2015 HSC Section 1 Book of Articles

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Outcomes of Mandibular Distraction Osteogenesis
in the Treatment of Severe Micrognathia
Derek J. Lam, MD, MPH; Meredith E. Tabangin, MPH; Tasneem A. Shikary, MD; Armando Uribe-Rivera, DDS;
Jareen K. Meinzen-Derr, PhD; Alessandro de Alarcon, MD, MPH; David A. Billmire, MD; Christopher B. Gordon, MD
IMPORTANCE Patients with severe micrognathia are predisposed to airway obstruction.
Mandibular distraction osteogenesis (MDO) is an alternative to tracheotomy that lengthens
the mandible in order to improve the retrolingual airway. This study presents outcomes from
one of the largest cohorts reported.
OBJECTIVE To assess the rate and predictors of surgical success and complications among
(1) patients who underwent MDO prior to other airway procedures (MDO first), and
(2) patients who required an initial tracheotomy and were subsequently treated with MDO
(tracheotomy first).
DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study at a tertiary care pediatric
medical center of patients diagnosed as having micrognathia resulting in symptomatic airway
obstruction (Pierre Robin sequence) and who underwent MDO from September 1995 to
December 2009.
INTERVENTIONS Electronic medical records were reviewed. Multivariable regression analysis
was used to assess for predictors of outcome.
MAIN OUTCOMES AND MEASURES Rates of surgical success (defined as either tracheotomy
avoidance or decannulation) and complications. Potential predictors included demographics,
syndrome presence, follow-up time, and surgical history.
RESULTS A total of 123 patients (61 in MDO-first subgroup, 62 in tracheotomy-first subgroup)
underwent MDO during the study period. Median age at time of distraction was 21 months
(range, 7 days–24 years). Surgical success and complication rates were 83.6% and 14.8% in
the MDO-first subgroup and 67.7% and 38.7% in the tracheotomy-first subgroup.
Tracheotomy-first patients were more likely to have a syndromic diagnosis (66.0% vs 43.0%;
P = .009) and were older at the time of MDO (median age, 30 months vs 5.1 months;
P < .001). Poorer odds of success were associated with the need for 2 or more other airway
procedures (odds ratio [OR], 0.14 [95% CI, 0.02-0.82]) in the MDO-first subgroup and
craniofacial microsomia or Goldenhar syndrome (OR, 0.07 [95% CI, 0.009-0.52]) in the
tracheotomy-first subgroup.
CONCLUSIONS AND RELEVANCE Mandibular distraction osteogenesis has a high rate of
success in avoiding tracheotomy. Patients who required a tracheotomy before MDO had a
lower success rate in achieving decannulation and a higher rate of complications. However,
these patients also had a higher rate of syndromic diagnoses and associated comorbidities.
Patients with Goldenhar syndrome have a decreased likelihood of surgical success.
JAMA Otolaryngol Head Neck Surg. 2014;140(4):338-345. doi:10.1001/jamaoto.2014.16
Published online February 27, 2014.
Author Affiliations: Department of
Otolaryngology–Head and Neck
Surgery, Doernbecher Children’s
Hospital, Oregon Health and Science
University, Portland (Lam); Division
of Otolaryngology–Head and Neck
Surgery, Cincinnati Children’s
Hospital Medical Center, Cincinnati,
Ohio (Lam, Shikary, de Alarcon);
Division of Biostatistics and
Epidemiology, Cincinnati Children’s
Hospital Medical Center, Cincinnati,
Ohio (Tabangin, Meinzen-Derr);
Division of Plastic Surgery, Cincinnati
Children’s Hospital Medical Center,
Cincinnati, Ohio (Uribe-Rivera,
Billmire, Gordon).
Corresponding Author: Derek J.
Lam, MD, MPH, Department of
Otolaryngology–Head and Neck
Surgery, Oregon Health and Science
University, 3181 SW Sam Jackson Park
Rd, PV-01, Portland, OR 97239-3098
).
Research
Original Investigation
Reprinted by permission of JAMA Otolaryngol Head Neck Surg. 2014; 140(4):338-345.
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