Predictors of Failure in Infant Mandibular Distraction Osteogenesis

Publication date: Available online 15 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jeffrey A. Hammoudeh, Artur Fahradyan, Colin Brady, Michaela Tsuha, Beina Azadgoli, Sally Ward, Mark M. Urata
BackgroundMandibular distraction osteogenesis (MDO) has been shown to be successful in treating upper airway obstruction (UAO) caused by micrognathia in pediatric patients. The purpose of this study was to assess the success rate of MDO and possible predictors for failure.MethodsThe records of all neonates and infants who underwent MDO from 2008 to 2015 were retrospectively reviewed. Procedural failure was defined as patient mortality or need for tracheostomy post-operatively. Details of distraction, length of stay (LOS), and failures were captured and elucidated.ResultsOut of the 82 patients, 47 (57.3%) were males, 46 (56.1%) had sporadic Pierre Robin sequence (PRS), 33 (40.3%) had syndromic PRS, and three (3.7%) had micrognathia, not otherwise specified. The average distraction length was 27.5 (15-30, SD 4.4) mm, average age at operation was 63.3 (3-342, SD 71.4) days, and average length of post-MDO hospital stay was 43 (9-219, SD 35) days with a follow-up period of 4.3 (1.1-9.6, SD 2.6) years. There were seven (8.5%) failures (5 tracheostomies, 2 mortalities) resulting in a 91.5% success rate. Regression analysis showed that predicted probability of the need for tracheostomy was 45% (p-0.02) when the patient had a CNS anomaly. The predicted probability of the need for tracheostomy and mortality combined was 99.6 % when the patient had laryngomalacia, CNS anomaly and was pre-operatively intubated (p <0.05).ConclusionThis review confirms that MDO is an effective method of treating the UAO caused by micrognathia with a high success rate. In our sample, the presence of CNS abnormalities, laryngomalacia, and pre-operative intubation had significant impact on the failure rate.



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