{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:50:33Z","timestamp":1780339833695,"version":"3.54.1"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2012,10,9]],"date-time":"2012-10-09T00:00:00Z","timestamp":1349740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To document the incidence of difficult intubation following mandibular distraction osteogenesis (<jats:styled-content style=\"fixed-case\">MDO<\/jats:styled-content>) in children with severe mandibular hypoplasia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Syndromes associated with significant mandibular hypoplasia, especially <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ierre <jats:styled-content style=\"fixed-case\">R<\/jats:styled-content>obin sequence, provide a challenge in airway management both in and out of the operating room. Mandibular advancement using mandibular distraction osteogenesis devices has been used in infants in an attempt to reduce the incidence of acute life\u2010threatening airway obstruction. Whether <jats:styled-content style=\"fixed-case\">MDO<\/jats:styled-content> also reduces the incidence of difficult intubation has not been adequately described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review of 51 infants with upper airway obstruction secondary to mandibular hypoplasia who required <jats:styled-content style=\"fixed-case\">MDO<\/jats:styled-content> between <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>anuary 2002 and 2012. The primary outcome was the incidence of difficult or failed intubation. Secondary outcomes were the relationship between syndrome type and the incidence of difficult intubation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010one <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content> infants were identified. Twenty\u2010eight patients had isolated <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content>, six had syndromic <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content>, seven had <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>reacher <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ollins syndrome, and 10 had another coexisting syndrome. Prior to mandibular distraction osteogenesis (<jats:styled-content style=\"fixed-case\">MDO<\/jats:styled-content>), the incidence of difficult intubation was 71%, with the highest incidence in patients with <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>reacher <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ollins syndrome (100%), <jats:styled-content style=\"fixed-case\">sPRS<\/jats:styled-content> syndrome (100%), and <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content> (65%). Following <jats:styled-content style=\"fixed-case\">MDO<\/jats:styled-content>, the incidence of difficult intubation was 8.3%. The difference was statistically significant for all patients (<jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>ruskal\u2013<jats:styled-content style=\"fixed-case\">W<\/jats:styled-content>allis rank test <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0001) those with isolated <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0001), syndromic <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0023), and other syndromes (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0002), but not for <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>reacher <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ollins syndrome (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.21). Three patients had pre existing tracheostomies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a select group of infants with severe upper airway obstruction who have failed nonsurgical airway interventions, mandibular distraction osteogenesis reduces the incidence of difficult mask ventilation and difficult intubation. We were not able to compare the improvement in airway management to a comparable group of <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content> infants who did not undergo surgical intervention. The improvement in laryngeal view was most marked for infants with isolated <jats:styled-content style=\"fixed-case\">PRS<\/jats:styled-content> but no significant benefit was demonstrated in infants with <jats:styled-content style=\"fixed-case\">TCS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12049","type":"journal-article","created":{"date-parts":[[2012,10,9]],"date-time":"2012-10-09T10:46:14Z","timestamp":1349779574000},"page":"342-348","source":"Crossref","is-referenced-by-count":39,"title":["Anesthetic implications of infants with mandibular hypoplasia treated with mandibular distraction osteogenesis"],"prefix":"10.1111","volume":"23","author":[{"given":"Geoff","family":"Frawley","sequence":"first","affiliation":[{"name":"Department of Paediatric Anaesthesia and Pain Management Royal Children's Hospital Melbourne Vic. Australia"},{"name":"Anaesthesia Research Unit Murdoch Children's Research Institute Melbourne Vic. 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