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Title Distraction Osteogenesis As An Adjunct To Tracheotomy In Micrognathic Infants
Clinical Question In the micrognathic infant, does distraction osteogenesis shorten the time to decannulation compared to tracheotomy alone?
Clinical Bottom Line Distraction osteogenesis is effective in allowing decannulation in less than one year or preventing tracheotomy altogether. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 8544588Tomaski/1995Pierre RobinCase series
Key resultsEleven of ninety patients with Pierre Robin sequence were treated with tracheostomy. They were decannulated at a mean time of 3.1 years, ranging from fourteen months to five years. No patients were treated with distraction osteogenesis. This study provides a baseline for tracheotomy alone and allows comparison with the results of Genecov et al.
#2) 19816357Genecov/2009MicrognathicCase Seeries
Key resultsOf forty-one patients already with tracheotomy, thirty-eight were successfully decannulated up to one year after distraction. Of twenty-six patients without prior surgical intervention (no tracheotomy), twenty-five were treated successfully with distraction osteogenesis alone and one patient required tracheotomy in addition to distraction osteogenesis.
Evidence Search ("Outcome Assessment (Health Care)"[Mesh] OR outcomes[All Fields]) AND ("osteogenesis, distraction"[MeSH Terms] OR "osteogenesis"[All Fields] OR "distraction"[All Fields]) AND ("mandible"[MeSH Terms] OR "mandible"[All Fields]) AND ("micrognathism"[MeSH Terms] OR "micrognathism"[All Fields] OR "micrognathia"[All Fields])
Comments on
The Evidence
The evidence is limited to case-series data. However, the Genecov study shows that distraction of infants already with tracheotomy is likely to allow for decannulation within one year, which is an improvement over the average time of 3.1 years reported by Tomaski.
Applicability The study subjects are appropriate to a craniofacial surgery population. Decreased time with a tracheotomy is of value to the patient and his or her family.
Specialty/Discipline (Oral Surgery) (Orthodontics) (Pediatric Dentistry)
Keywords micrognathia, Pierre-Robin Sequence, distraction osteogenesis, decannulation, tracheotomy
ID# 757
Date of submission: 04/12/2011spacer
E-mail curtisjg@livemail.uthscsa.edu
Author Joseph Curtis
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail GAKUNGA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Mylinh Duong, Derick Mayberry, Kyle Trobough (San Antonio, TX) on 01/06/2014
A PubMed search on this topic was performed January 2014. More recent publications were found that support the effectiveness of the treatment; however they do not specifically address the one year period to achieve decannulation.

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