Chigurupati Radhika, Massie John, Dargaville Peter, Heggie Andrew
Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Australia.
Pediatr Pulmonol. 2004 Mar;37(3):230-5. doi: 10.1002/ppul.10426.
Micrognathia may cause upper airway obstruction requiring complex medical interventions and sometimes tracheostomy. The role of distraction techniques to lengthen the mandible is yet to be clarified. The aim of this paper is to present a series of five cases in which mandibular lengthening by osteotomy and internal distraction was used to relieve airway obstruction. Five patients whose ages ranged from 4-39 months (mean, 15 months) were managed at our center with internal distraction osteogenesis to relieve airway obstruction. Three patients had a tracheostomy, and two patients had refractory airway obstruction prior to distraction. Following osteotomy and insertion of internal distraction devices, the mandible was distracted a mean of 17 mm (range, 15-25 mm). The distraction devices were removed at the end of a consolidation period ranging from 3-10 weeks. Two of 3 patients with a tracheostomy were decannulated, while the third patient with tracheostomy is awaiting choanal atresia repair before being decannulated. The two patients who were not managed with a tracheostomy but who had persistent upper airway obstruction have not required further airway intervention after mandibular distraction. In conclusion, mandibular lengthening by distraction osteogenesis can relieve airway obstruction in infants and small children. This is a promising new technique that may avoid the need for tracheostomy in some infants with micrognathia, and facilitate early decannulation in those who have a tracheostomy.
小下颌可能导致上呼吸道梗阻，需要复杂的医学干预，有时还需要气管切开术。牵张技术在下颌骨延长中的作用尚待阐明。本文的目的是介绍5例通过截骨术和内置式牵张成骨延长下颌骨以缓解气道梗阻的病例。5例年龄在4至39个月（平均15个月）的患者在我们中心接受了内置式牵张成骨术以缓解气道梗阻。3例患者进行了气管切开术，2例患者在牵张前存在难治性气道梗阻。在截骨术和植入内置式牵张装置后，下颌骨平均牵张了17毫米（范围为15至25毫米）。在3至10周的巩固期结束时取出牵张装置。3例气管切开术患者中有2例拔除了气管套管，而第3例气管切开术患者在等待后鼻孔闭锁修复后再拔除气管套管。2例未进行气管切开术但存在持续性上呼吸道梗阻的患者在进行下颌骨牵张后无需进一步的气道干预。总之，牵张成骨延长下颌骨可缓解婴幼儿的气道梗阻。这是一项有前景的新技术，可能避免一些小下颌婴儿进行气管切开术的需要，并有助于已进行气管切开术的患者早期拔除气管套管。
