Author(s)
Christian Francom, MD1
Christopher Greenlee, BS2
Alex Kaizer, PhD3
Kaitlyn Tholen, BS1
Melissa Scholes, MD1
Gregory Allen, MD1
Affiliation(s)
1Otolaryngology & Head and Neck Surgery, Children's Hosp. of Colorado, Aurora, CO, 2Univ. of Colorado Sch. of Med., Aurora, CO, 3Biostatistics and Informatics, Univ. of Colorado, Aurora, CO.;
Abstract:
Introduction: Micrognathia in neonates can lead to adverse outcomes affecting breathing, feeding, growth, and development. Patients are managed with a range of conservative to invasive measures dependent upon the severity of symptoms and response to conservative therapies. When conservative therapy is unsuccessful, selected patients have been managed with mandibular distraction osteogenesis (MDO). We previously reported airway, feeding and growth outcomes. This follow-up study is to evaluate MDO over a longer time and with a larger cohort.
Methods: We performed a retrospective review over an 18-year period of patients with micrognathia who underwent MDO within the first 90 days of life. Demographic data, hospital course, associated syndromes, duration of distraction, need for additional procedures, and growth data were included. The Cormack-Lehane classification was used to evaluate the grade of laryngeal view pre and post MDO. Descriptive statistics along with Mixed-Effects growth curve analyses were used to evaluate the data.
Results: Sixty-three patients were included in the analysis. The average age at MDO was 36.0 days (SD±24.3), the average duration of distraction was 7.62 days (SD±2.11), and the average discharge was on postoperative day 20.4 days (SD±12.0). Ninety-six percent of patients showed objective improvement in airway grade following MDO with 95% obtaining a grade II view or better. Seventy percent of patients were able to feed exclusively with oral intake and no patients required tracheostomy placement following MDO.
Conclusion: Our results support early intervention with MDO as a successful option for neonates with symptomatic micrognathia refractory to conservative measures. Airway improvement is significant as tracheostomy is avoided and ease of future intubation is enhanced. Feeding outcomes are also encouraging as many patients are able to avoid gastrostomy tube placement. Though retrospective, our series is one of the largest in the literature.