Reformatted 3D airway imaging in patients with airway obstruction and micrognathia.
PURPOSE
Mandibular distraction osteogenesis (MDO) is an effective treatment for patients with micrognathia and severe recurrent airway obstruction (Denny, 2004; Denny and Amm, 2005; Denny, 2009; Cicchetti et al., 2012; Flores et al., 2014). However the efficacy of the procedure is based on selecting the appropriate patient. Presence of central apnea or airway obstruction anywhere other than the tongue base will make MDO futile. The availability of three dimensional reformatting of the airway has greatly improved the accuracy of correct patient selection, providing a powerful tool to further characterize the pathology in these patients.


METHODS
We conducted a retrospective review of the last thirty patients with micrognathia and severe recurrent airway obstruction seen in consult by the senior author for potential role of surgery in their management.


RESULTS
Twenty-one patients met our inclusion criteria, with fourteen treated appropriately with MDO. The remaining patients had findings on the 3D airway CT scans with other anatomic causes of obstruction making them inappropriate candidates for mandibular distraction osteogenesis.


CONCLUSIONS
The use of three dimensional formatting of the airway from CT scans obtained using low dose protocols has improved the accuracy of evaluation and treatment of Pierre Robin patients. Most valuable is the non-invasive identification of airway abnormalities that would make mandibular distraction osteogenesis ineffective in correcting the airway obstruction.
['Henry|Cathy R|CR|', 'Denny|Arlen D|AD|']
D000402:Airway Obstruction D006801:Humans D008334:Mandible D008844:Micrognathism D019857:Osteogenesis, Distraction D010855:Pierre Robin Syndrome D012189:Retrospective Studies D016896:Treatment Outcome
Airway obstruction/surgery Finite element analysis Imaging, Three-dimensional Micrognathism/surgery Osteogenesis, Distraction Pierre Robin Sequence/surgery