Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles.
Plast Reconstr Surg. 2013 May;131(5):1116-1123. doi: 10.1097/PRS.0b013e3182865da0.
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.
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.
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).
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.
对于患有小下颌和严重上呼吸道阻塞的新生儿，了解潜在的气道病变对于确定适当的治疗方法非常重要：观察、下颌骨牵引或气管切开术。当存在伴发性气道异常时，下颌骨牵引往往无法缓解阻塞原因，需要进行气管切开术。本研究的第一部分评估了使用加利福尼亚大学洛杉矶分校手术候选算法的 10 年结果，以确定哪些患者将受益于新生儿下颌骨牵引。第二部分描述了在诊断性喉镜/支气管镜检查时发现的伴发性气道异常，以及这些异常如何影响这些患者的新生儿牵引候选资格。
将因小下颌和上呼吸道阻塞而入住新生儿重症监护病房的新生儿（n=133）纳入由加利福尼亚大学洛杉矶分校多学科团队制定的决策树模型方案中，以决定适当的治疗方法。记录伴发性气道异常，并记录患者生命的前 5 年的结果。
55%的患者接受了内置式下颌骨牵引，成功率为 97%。11%的患者选择经鼻咽管进行家庭观察，34%的患者进行了气管切开术。在内窥镜检查中，51.7%的未牵引患者存在伴发性气道异常：喉软化症（53.3%）、气管蹼（20.0%）、声带麻痹（13.3%）、会厌塌陷（6.7%）和下声门狭窄（6.7%）。
对于小下颌伴新生儿上呼吸道阻塞的管理，决策树算法有助于确定下颌骨牵引的候选者。诊断性喉镜/支气管镜检查是该算法的重要组成部分，因为可能存在多种气道异常。
临床问题/证据水平：治疗性，IV。
