International Journal of Anesthesiology & Pain Medicine

Synchronous Airway Lesions in Mandibular Distraction Osteogenesis Patients

Objective: 1. Determine prevalence and type of synchronous airway lesions (SALs) present in patients undergoing Mandibular Distraction Osteogenesis (MDO) at Lurie Children's Hospital of Chicago
2. To determine whether these SALs affect the surgical outcomes of MDO in relieving airway obstruction

Design: Retrospective Chart Review

Setting: Tertiary care pediatric hospital

Patients, Participants: Patients with micrognathia undergoing MDO and direct laryngoscopy and bronchoscopy (DLB) from 2001-2011. A total of 54 patients were included in the study.

Main Outcome Measure(s): Charts were reviewed for demographics, prevalence and type of SALs, success rate for airway improvement for MDO, and coexisting medical and craniofacial conditions.

Results: A total of 54 patients underwent MDO and of those 21 patients were found who have undergone both MDO and DLB. The incidence of at least 1 SAL was 71.4% in this group. A subgroup of patients less than 24 months had an incidence of SALs that was 78%. Types of SALs encountered include laryngeal edema (57.1%), tracheobronchitis (42.9%), laryngomalacia (33.3%), tracheomalacia (14.3%), bronchomalacia (14.3%), subglottic stenosis (9.5%), and pulsatile airway compression (9.5%). Nine of 21 patients (42.9%) demonstrated airway lesions that have been known to have the potential for more significant airway obstruction than the more minor SALs. These include subglottic stenosis, laryngomalacia, tracheomalacia, bronchomalacia or pulsatile airway compression. Of those patients with MDO and DLB, 19/21 (90.5%) received tracheostomy, and 18/19 of those were decannulated. The patient that was not decannulated had two synchronous airway lesions. There was a second failure that also had a SAL and was determined to be a failure due to lack of clinical improvement after MDO.

Conclusion: There is a high rate of SALs in patients undergoing MDO surgery which can have a significant impact on the anesthesia and acute care practice. In our study population the most common SALs were laryngeal edema, tracheobronchitis and laryngomalacia. Direct laryngoscopy and bronchoscopy should be considered preoperatively for patients undergoing MDO as it has the potential to diagnose other treatable causes of airway obstruction that may affect surgical and anesthetic outcomes.

Author(s):

Jeffrey C Rastatter, Benjamin Caughlin, Corlyne S Mulder, Pravin K Patel and Frank Vicari

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