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David L. Mandell, MD; Robert F. Yellon, MD; James P. Bradley, MD; Keyoumars Izadi, MD, DDS; Christopher B. Gordon, MD

Arch Otolaryngol Head Neck Surg. 2004;130:344-348.

Objective  To determine whether the use of mandibular distraction osteogenesis (DOG) can help to avoid tracheotomy or achieve decannulation in patients with mandibular hypoplasia and severe upper airway obstruction.

Design  Retrospective medical record review (spanning a 27-month period).

Setting  Tertiary care children's hospital.

Subjects  Group A (n = 8) was composed of infants with Pierre Robin sequence and no tracheotomy (mean age, 2.5 months); group B (n = 6), older nontracheotomized micrognathic children with obstructive sleep apnea (OSA) (mean age, 69 months); and group C (n = 12), tracheotomized children with complex congenital syndromes (mean age, 33 months).

Intervention  Bilateral mandibular DOG with endoscopic (n = 24) and/or radiographic (n = 17) airway evaluation (mean follow-up, 16 months [range, 2-42 months]).

Outcome Measures  Group A, tracheotomy avoidance; group B, resolution of OSA (clinically or on polysomnography); and group C, decannulation.

Results  Group A, 7 patients (88%) successfully avoided tracheotomy; group B, 5 patients (83%) had resolution of OSA; and group C, 2 patients (17%) underwent decannulation.

Conclusions  Mandibular DOG (1) allows tracheotomy avoidance in infants with isolated Pierre Robin sequence and (2) relieves OSA in older micrognathic children without tracheotomy. However, mandibular DOG does not frequently lead to decannulation in tracheotomized patients with complex congenital syndromes.

From the Department of Pediatric Otolaryngology (Drs Mandell and Yellon) and the Division of Pediatric Plastic and Reconstructive Surgery (Dr Izadi), Children's Hospital of Pittsburgh, Pittsburgh, Pa; the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, UCLA Medical Center (Dr Bradley); and the Division of Pediatric Plastic Surgery, Children's Hospital Medical Center, Cincinnati, Ohio (Dr Gordon). The authors have no relevant financial interest in this article.

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