The Radiographic “Air Sign” in Neonatal Mandibular Distraction Osteogenesis

2021 ◽  
pp. 229255032110485
Author(s):  
Tyler Safran ◽  
Abdulaziz Alabdulkarim ◽  
Rafael Galli ◽  
Mirko S. Gilardino
Keyword(s):  
Airway Obstruction ◽  
Distraction Osteogenesis ◽  
Mandibular Advancement ◽  
Mandibular Distraction ◽  
Risk Of Failure ◽  
Mandibular Distraction Osteogenesis ◽  
Objective Sign ◽  
Difficult Airways

Timing of extubation on post-mandibular distraction osteogenesis (MDO) surgery is critical, given that at baseline these infants have difficult airways and failed extubation requires either re-intubation of an already complex airway with a fragile, recently osteotomized mandible, or adjunctive airway measures such as CPAP that may apply unwanted pressure to the surgical site. Thus, the goal is to plan extubation when the risk of failure is minimal. Currently, there is a void in the literature addressing the timing of extubation post-MDO and no objective sign of extubation readiness has been elucidated. This study describes a simple clinical pearl to assist in the evaluation of extubation readiness in these patients. Postoperatively, we obtain weekly radiographs to assess distractor stability and advancement, and to assess for the “Air Sign”. The Air Sign describes a radiolucent space (air) visualized in the oropharynx on lateral radiographs, likely indicating that the tongue based airway obstruction has been relieved by mandibular advancement.

A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence

2021 ◽  
pp. 105566562110118
Author(s):  
Darren B. Abbas ◽  
Christopher Lavin ◽  
Evan J. Fahy ◽  
HyeRan Choo ◽  
Mai Thy Truong ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Distraction Osteogenesis ◽  
Literature Search ◽  
Oral Feeding ◽  
Treatment Modalities ◽  
Pierre Robin Sequence ◽  
Mandibular Distraction ◽  
Robin Sequence ◽  
Mandibular Distraction Osteogenesis ◽  
Pierre Robin

Objective: Mandibular distraction osteogenesis (MDO) is frequently performed to address airway obstruction in patients with Pierre Robin sequence (PRS), though more recently the technique of orthodontic airway plating (OAP) has gained traction. We aimed to evaluate OAP compared to MDO for airway obstruction in PRS. Design: A systematic literature search across PubMed, Embase, and Google Scholar identified all studies published in English, which involved MDO or any form of OAP as treatments for PRS. All relevant articles were reviewed in detail and reported on, adhering to PRISMA guidelines. Main Outcome Measures: Airway (tracheostomy avoidance, decannulation rate), feeding (full oral feeding tolerance). Results: Literature search identified 970 articles, of which 42 MDO studies and 9 OAP studies met criteria for review. A total of 1159 individuals were treated with MDO, and 322 individuals were treated with OAP. Primary outcomes appear similar for MDO and OAP at face value; however, this must be interpreted with different pretreatment contexts in mind. Conclusions: Orthodontic airway plating may be considered for airway obstruction in PRS, as some airway-related and feeding-related outcomes appear similar with MDO, per existing evidence in the literature. However, since PRS severity differed between studies, OAP cannot be uniformly considered a replacement for MDO. Further research is required to more comprehensively assess these treatment modalities inclusive of metrics that allow for direct comparison.

Quantification of Mandibular Morphology in Pierre Robin Sequence to Optimize Mandibular Distraction Osteogenesis

2020 ◽  
Vol 57 (8) ◽  
pp. 1032-1040 ◽  
Author(s):  
Angela S. Volk ◽  
Matthew J. Davis ◽  
Amit M. Narawane ◽  
Amjed Abu-Ghname ◽  
Robert F. Dempsey ◽  
...  
Keyword(s):  
Airway Management ◽  
Airway Obstruction ◽  
Distraction Osteogenesis ◽  
Pierre Robin Sequence ◽  
Management Decisions ◽  
Mandibular Distraction ◽  
Robin Sequence ◽  
Mandibular Distraction Osteogenesis ◽  
Mandibular Body ◽  
Pierre Robin

Background: Mandibular distraction osteogenesis (MDO) is the primary surgical intervention to treat airway obstruction in Pierre Robin sequence (PRS). Current morphologic studies of PRS mandibles do not translate into providing airway management decisions. We compare mandibles of infants with nonsyndromic PRS to controls characterizing morphological variances relevant to distraction. We also examine how morphologic measurements and airway grades correlate with airway management. Methods: Patients with PRS under 2 months old were age and sex matched to controls. Demographic and perioperative data, and Cormack-Lehane airway grades were recorded. Computed tomography scans were used to generate mandibular models. Bilateral condylions, gonions, and the menton were identified. Linear and angular measurements were made. Wilcoxon rank sum and 2-sample t tests were performed. Results: Twenty-four patients with PRS and 24 controls were included. Seventeen patients with PRS required MDO. PRS patients had shorter ramus heights (16.7 vs 17.3 mm; P = .346) and mandibular body lengths (35.3 vs 39.3 mm; P < .001), more acute gonial angles (125.3° vs 131.3°; P < .001), and more obtuse intergonial angles (94.2° vs 80.4°; P < .001) compared to controls. No significant differences were found among patients requiring MDO versus conservative management nor among distracted patients with high versus low airway grades. Conclusion: Our study examines the largest and youngest PRS population to date regarding management of early airway obstruction with MDO. Our findings indicate that univector mandibular body distraction allows for normalization in nonsyndromic patients with PRS, and airway obstruction management decisions should remain clinical.

Pediatric Feeding in Infants With Pierre Robin Sequence Following Mandibular Distraction Osteogenesis

2016 ◽  
Vol 1 (13) ◽  
pp. 5-9
Author(s):  
Kelly Mabry
Keyword(s):  
Cleft Palate ◽  
Airway Obstruction ◽  
Distraction Osteogenesis ◽  
Pierre Robin Sequence ◽  
Mandibular Distraction ◽  
Post Surgery ◽  
Feeding Experience ◽  
Robin Sequence ◽  
Mandibular Distraction Osteogenesis ◽  
Pierre Robin

Pierre Robin sequence (PRS) causes anomalies that can include micrognathia, cleft palate, and glossoptosis. At birth, infants typically present with a small mandible (micrognathia) which displaces the tongue posteriorly and causes breathing difficulties due to airway obstruction. A large, U-shaped cleft palate is often associated with this condition and the combined phenotype can be seen in isolation or in conjunction with a syndrome. In the neonatal period, management of PRS focuses on airway obstruction and feeding through conservative positioning techniques that are often successful. However, infants that do not respond to conservative measures require surgical intervention such as tongue-lip adhesion, tracheostomy, or mandibular distraction osteogenesis (MDO) to manage their airway. While each of these surgical procedures have been used effectively, the process of MDO has become the definitive technique to surgically correct the airway obstruction in PRS by lengthening the mandible, which also brings the tongue forward and out of the airway. Feeding intervention is directly related to the resolution of micrognathia which in turn advances the tongue base anteriorly, resolving the glossoptosis and airway obstruction. The infant's feeding experience, including pre-surgery and post-surgery considerations, are discussed.

Correction of Upper Airway Obstruction in the Newborn With Internal Mandibular Distraction Osteogenesis

2003 ◽  
Vol 14 (4) ◽  
pp. 493-499 ◽  
Author(s):  
Keyoumars Izadi ◽  
Robert Yellon ◽  
David L. Mandell ◽  
Meghan Smith ◽  
Sung Y. Song ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Distraction Osteogenesis ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Mandibular Distraction ◽  
Mandibular Distraction Osteogenesis
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