2015 HSC Section 1 Book of Articles

Research Original Investigation

Mandibular Distraction Osteogenesis

Table 1. Characteristics and Outcomes of 123 Patients in Cohort

Tracheotomy First (n = 62 [50.4%])

MDO First (n = 61 [49.6%])

P Value

Characteristic

No. (%)

Male

69 (56.1) 54 (43.9) 69 (56.1) 12 (9.8) 11 (8.9) 4 (3.3) 42 (3.1)

Isolated Pierre Robin sequence

21 (33.9) 41 (66.3) 8 (12.9) 7 (11.3) 3 (4.8) 23 (3.7)

35 (57.4) 26 (42.6) 4 (6.6) 4 (6.6) 1 (1.6) 17 (2.8)

Syndromic

Treacher-Collins syndrome CFM–Goldenhar syndrome

.009

Stickler syndrome

Other a

Age at distraction, mo Mean (SD)

40 (52)

46 (47)

34 (57)

.20

Median (IQR)

21 (2.2-48.2)

30 (15.2-52.8)

5.1 (0.6-42.1)

<.001

Range

6 d–20 y

25 d–20 y

6 d–19 y

Follow-up time, mean (SD), y

3.2 (3.2)

3.8 (3.8) 23.1 (7.9)

2.5 (2.3) 21.6 (7.7)

.03 .28

Amount distracted, mean (SD), mm 22.3 (7.9)

Distractions, No. 1

Abbreviations: CFM, craniofacial microsomia; IQR, interquartile range; NA, not applicable. a Includes arthrogryposis; Pfeiffer, Nager, Klippel-Feil, amniotic band, orofaciodigital, Cornelia de Lange, Loeys-Dietz, Dandy-Walker, cri-du-chat, Crouzon, Moebius, and Katel-Manske syndromes; achondroplasia; and chromosomal abnormalities. b Includes laryngotracheoplasty, endoscopic airway procedures, base of tongue procedures, choanal atresia repair. c Fisher exact test. d Need for repeated distraction within 30 days of initial distraction, transient facial nerve injury, emergent reintubation, prolonged intubation, and internal carotid artery dissection.

107 (87.0) 14 (11.4)

55 (88.7) 7 (11.3)

52 (85.2) 7 (11.5)

2

.52 c

≥3

2 (1.6)

0

2 (3.3)

Subsequent airway procedures, No. b 0

67 (55.4) 27 (22.3) 10 (8.3) 17 (14.0)

24 (38.7) 18 (29.0) 7 (11.3) 13 (21.0)

43 (72.9) 9 (15.2)

1 2

.002

3 (5.1) 4 (6.8)

≥3

Outcomes by treatment group Surgical success Avoidance of tracheotomy

93 (75.6)

42 (67.7)

51 (83.6) 51 (83.6) 5 (8.2) 9 (14.8) 2 (3.3) 4 (6.6)

NA NA

NA

<.001

Decannulation

42 (67.7) 24 (38.7) 12 (19.4)

Complications

33 (26.8) 14 (11.4)

.03

Premature consolidation

.005

>.99 c

Open bite deformity

9 (7.3) 5 (4.1) 9 (7.3)

5 (8.1) 5 (8.1) 6 (9.7)

.06 c .49 c

Temporomandibular joint ankylosis

0

Other d

3 (5.0)

underwent MDO first. Median follow-up time was approxi- mately 5 years (range, 30 days–16.2 years). The median dis- traction amount was 22 mm (range, 7-52 mm). One hundred seven patients (87.0%) underwent a single distraction, while the remainder of the cohort required repeated distractions. Most these patients underwent repeated distractions at least 6 months after the initial distraction. Seven patients (5.7%) required repeated distractions within 30 days of the initial procedure. Of these, 4 could be attributed to either hardware malfunction or premature consolidation. Sixty-seven patients (55.0%) did not require any further airway proce- dures after distraction, although a substantial minority of patients required at least 1 other procedure. Patients who underwent tracheotomy first were signifi- cantly more likely to have an associated syndromic diagnosis compared with those who underwent MDO first (66.0% vs 43.0%, respectively). Patients treated with MDO first were also significantly younger at the time of distraction than those treated with tracheotomy first (median age, 5 months vs 30 months) and required fewer subsequent air- way procedures.

sion in subsequentmultivariable regressionmodels. Anα = .05 was considered for statistical significance in all final models. SAS statistical software (version 9.3; SAS Institute) was used to conduct all analyses.

Results There were 132 patients who underwent MDO during the study period. Of these, 8 patients were lost to follow-up, and 1 died shortly after distraction owing to congenital heart dis- ease. These patients were excluded from subsequent analy- sis, leaving 123 patients in the cohort. Patient characteristics for the entire cohort and stratified by initial treatment group are described in Table 1 . A slight majority of patients were male, and 56.0% were diagnosed as having an associated syndrome. Treacher-Collins (9.8%) and CFM-Goldenhar (8.9%) syndromes were the most commonly encountered syndromes. Median age at time of distraction was 21 months (range, 6 days–24 years). Sixty-two patients (50.4%) under- went an initial tracheotomy prior to MDO while 61 (49.6%)

JAMA Otolaryngology–Head & Neck Surgery April 2014 Volume 140, Number 4

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