Scott Andrew R, Tibesar Robert J, Lander Timothy A, Sampson Daniel E, Sidman James D
Department of Otolaryngology-Head & Neck Surgery, Tufts University School of Medicine, PO Box 850, 800 Washington St, Boston, MA 02111, USA.
Arch Facial Plast Surg. 2011 May-Jun;13(3):173-9. doi: 10.1001/archfacial.2010.114. Epub 2011 Jan 17.
To examine the long-term outcomes and complications in infants with upper airway obstruction and feeding difficulty who underwent bilateral mandibular distraction osteogenesis (MDO) within the first 3 months of life and to identify any preoperative characteristics that may predict the long-term outcome following early MDO intervention for airway obstruction.
An institutional, retrospective medical chart review was performed. Inclusion criteria were bilateral MDO performed at an age younger than 3 months, with a minimum follow-up of 3 years. A quantitative outcome measures scale was developed, and patients were scored based on long-term postoperative complications as well as airway and feeding goals. Factors such as need for an additional surgical procedure were also considered.
Nineteen children were identified as having undergone MDO before 3 months of age and having more than 3 years of follow-up data. The mean age at distraction was 4.8 weeks (range, 5 days-12 weeks); the mean length of follow-up was 5.6 years (range, 37-122 months). Of these 19 patients, 14 had isolated Pierre Robin sequence (PRS) and 5 had syndromic PRS. All patients with isolated PRS had a good or intermediate long-term result. Infants with comorbidities such as developmental delay, seizures, or arthrogryposis had the poorest outcomes.
Bilateral MDO is a relatively safe and effective means of treating airway obstruction and feeding difficulty in infants with PRS. The effects of this procedure, which carries a relatively low morbidity, persist through early childhood in most patients.
研究在出生后3个月内接受双侧下颌骨牵张成骨术（MDO）的上气道梗阻和喂养困难婴儿的长期预后及并发症，并确定任何可能预测早期MDO干预气道梗阻后长期预后的术前特征。
进行了一项机构性回顾性病历审查。纳入标准为在3个月龄前进行双侧MDO，且至少随访3年。制定了定量预后测量量表，并根据术后长期并发症以及气道和喂养目标对患者进行评分。还考虑了诸如是否需要额外手术等因素。
确定19名儿童在3个月龄前接受了MDO并拥有超过3年的随访数据。牵张时的平均年龄为4.8周（范围为5天至12周）；平均随访时间为5.6年（范围为37至122个月）。在这19例患者中，14例患有孤立性皮埃尔·罗宾序列征（PRS），5例患有综合征性PRS。所有孤立性PRS患者的长期预后良好或中等。患有发育迟缓、癫痫或关节挛缩等合并症的婴儿预后最差。
双侧MDO是治疗PRS婴儿气道梗阻和喂养困难的一种相对安全有效的方法。该手术发病率相对较低，其效果在大多数患者的幼儿期持续存在。
