2015 HSC Section 1 Book of Articles

69 / 280

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
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.2,21,22However, inour study
the 2 most frequent syndromic diagnoses were Treacher-
Table 4. Unadjusted and Adjusted Associations Between Potential Predictors and Any Complication
Variable
Unadjusted Adjusteda
OR (95% CI) P Value OR (95% CI) P Value
Tracheotomy vs MDO first 2.90 (1.20-7.10) .02 1.80 (0.67-4.70) .24
Male 1.50 (0.64-3.50) .36
Diagnosisb
CFM–Goldenhar syndrome 1.10 (0.20-6.00) .90
Treacher-Collins syndrome 3.60 (0.90-13.80) .07
Other 2.20 (0.80-5.70) .11
Age at distraction, y 1.10 (0.98-1.10) .14
Follow-up, y 1.20 (1.00-1.30) .02 1.20 (1.00-1.30) .05
Distraction amount, mm 1.00 (0.98-1.10) .31
Distractions, No.
2 vs 1 0.56 (0.13-2.40) .44
3 vs 1 0.56 (0.01-23.00) .76
Open air surgical procedures, No. 1.00 (0.44-2.30) .99
Other airway procedures, ≥2 vs <2 3.40 (1.40-8.40) .009 3.20 (1.20-8.60) .02
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.
Figure 2. Predicted Probabilities for Complications Stratified by Initial Treatment Subgroup
0.0
0 4 6 8 10
1.0
0.8
Probability of Complication
Follow-up Length, y
0.6
0.4
0.2
2
A
0.0
0 4 6 8 10
1.0
0.8
Probability of Complication
Follow-up Length, y
0.6
0.4
0.2
2
B
<2
≥2
Other airway
procedures, No.
Females Males
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.
Mandibular Distraction Osteogenesis Original Investigation Research
JAMA Otolaryngology–Head & Neck Surgery April 2014 Volume 140, Number 4
47