Objective:To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. Methods:From January to December 2022, a total of 6 newborns with micrognathia and laryngomalacia were included. Preoperative laryngoscopy revealed concomitant laryngomalacia. These micrognathia were diagnosed as Pierre Robin sequences. All patients had grade Ⅱ or higher symptoms of laryngeal obstruction and required oxygen therapy or non-invasive ventilatory support. All patients underwent simultaneous laryngomalacia surgery and mandibular distraction osteogenesis. The shortened aryepiglottic folds were ablated using a low-temperature plasma radiofrequency during the operation. Tracheal intubation was maintained for 3-5 days postoperatively. Polysomnography（PSG） and airway CT examination were performed before and 3 months after the surgery. Results:Among the 6 patients, 4 required oxygen therapy preoperatively and 2 required non-invasiveventilatory support. The mean age of patients was 40 days at surgery. The inferior alveolar nerve bundle was not damaged during the operation, and there were no signs of mandibular branch injury such as facial asymmetry after the surgery. Laryngomalacia presented as mixed type: type Ⅱ+ type Ⅲ. The maximum mandibular distraction distance was 20 mm, the minimum was 12 mm, and the mean was 16 mm. The posterior airway space increased from a preoperative average of 3.5 mm to a postoperative average of 9.5 mm. The AHI decreased from a mean of 5.65 to 0.85, and the lowest oxygen saturation increased from a mean of 78% to 95%. All patients were successfully extubated after the surgery, and symptoms of laryngeal obstruction such as hypoxia and feeding difficulties disappeared. Conclusion:Newborns with micrognathia and laryngomalacia have multi-planar airway obstruction. Simultaneous laryngomalacia surgery and mandibular distraction osteogenesis are safe and feasible, and can effectively alleviate symptoms of laryngeal obstruction such as hypoxia and feeding difficulties, while significantly improving the appearance of micrognathia.
Humans ; Infant, Newborn ; Infant ; Micrognathism/surgery* ; Laryngomalacia/surgery* ; Treatment Outcome ; Mandible/surgery* ; Airway Obstruction/surgery* ; Intubation, Intratracheal ; Laryngeal Diseases ; Osteogenesis, Distraction ; Oxygen ; Retrospective Studies

Dysphasia related to oral anomaly is a common situation in oral and maxillofacial surgery. The etiology of oral anomalies causing dysphasia can be divided into congenital and acquired disease. Congenital diseases include teratoma or benign tumors and congenital defects such as cleft lip and palate. Benign tumors include cystic hygroma in the neck and hemangioma in the tongue. Certain syndromes with macroglossia and micrognathia are also related to difficulty in swallowing. The three common syndromes are Pierre-Robin syndrome, Beckwith-Widermann syndrome and ectodermal dysplasia. Taken together, these congenital diseases require a multi-discipline approach to obtain optimal results. Representative disease of acquired dysphasia is the oral cavity cancer. Cancer ablation results in tissue defect and decreased motor function. Free flap reconstruction is the choice of treatment following oral cavity caner operation; however, dysphasia after cancer operation is inevitable. In this review article, the full scopes of oral anomaly associated with dysphasia were classified and treatment was suggested.
Aphasia ; Cleft Lip ; Congenital Abnormalities ; Deglutition ; Ectodermal Dysplasia ; Free Tissue Flaps ; Hemangioma ; Lymphangioma, Cystic ; Macroglossia ; Micrognathism ; Mouth ; Mouth Neoplasms ; Neck ; Palate ; Pierre Robin Syndrome ; Surgery, Oral ; Teratoma ; Tongue

OBJECTIVETo evaluate the clinical effect of distraction osteogenesis for patients with mandibular micrognathia secondary to temporomandibular joint (TMJ) ankylosis.

METHODS43 patients (aged from 2 to 61 years old) with mandibular micrognathia were treated with mandibular distraction osteogenesis. Two types of mechanical distraction were utilized in this study. Ten patients (age ranged from 2 to 16-years-old, mean age 7.6 years old) with severe micrognathia underwent bilateral mandibular distraction with rigid external distraction (RED) device. Other 33 patients were treated with unilateral(6 cases) or bilateral (27 cases) mandibular distraction using internal distraction device. Distraction was started on the 4th to 8th day after operation and distraction rate was 0.25 mm every time, four times a day. Distractor was removed after 3 to 6 months of consolidation period.

RESULTSEighty sides of mandible in 43 patients were lengthened. The mean distraction distance was 23.2 mm (ranged from 14 to 35 mm). After distraction, the average posterior airway space (PAS) was enlarged from 4.9 mm to 10.4 mm and average angle of sella-nasion-point B (SNB) was increased from 64.2 degrees to 74.5 degrees. The apnea hypopnea index (AHI) was decrease significantly. The profile was improved and OSA was improved effectively in each patient. No complication occurred during treatment. No persistent numbness of lower lip was observed. All patients were satisfied with the results. After a mean follow-up period of 20.3 months(5 to 103 months) , the result was stable and no obvious relapse of micrognathia was observed.

CONCLUSIONSDistraction osteogenesis is an effective way in correction of mandibular micrognathia secondary to TMJ ankylosis. RED is a new method for treatment of children and adolescence with severe mandibular micrognathia. The procedure is simple and safe with stable result.

Adolescent ; Adult ; Ankylosis ; complications ; Child ; Child, Preschool ; Humans ; Mandible ; surgery ; Micrognathism ; etiology ; surgery ; Middle Aged ; Osteogenesis, Distraction ; instrumentation ; methods ; Sleep Apnea, Obstructive ; surgery ; Temporomandibular Joint ; Temporomandibular Joint Disorders ; complications ; Young Adult

OBJECTIVETo investigate the effect of distraction osteogenesis (DO) in the treatment of severe mandibular micrognathia with severe obstructive sleep apnea and hypopnea syndrome (OSAHS).

METHODS19 cases of severe mandibular micrognathia with OSAHS were treated by DO. All the patients received PSG and MSCT examination before and after DO to evaluate the therapeutic effect and changes in the upper airway.

RESULTSAccording to the evaluation standard, 17 cases were cured and 2 cases improved markedly. The sagittal distance and area, transverse distance and area of the upper airway increased markedly after DO. The volume of upper airway increased from (15 572.03 +/- 3 370.11) mm3 to (21 182.69 +/- 4 533.15) mm3.The airway change happened mainly in velopharyngeal region and the lingopharyngeal region, but not in the laryngopharyngeal region.

CONCLUSIONSDO can treat severe mandibular micrognathia patients with OSAHS effectively by enlarging the volume of upper airway,especially in the velopharynx and glossopharyngeum region. The MSCT plays an effective and important role.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Male ; Mandible ; surgery ; Micrognathism ; complications ; surgery ; Osteogenesis, Distraction ; methods ; Sleep Apnea, Obstructive ; complications ; surgery ; Young Adult

OBJECTIVETo evaluate the effect of distraction osteogenesis for severe micrognathia by comparing the pre- and post-operative profile and mentolabial relationship.

METHODS16 cases underwent temporal-mandibular joint plasty and temporal fasciomuscular flap transfer. The mandibular distraction began at the 5th postoperative day at a rate of 0.8 mm a day, two times a day. Bony and soft tissue cephalometry were performed before and after operation. T-test was used to study the change after distraction osteogenesis.

RESULTSThere were significant differences in facial convexity, lower facial height, lower lip length, inter-labial distance, the ratio of lip to mental, the distance from lip to esthetic plane, the depth of mentolabial crease and the thickness of mental soft tissue.

CONCLUSIONSMandibular distraction osteogenesis can markedly improve the soft tissue profile of the middle and lower face for severe micrognathia.

Child ; Child, Preschool ; Facial Muscles ; pathology ; Humans ; Male ; Micrognathism ; pathology ; surgery ; Osteogenesis, Distraction ; Postoperative Period

Adolescent ; Adult ; Ankylosis ; complications ; surgery ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Micrognathism ; complications ; surgery ; Models, Anatomic ; Skull ; anatomy & histology ; Temporomandibular Joint Disorders ; complications ; surgery ; Young Adult

OBJECTIVETo approach the treatment of severe micrognathia accompanying obstructive sleep apnea hypopnea syndrome (OSAHS) with rigid external distractor (RED) in children.

METHODSSix cases patients (4 males, 2 females) aged between 1.5 and 14 years, were diagnosed as ankylosis of temporomandibular joint severe micrognathia, and OSAHS. Under the nasal intubation and general anesthesia, the surgical procedures were performed by submandibular approach and osteotomy was done in mandible body. Mini plate was fixed and connected to RED. The distraction procedure was carried out

RESULTSPatients' profile, posterior airway space, and the results of polysomnography were improved significantly. There were no complications. Four months after removing the RED, the new bone was well formed.

CONCLUSIONSRED technique has advantages of uncomplicated procedures, high quality of new bone formation, and accurate regulation in the treatment of micrognathia. It is especially suitable for the treatment of children with severe micrognathia whose mandibular body is too small to insert the internal distractor.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Mandible ; surgery ; Micrognathism ; complications ; surgery ; Osteogenesis, Distraction ; methods ; Sleep Apnea, Obstructive ; complications ; surgery ; Temporomandibular Joint Disorders ; complications ; surgery ; Treatment Outcome

OBJECTIVETo investigate the morphologic changes of upper airway in obstructive sleep apnea and hypopnea syndrome (OSAHS) associated with micrognathism before and after orthognathic surgery and distraction osteogenesis, and subsequently to instruct clinical jobs effectively.

METHODSNine OSAHS patients associated with micrognathism (8 males, 1 female, mean age: 28.6 years) received orthognathic surgery and (or) distraction osteogenesis, and the curative effect was evaluated according to the subjective feelings and PSG. Upper airway structure before and after the treatment was measured by Somatom Sensation 16 CT scanner.

RESULTSAll 9 patients were clinically cured. The transverse length, the cross section area, and especially the sagittal length of the upper airway were obviously increased after the orthognathic surgery. The changes involved mainly in the velopharyngeal region and the laryngopharyngeal region, but not in the laryngopharyngeal region.

CONCLUSIONSThe orthognathic surgery and distraction osteogenesis can treat the OSAHS patients with microgonathism effectively by increasing their velopharyngeal and laryngopharyngeal sagittal length of upper airway.

Adolescent ; Adult ; Female ; Humans ; Male ; Micrognathism ; complications ; diagnostic imaging ; surgery ; Osteogenesis, Distraction ; Pharynx ; diagnostic imaging ; Polysomnography ; Sleep Apnea, Obstructive ; diagnostic imaging ; etiology ; surgery ; Tomography, Spiral Computed ; Treatment Outcome ; Young Adult

OBJECTIVETo study the significance and principle of simultaneous orthodontics during mandibular distraction osteogenesis.

METHODSTotally 11 patients simultaneously underwent occlusal orthodontic treatment for 3-4 months during mandibular distraction osteogenesis. Square-wire and elastic loops were adapted to perform the orthodontics by ways of more frequent adjustment of orthodontic device than routine method.

RESULTSAll 11 patients with mandibular micronathia obtained the improved occlusion with their mandibular expected elongation, for instance, their open-bite and teeth displacement were partially corrected.

CONCLUSIONSimultanous orthodontics with mandibular distraction osteogenesis may improve the malocclusion, decrease the orthodontic time, and lead the mandibular distraction direction.

Adolescent ; Adult ; Female ; Humans ; Male ; Malocclusion ; complications ; therapy ; Mandible ; surgery ; Micrognathism ; complications ; surgery ; Orthodontics ; Osteogenesis, Distraction

OBJECTIVETo evaluate the treatment of obstructive sleep apnea syndrome (OSAS) in children with congenital micrognathia using mandibular distraction osteogenesis and to discuss the advantages and disadvantages of this approach.

METHODS6 patients (4 males, 2 females) had undergone mandibular distraction osteogenesis, 12 distraction devices were placed through extraoral incision for bilateral distraction. The mean age of treatment was 1 year and 9 months (range 4 months to 9 years). Every patient had been evaluated pre and postoperatively with cephalometry. The period of consolidation was 4 - 11 weeks. The period of follow-up was from 2 to 10 months.

RESULTSThe average distraction distance was 19.2 mm (range 15 to 25 mm). The osteotomy and distraction processes were smooth in all the cases, the osteogenesis was good, without infection and other complications. The posterior airway space was increased from averaged 4.5 mm preoperatively to 10. 1mm after surgery. Five children had normal respiration and sleep restored with naso-pharyngeal airway removal or tracheostomy decannulation. One patient is to receive a planned second stage of distraction with a horizontal vector. The results were stable without relapse during a follow-up period of 2 to 10 months.

CONCLUSIONSApplication of mandibular distraction osteogenesis is an important component and effective in the treatment of OSAS and permits mandibular advancement in the younger child. As more experience is gained with distraction osteogenesis in the treatment of children with OSAS, the role of distraction will become better defined.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Micrognathism ; complications ; surgery ; Osteogenesis, Distraction ; methods ; Sleep Apnea, Obstructive ; complications ; surgery