Affiliations: Division of Plastic and Reconstructive Surgery, David
Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA | Department of Human Genetics and Pediatrics, Mattel
Children's Hospital at UCLA & David Geffen School of Medicine at UCLA, Los
Angeles, CA 90095, USA | Division of Head and Neck Surgery, David Geffen School
of Medicine at UCLA, Los Angeles, CA 90095, USA | Department of Anesthesiology, David Geffen School of
Medicine at UCLA, Los Angeles, CA 90095, USA | Children's Hospital of Pittsburgh, Pittsburgh, PA
46556, USA
Note: [] Corresponding author: James P. Bradley, MD, 200 UCLA Medical
Plaza, Suite 465, Los Angeles, CA 90095-6960, USA. Tel.: +1 310 794 7616; Fax:
+1 310 206 6833; E-mail: [email protected]
Abstract: Objective: Upper airway obstruction in a newborn with a craniofacial
anomaly requires urgent management. While tracheostomy may be life saving in
these circumstances, it may be associated with numerous morbidities.
Distraction osteogenesis (DO) or lengthening of the mandible offers an
alternative to tracheostomy with proper patient selection. Study Design: A ten-year review of neonates with upper airway
obstruction at two academic centers was performed (n=149). We compared
conventionally treated neonates, receiving home monitoring or a tracheostomy on
a case by case basis, to newborns managed by a new decision tree model (DTM),
in which a specific pattern of diagnostic tests and specialist consultations
were obtained to decide among home monitoring, tracheostomy, or distraction.
Results: Neonates managed with our DTM were significantly less
likely to undergo a tracheostomy than those managed conventionally. In our DTM
group, no deaths occurred and only one of 43 children who initially underwent
DO required subsequent tracheostomy. In the conventionally managed children
there were 3 deaths and significantly more hospital days, emergency department
visits, respiratory infections, and gastrointestinal reflux. The DTM group had
improved feeding, growth, and speech. Conclusion: In treating newborns with micrognathia and upper airway
obstruction, patient outcomes may be improved by utilizing a decision tree
model with multidisciplinary specialists, timely studies, and an option for
mandibular distraction osteogenesis.
Keywords: Micrognathia, tracheostomy, multidisciplinary team
