnea index (OAHI), and central apnea index (CAI). We then analyzed a subset of 9 patients who underwent MDO with pre- and post-operative PSGs. Wilcoxon signed-rank test was utilized to examine differences in pre- and post-operative OSA and CSA scores. RESULTS Forty-five patients received pre-operative PSGs. Of these, 80.0% demonstrated severe sleep apnea (AHI≥10), 68.9% demonstrated severe obstructive sleep apnea (OAHI≥10), and 55.6% demonstrated central sleep apnea (CAI≥1). There was no significant pattern of decrease in AHI, OAHI, and CAI with increased age up to 1 year. Among the 9 patients who underwent MDO with pre- and post-operative PSGs, significant reductions in AHI, OAHI, CAI, and percentage of total sleep time with arterial oxygen saturation (SaO2) <90% and significant increases in SaO2 nadir were identified after MDO. CONCLUSIONS Contrary to previously examined literature in non-PRS patients, we did not find a decreased severity of central or obstructive sleep apnea with advancing age. Infants with PRS who underwent MDO demonstrated significant decreases in both obstructive and central apnea indices.
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Affiliation(s)
- Jake J Lee
- University of Pittsburgh School of Medicine, Department of Otolaryngology, 3550 Terrace St, Pittsburgh, PA 15261, United States
| | - Prasad J Thottam
- Department of Otolaryngology, Children's Hospital of Michigan, 3901 Beaubien St, Detroit, MI 48201, United States; Michigan Pediatric Ear, Nose & Throat Associates, 3901 Beaubien St, Detroit, MI 48201, United States
| | - Matthew D Ford
- Cleft-Craniofacial Center, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA, United States
| | - Noel Jabbour
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, United States.
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Qu M, Hou Y, Xu Y, Shen C, Zhu M, Xie L, Wang H, Zhang Y, Chai G. Precise positioning of an intraoral distractor using augmented reality in patients with hemifacial microsomia. J Craniomaxillofac Surg 2014; 43:106-12. [PMID: 25465484 DOI: 10.1016/j.jcms.2014.10.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/23/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Through three-dimensional real time imaging, augmented reality (AR) can provide an overlay of the anatomical structure, or visual cues for specific landmarks. In this study, an AR Toolkit was used for distraction osteogenesis with hemifacial microsomia to define the mandibular osteotomy line and assist with intraoral distractor placement. METHODS 20 patients with hemifacial microsomia were studied and were randomly assigned to experimental and control groups. Pre-operative computed tomography was used in both groups, whereas AR was used in the experimental group. Afterwards, pre- and post-operative computed tomographic scans of both groups were superimposed, and several measurements were made and analysed. RESULTS Both the conventional method and AR technique achieved proper positioning of the osteotomy planes, although the AR was more accurate. The difference in average vertical distance from the coronoid and condyle process to the pre- and post-operative cutting planes was significant (p < 0.01) between the two groups, whereas no significant difference (p > 0.05) was observed in the average angle between the two planes. The difference in deviations between the intersection points of the overlaid mandible across two cutting planes was also significant (p < 0.01). CONCLUSION This study reports on an efficient approach for guiding intraoperative distraction osteogenesis. Augmented reality tools such as the AR Toolkit may be helpful for precise positioning of intraoral distractors in patients with hemifacial microsomia in craniofacial surgery.
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Affiliation(s)
- Miao Qu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Yikang Hou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Yourong Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Congcong Shen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Ming Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Le Xie
- National Digital Manufacturing Technology Center, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- National Digital Manufacturing Technology Center, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi Zao Ju Rd, Shanghai, 200011, China.
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Doscher ME, Garfein ES, Bent J, Tepper OM. Neonatal mandibular distraction osteogenesis: converting virtual surgical planning into an operative reality. Int J Pediatr Otorhinolaryngol 2014; 78:381-4. [PMID: 24374142 DOI: 10.1016/j.ijporl.2013.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 11/23/2022]
Abstract
Mandibular distraction osteogenesis (DO) has become an accepted method to manage severe cases of micrognathia-induced airway obstruction in neonates. Current imaging used to plan these procedures aids in surgical planning, but offers only a rough guide for the operating room. To our knowledge the following report offers the first description of virtual surgery used to guide DO in the mandible of a neonate. The plan provided a valuable link between the simulated procedure and the actual operative steps. Such technology can serve an important role in DO and offers objective guidance in device selection, vector planning and operative guide positioning.
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Paes EC, Fouché JJ, Muradin MS, Speleman L, Kon M, Breugem CC. Tracheostomy versus mandibular distraction osteogenesis in infants with Robin sequence: a comparative cost analysis. Br J Oral Maxillofac Surg 2014; 52:223-9. [PMID: 24388657 DOI: 10.1016/j.bjoms.2013.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 11/28/2013] [Indexed: 11/24/2022]
Abstract
Many treatments have been described for infants with Robin sequence and severe respiratory distress, but there have not been many comparative studies of outcome and cost-effectiveness. The aim of this study was to compare the cost and complications of two common interventions - mandibular distraction osteogenesis and tracheostomy. Nine patients with isolated Robin sequence (mandibular distraction osteogenesis, n=5, and tracheostomy, n=4) were included in the analyses. Predetermined costs and complications were obtained retrospectively from medical records and by questionnaires to the parents over a 12-month period. Overall direct costs (admission to hospital, diagnostics, surgery, and homecare) were 3 times higher for tracheostomy (€105.523 compared with €33.482, p=0.02). Overall indirect costs (absence from work) were almost 5 times higher (€2.543 compared with €543, p=0.02). There was a threefold increase in overall total cost/patient (both direct and indirect) for tracheostomy (€108.057 compared with 34.016, p=0.02) and 4 times more complications were encountered. This study shows that mandibular distraction osteogenesis in infants diagnosed with Robin sequence costs significantly less and results in fewer complications than tracheostomy, and this contributes to our current knowledge about the ideal approach for infants with Robin sequence and might provide a basis for institutional protocols in the future.
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Manikandhan R, Lakshminarayana G, Sneha P, Ananthnarayanan P, Naveen J, Sailer HF. Impact of mandibular distraction osteogenesis on the oropharyngeal airway in adult patients with obstructive sleep apnea secondary to retroglossal airway obstruction. J Maxillofac Oral Surg 2014; 13:92-8. [PMID: 24821997 DOI: 10.1007/s12663-013-0493-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/19/2013] [Indexed: 10/27/2022] Open
Abstract
AIM To evaluate the impact of mandibular advancement by distraction osteogenesis on the oropharyngeal airway in adult patients with retroglossal airway obstruction using two different techniques of mandibular distraction. MATERIALS AND METHODS 13 adult patients with mandibular hypoplasia secondary to TMJ ankylosis with OSAS and radiographic, CT and polysomnographic evidence of OSAS were included in the study. MDO was performed (corpus distraction in 8 cases and morphometric distraction in 5 patients). Post-operatively the patients were followed up by radiographs, CT and polysomnography after 1 month and 6 months. RESULTS There was an increase in the linear dimension of mandible by 11.07 mm, the volume by 19.3% and a decrease in AHI from 44.8 to 13.2. CONCLUSION Mandibular distraction (corpus and orthomorphic-equivocal results) is an effective method of relieving the retroglossal airway obstruction in adult patients with OSAS.
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Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is often associated with congenital craniofacial malformations such as Pierre-Robin Syndrome, Hemifacial Microsomia, Treacher Collins Syndrome resulting in decreased pharyngeal airway, which, in severe cases, leads to tracheostomy dependence. Some pediatric patients had tracheostomies done and others with severe respiratory distress were considered tracheostomy candidates. MATERIALS AND METHODS Twelve patients with severe respiratory distress without tracheostomy and ten patients with tracheostomy were treated by mandibular distraction osteogenesis using either external or internal devices. The expansion of mandibular framework was analyzed using bony cephalometric landmarks and computed tomography (CT). RESULTS The results demonstrated average mandibular elongation of 29 mm on each side using the external devices and 22 mm using the internal devices, and an increase in mandibular volume and pharyngeal airway. The group of patients with tracheostomies were decannulated and in the patients with respiratory distress there was improved airway with improvement of signs and symptoms of OSA with elimination of oxygen requirement. CONCLUSIONS Mandibular distraction is a useful method in younger children with OSA expanding the mandible and concomitantly advancing the base of tongue and hyoid bone increasing the pharyngeal airway. The external devices permit greater distraction length, the removal is simple but the devices are uncomfortable for the patients. On the other hand, the internal devices are more comfortable for patients but permit shorter distraction length and require a second operation for removal.
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Affiliation(s)
- Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Medical Centre, Haifa, Israel
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