Zim Shane
Department of Head and Neck Surgery, Kaiser Permanente, San Diego, CA 92120, USA.
Facial Plast Surg. 2007 May;23(2):107-12. doi: 10.1055/s-2007-979279.
Mandibular distraction osteogenesis has become an accepted alternative treatment for infants and children with upper airway obstruction associated with micrognathia. Several reports exist that purport the efficacy of mandibular distraction in these patients, such as preventing tracheostomy or facilitating tracheostomy removal. However, the majority of these studies are retrospective reviews with small cohorts and relatively short-term follow-up. Consequently, the ideal indications, pre- and postoperative evaluation, timing, and treatment are subject to controversy and not currently well established. Significantly less attention has been given to short- and long-term complications of mandibular distraction, such as effects on the developing tooth buds, impact on future mandibular development, and temporomandibular joint abnormalities. This article reviews the basic principles of distraction osteogenesis, summarizes the outcomes of recent literature involving pediatric mandibular distraction including this author's experience, and discusses the known and potential adverse sequelae of mandibular distraction. Before a clearly defined role of mandibular distraction in the treatment of infants with micrognathia-associated upper airway obstruction can be established, additional prospective studies are necessary to delineate its benefits and limitations.
下颌骨牵张成骨术已成为治疗患有与小下颌相关的上气道阻塞的婴幼儿的一种公认的替代疗法。有几份报告声称下颌骨牵张术对这些患者有效，比如预防气管切开术或促进气管切开术拔除。然而，这些研究大多是对小样本队列进行的回顾性分析，且随访时间相对较短。因此，理想的适应证、术前和术后评估、时机及治疗仍存在争议，目前尚未完全明确。下颌骨牵张术的短期和长期并发症，如对发育中的牙胚的影响、对未来下颌骨发育的影响以及颞下颌关节异常，受到的关注明显较少。本文回顾了牵张成骨术的基本原则，总结了近期有关小儿下颌骨牵张术的文献结果，包括作者的经验，并讨论了下颌骨牵张术已知的和潜在的不良后果。在明确下颌骨牵张术在治疗与小下颌相关的上气道阻塞婴儿中的作用之前，需要进行更多的前瞻性研究来阐明其益处和局限性。
