Document Detail


Incidence of concomitant airway anomalies when using the university of California, Los Angeles, protocol for neonatal mandibular distraction.
MedLine Citation:
PMID:  23629092     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In newborns with micrognathia and severe upper airway obstruction, understanding potential airway lesions is important for determining appropriate treatment: observation, mandibular distraction, or tracheostomy. When concomitant airway anomalies are present, mandibular distraction is often unsuccessful at alleviating causes of obstruction, mandating the need for tracheostomy. The first part of this study evaluates 10-year results using the University of California, Los Angeles, algorithm for surgical candidacy to identify patients who will benefit from neonatal mandibular distraction. The second part describes the concomitant airway abnormalities found at the time of diagnostic laryngoscopy/bronchoscopy and how these anomalies affect neonatal distraction candidacy of these patients.
METHODS: Newborns admitted to the neonatal intensive care unit with micrognathia and upper airway obstruction (n = 133) were subjected to a decision tree model protocol formulated by a multidisciplinary team at the University of California, Los Angeles, to decide on appropriate treatment. Concomitant airway abnormalities were recorded and outcomes were documented for the first 5 years of life.
RESULTS: Fifty-five percent of patients underwent internal mandibular distraction with 97 percent success. Home observation with a nasopharyngeal tube was chosen in 11 percent of patients, and 34 percent had tracheostomies. On endoscopic examination, 51.7 percent of the nondistracted patients had concomitant airway anomalies: laryngomalacia (53.3 percent), tracheal web (20.0 percent), vocal cord paralysis (13.3 percent), epiglottal collapse (6.7 percent), and infraglottal narrowing (6.7 percent).
CONCLUSIONS: For the management of neonatal upper airway obstruction with micrognathia, a decision tree algorithm is useful to determine candidates for mandibular distraction. Diagnostic laryngoscopy/bronchoscopy is an important component of this algorithm because a multitude of airway anomalies may be present.
CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, IV.
Authors:
Brian T Andrews; Kenneth L Fan; Jason Roostaeian; Christina Federico; James P Bradley
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  131     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-30     Completed Date:  2013-07-16     Revised Date:  2014-01-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1116-23     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / epidemiology*,  surgery*
Algorithms
Bronchoscopy
Decision Trees
Epiglottis / abnormalities,  surgery
Female
Humans
Incidence
Infant
Infant, Newborn
Intensive Care, Neonatal / methods
Laryngoscopy
Male
Mandible / abnormalities,  surgery*
Micrognathism / epidemiology*,  surgery*
Osteogenesis, Distraction / methods*
Trachea / abnormalities,  surgery
Treatment Outcome
Vocal Cord Paralysis / surgery
Comments/Corrections
Comment In:
Plast Reconstr Surg. 2013 Dec;132(6):1071e-2e   [PMID:  24281617 ]
Plast Reconstr Surg. 2013 Dec;132(6):1072e-3e   [PMID:  24281618 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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