2015 HSC Section 1 Book of Articles

Original Investigation Research

Mandibular Distraction Osteogenesis

in other recent studies in which the proportion of syndromic diagnoses ranged from24% to 35%. 8-11,20 Themost frequently encountered syndromic diagnosis among all patients with micrognathia is Stickler syndrome. 2,21,22 However, inour study the 2 most frequent syndromic diagnoses were Treacher-

84%rate of avoidance of tracheotomy is slightly lower than the success rates in recent reports focusing on the outcomes of neonatal MDO. 8,9,17,18 However, thismay in part reflect the fact that there was a greater proportion of syndromic diagnoses (56%overall, 43%among patients treatedwithMDO first) than

Table 4. Unadjusted and Adjusted Associations Between Potential Predictors and Any Complication

Adjusted a

Unadjusted

P Value

P Value

Variable

OR (95% CI)

OR (95% CI)

Tracheotomy vs MDO first

2.90 (1.20-7.10) 1.50 (0.64-3.50)

.02 .36

1.80 (0.67-4.70)

.24

Male

Diagnosis b CFM–Goldenhar syndrome Treacher-Collins syndrome

1.10 (0.20-6.00) 3.60 (0.90-13.80) 2.20 (0.80-5.70) 1.10 (0.98-1.10) 1.20 (1.00-1.30) 1.00 (0.98-1.10) 0.56 (0.13-2.40) 0.56 (0.01-23.00) 1.00 (0.44-2.30) 3.40 (1.40-8.40)

.90 .07 .11 .14 .02 .31 .44 .76 .99

Other

Age at distraction, y

Abbreviations: CFM, craniofacial microsomia; MDO, mandibular distraction osteogenesis; OR, odds ratio. a The final model included only significant covariates from unadjusted analysis with P < .05. b Reference diagnosis was isolated Pierre Robin sequence.

Follow-up, y

1.20 (1.00-1.30)

.05

Distraction amount, mm

Distractions, No. 2 vs 1

3 vs 1

Open air surgical procedures, No. Other airway procedures, ≥2 vs <2

.009

3.20 (1.20-8.60)

.02

Figure 2. Predicted Probabilities for Complications Stratified by Initial Treatment Subgroup

Females

Males

A

B

1.0

1.0

0.8

0.8

0.6

0.6

0.4

0.4

Probability of Complication

Probability of Complication

0.2

0.2

<2 ≥2 Other airway procedures, No.

0.0

0.0

0

2

4

6

8

10

0

2

4

6

8

10

Follow-up Length, y

Follow-up Length, y

The predicted probabilities of complications stratified by the initial surgical intervention. A, Mandibular distraction osteogenesis (MDO) first; B, tracheotomy first. The colored lines indicate the differences in the probability

of success for patients who had less than 2 vs 2 or more other airway procedures. The shaded areas represent the 95% CIs for these probabilities. Open circles represent the observed values.

JAMA Otolaryngology–Head & Neck Surgery April 2014 Volume 140, Number 4

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