Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct;35(5):350-4.
doi: 10.14639/0392-100X-546.

3D computed tomographic evaluation of the upper airway space of patients undergoing mandibular distraction osteogenesis for micrognathia

A Bianchi  1 , E Betti  1 , G Badiali  1 , F Ricotta  1 , C Marchetti  1 , A Tarsitano  1
Affiliations

3D computed tomographic evaluation of the upper airway space of patients undergoing mandibular distraction osteogenesis for micrognathia

A Bianchi et al. Acta Otorhinolaryngol Ital. 2015 Oct.

Abstract
in English, Italian

Mandibular distraction osteogenesis (MDO) is currently an accepted method of treatment for patients requiring reconstruction of hypoplastic mandibles. To date one of the unsolved problems is how to assess the quantitative increase of mandible length needed to achieve a significant change in the volume of the posterior airway space (PAS) in children with mandibular micrognathia following distraction osteogenesis. The purpose of this study is to present quantitative volumetric evaluation of PAS in young patients having distraction osteogenesis for micrognathia using 3D-CT data sets and compare it with pre-operative situation. In this observational retrospective study, we report our experience in five consecutive patients who underwent MDO in an attempt to relieve severe upper airway obstruction. Each patient was evaluated before treatment (T0) and at the end of distraction procedure (T1) with computer tomography (CT) in axial, coronal, and sagittal planes and three-dimensional CT of the facial bones and upper airway. Using parameters to extract only data within anatomic constraints, a digital set of the edited upper airway volume was obtained. The volume determination was used for volumetric qualification of upper airway. The computed tomographic digital data were used to evaluate the upper airway volumes both pre-distraction and post-distraction. The mean length of distraction was 23 mm. Quantitative assessment of upper airway volume before and after distraction demonstrated increased volumes ranging from 84% to 3,087% with a mean of 536%. In conclusion, our study seems to show that DO can significantly increase the volume of the PAS in patients with upper airway obstruction following micrognathia, by an average of 5 times. Furthermore, the worse is the starting volume, the greater the increase in PAS to equal distraction.

La distrazione osteogenetica mandibolare rappresenta oggi un metodo di trattamento consolidato per i pazienti affetti da ipoplasia mandibolare. Ad oggi, un problema insoluto, nei bambini affetti da micrognazia, è la modalità di valutazione del guadagno di lunghezza mandibolare necessario ad ottenere un miglioramento significativo a livello del volume dello spazio aereo posteriore (PAS). La proposta di questo studio è la valutazione volumetrica quantitativa del PAS in giovani pazienti sottoposti a distrazione osteogenetica mandibolare per severa micrognazia, attraverso l'analisi di 'data-set' di TC pre-trattamento in comparazione ai medesimi dati post-trattamento. In questo studio retrospettivo osservazionale riportiamo la nostra esperienza relativa a cinque pazienti sottoposti a distrazione osteogenetica mandibolare. Per ciascuno dei pazienti in esame, è stata valutata la TC pre-trattamento (T0) ed al termine del trattamento (T1) nei piani assiale, coronale, sagittale e 3D a livello del PAS. Utilizzando parametri di estrazione dei dati anatomici, è stato ottenuto un modello di analisi dello spazio aereo posteriore, utilizzato per comparare le differenze volumetriche quantitative a T0 e T1. La lunghezza media di distrazione ottenuta è stata di 23 mm. L'analisi volumetrica quantitativa del PAS ha mostrato un incremento di volume, al termine del trattamento, variabile dal 84% sino 3,087% (media 536%) rispetto alla situazione pre-trattamento. Concludendo, il presente studio sembra confermare che la distrazione osteogenetica incrementi in maniera significativa il volume del PAS in pazienti con ostruzione delle vie aeree dovuta alla micrognazia. La quantificazione di tale incremento appare lineare con il guadagno ottenuto grazie alla distrazione. Nella suddetta popolazione di studio, tale guadagno è stato, in media, di 5 volte rispetto al volume di partenza. Il dato da sottolineare è che tanto minore è il volume del PAS al T0, tanto maggiore risulta il guadagno volumetrico al T1.

Keywords: 3D Computed tomographic evaluation; Mandibular distraction osteogenesis; Micrognathia; PAS.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Anatomic limits of upper airway in sagittal and 3D reconstructed CT scans.
Fig. 2.
Fig. 2.
3D reconstructed CT scan volumetric assessment of the upper airway.
Fig. 3.
Fig. 3.
3D reconstructed CT scan showing pre-treatment airway volume (left side) and post-treatment increased volume (right side).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Cosman B, Crikelair GF. Mandibular hypoplasia and the late development of glossopharyngeal airway obstruction. Plast Reconstr Surg. 1972;50:573–579. - PubMed
    1. Perkins JA, Sie KC, Milczuk H, et al. Airway management in children with craniofacial anomalies. Cleft Palate Craniofac J. 1997;34:135–140. - PubMed
    1. Knapp RH, Vannier MW, Marsh JL. Generation of three dimensional images from CT scans: technological perspective. Radiol Technol. 1985;56:391–398. - PubMed
    1. Bianchi A, Betti E, Tarsitano A, et al. Volumetric three-dimensional computed tomographic evaluation of the upper airway in patients with obstructive sleep apnoea syndrome treated by maxillomandibular advancement. Br J Oral Maxillofac Surg. 2014;52:831–837. - PubMed
    1. Tarsitano A, Marchetti C. Unusual presentation of obstructive sleep apnoea syndrome due to a giant mandible osteoma: case report and literature review. Acta Otorhinolaryngol Ital. 2013;33:63–66. - PMC - PubMed