Severe Obstructions Research Articles

Biodegradable airway stents in infants – Potential life-threatening pitfalls

ObjectiveThe solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept. MethodsFive SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old). ResultsThe breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing ‘foreign body’ from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen. ConclusionsPolydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4–6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous.

Efficient registration of terrestrial LiDAR scans using a coarse-to-fine strategy for forestry applications

Terrestrial Laser Scanning (TLS) plays an increasing role in acquiring 3-dimensional forest structure information. Obstructions and stem density often need multiple scans, making the registration procedure vitally important. Since natural features are difficult to find, traditional registration methods often use artificial reflectors as tie points in forest areas. However, the placement of reflectors reduces the scanning efficiency, especially in forest stands with severe obstructions. In this paper, an efficient registration method using a coarse-to-fine strategy is proposed to overcome the challenge of placing artificial targets so as to improve the scanning efficiency. The coarse registration step utilizes the backsighting orientation approach to form a coarse alignment. Unlike other backsighting research used in urban areas, we solely rely on a TLS system with an internal compass and a built-in inclination sensor. In the fine registration step, stem center locations are calculated in each individual scan. Then, corresponding stem center pairs are found between adjacent scans with the help of the coarse registration results. They are used as tie points to perform a rigid-body transformation for the fine registration. The proposed coarse-to-fine registration method was tested at two forest sites in northeast China. The registration accuracy is approximately 1.5cm. Results also show that the diameters at breast height (DBHs) extracted from registered TLS data sets are highly correlated with field-measured DBHs (coefficient of determination (R2): 0.92, root mean square error (RMSE): 0.27cm). Considering both the scanning efficiency and accuracy, the proposed coarse-to-fine registration method provides a feasible and effective way for forest measurements.

Forced oscillation, integer and fractional-order modeling in asthma

The purpose of this study was to evaluate the use of fractional-order (FrOr) modeling in asthma. To this end, three FrOr models were compared with traditional parameters and an integer-order model (InOr). We investigated which model would best fit the data, the correlation with traditional lung function tests and the contribution to the diagnostic of airway obstruction. The data consisted of forced oscillation (FO) measurements obtained from healthy (n=22) and asthmatic volunteers with mild (n=22), moderate (n=19) and severe (n=19) obstructions. The first part of this study showed that a FrOr was the model that best fit the data (relative distance: FrOr=4.3±2.4; InOr=5.1±2.6%). The correlation analysis resulted in reasonable (R=0.36) to very good (R=0.77) associations between FrOr parameters and spirometry. The closest associations were observed between parameters related to peripheral airway obstruction, showing a clear relationship between the FrOr models and lung mechanics. Receiver–operator analysis showed that FrOr parameters presented a high potential to contribute to the detection of the mild obstruction in a clinical setting. The accuracy [area under the Receiver Operating Characteristic curve (AUC)] observed in these parameters (AUC=0.954) was higher than that observed in traditional FO parameters (AUC=0.732) and that obtained from the InOr model (AUC=0.861). Patients with moderate and severe obstruction were identified with high accuracy (AUC=0.972 and 0.977, respectively). In conclusion, the results obtained are in close agreement with asthma pathology, and provide evidence that FO measurement associated with FrOr models is a non-invasive, simple and radiation-free method for the detection of biomechanical abnormalities in asthma.

Correlation between adenoidal nasopharyngeal ratio and symptoms of enlarged adenoids in children with adenoidal hypertrophy.

Background:Adenoid hypertrophy is one of the most common health problems affecting the paediatric population. This study aims to correlate adenoidal nasopharyngeal ratio (ANR) with symptoms of enlarged adenoids in children with enlarged adenoids.Materials and Methods:It was a year, cross-sectional, hospital-based study conducted at Lautech Teaching Hospital, Osogbo. ANR was determined by dividing adenoidal depth with nasopharyngeal depth on the plain lateral radiographs.Results:A total of 90 consecutive children consisting of 61 males and 29 females were included in the study with M:F ratio of 2.1:1. Their ages ranged from 8 months to 11 years. All the patients presented with nasal obstruction, mouth breathing and noisy breathing. Majority (64.5%) had severe obstructions with preponderance among children of 3-5 years (39.9%). Linear regression analysis showed significant association between age and ANR (t = 10.447, P < 0.001). There was high significant association (P < 0.05) between presenting symptoms and degree of nasopharyngeal airway obstruction; for snoring (r = 0.251, P = 0.000), sleep apnoea (r = 0.594, P = 0.000), nasal discharge (r = 0.314, P = 0.001), excessive daytime sleepiness (r = 0.219, P = 0.019) and failure to thrive (r = 0.240, P = 0.011).Conclusion:Lateral X-ray of the nasopharynx is an effective tool to evaluate children with suspected adenoid hypertrophy. It correlates well with patients’ symptoms and provides objective measures of adenoid hypertrophy.

Cardiac Rehabilitation: Underrecognized/Underutilized.

Unfortunately, too many patients continue to rely on costly coronary revascularization procedures, cardioprotective medications, or both, as first-line strategies to stabilize the course of coronary heart disease. However, these palliative therapies do not address the foundational or most proximal risk factors for coronary disease, that is, unhealthy dietary habits, physical inactivity, and cigarette smoking. Because most acute myocardial infarctions evolve from mild-to-moderate coronary artery stenosis (<70% obstruction), rather than at the more severe obstructions that are commonly treated with coronary revascularization, these findings help explain the inability to demonstrate a reduction in acute cardiac events in most studies examining coronary artery bypass graft surgery and/or percutaneous coronary interventions. The delivery of comprehensive cardiovascular risk reduction, including exercise-based cardiac rehabilitation as an integral component, offers patients a bona fide treatment intervention to prevent recurrent cardiovascular events and the need for repeated revascularization procedures, while simultaneously providing referring physicians with ongoing surveillance data to potentially enhance their medical management.

Network design and planning of wireless embedded systems for industrial automation

The widespread adoption of wireless systems for industrial automation calls for the development of efficient tools for virtual planning of network deployments similarly as done for conventional Fieldbus and wired systems. In industrial sites the radio signal propagation is subject to blockage due to highly dense metallic structures. Network planning should therefore account for the number and the density of the 3D obstructions surrounding each link. In this paper we address the problem of wireless node deployment in wireless industrial networks, with special focus on WirelessHART IEC 62591 and ISA SP100 IEC 62734 standards. The goal is to optimize the network connectivity and develop an effective tool that can work in complex industrial sites characterized by severe obstructions. The proposed node deployment approach is validated through a case study in an oil refinery environment. It includes an ad-hoc simulation environment (RFSim tool) that implements the proposed network planning approach using 2D models of the plant, providing connectivity information based on user-defined deployment configurations. Simulation results obtained using the proposed simulation environment were validated by on-site measurements.

Analysis of Cardiorenal Physiological Dysfunction in a Mouse Model of Neonatal‐lethal Congenital Obstructive Nephropathy

Congenital obstructive nephropathy is the most common cause of pediatric chronic kidney disease and end stage renal disease. This disease is caused by obstruction of the urinary tract during fetal development and most commonly occurs at the ureteropelvic junction (UPJ), where the renal pelvis transitions into the ureter. The exocyst is a highly‐conserved 8‐protein trafficking complex and we recently generated a novel conditional knockout mouse for the central exocyst subunit, Sec10 (Sec10‐CKO). Upon Sec10 deletion in the developing kidney and ureter epithelial cells, the mice displayed late‐gestational congenital UPJ obstructions that caused death 10‐14 hours after birth. To further investigate the physiological consequences of these lethal urinary obstructions, cardiorenal and pulmonary parameters were compared in wild‐type and mutant newborn littermates. Upon necropsies, atrial distension with severe hemorrhaging was grossly visible in the mutants compared to littermate controls, which was also confirmed with histological analysis. We performed M‐mode and Doppler echocardiography on the hearts of newborn mice, which indicated signs of diastolic dysfunction. Assessment of newborn lung mass and surface area showed no significance between control and mutant mice. Although our analysis is ongoing, these preliminary results suggest this new mouse model may be a useful tool in studying the cardiovascular consequences of severe urinary obstructions in humans.

PRELIMINARY FINDINGS OF TASHKENT HOSPITAL BASED STUDY OF RISK FACTORS FOR DIFFERENT ISCHEMIC STROKE SUBTYPES

Objective: To determine risk factors in different pathogenic subtypes of ischemic stroke in Tashkent hospital registry and to compare with the data of other stroke registers.Design: Prospective observational study.Participants: 300 adults aged 18 years or over who suffered first-ever acute ischemic stroke, of them, the data of 100 patients with atherothrombotic, lacunar and cardioembolic strokes were analyzed.Main outcome measures: Mathematically significant differences and not significant differences but interesting from other point of view. Categorical variables are expressed as frequencies and percentages. Differences were regarded as statistically significant when the P value was less than 0.05 (P&lt;0.05).Results: Of 100 patients with acute first-ever ischemic stroke at the median age of 62.63±4.68 (interquartile range 25-92) years, 57% were men and 43% were women. Depending on aetiology and stroke subtype, all the patients were divided into three groups: 42 patients with atherothrombotic stroke, 41 – with lacunar stroke, and 17 patients with cardioembolic stroke. Atherothrombotic stroke developed often in people over 60 years old, while lacunar stroke prevailed at the younger age. Stroke cases increased in people over 51 years old. Although men were more likely to suffer strokes than women, stroke incidence was equal in both sexes with increasing of age (over 60 years old), especially in atherothrombotic stroke, testifying to that women live longer. Combination of cerebral atherosclerosis and hypertension was the most significant risk factor for stroke. Atherosclerosis was the main aetiological factor for ischemic stroke, independently of its pathogenic heterogeneity. Diabetes mellitus was an independent risk factor for all stroke subtypes, which in most cases worsened the course and outcome of stroke. Hypertension was the leader aetiological factor for lacunar stroke. In these patients, we also should consider the presence of other risk factors, e.g. severe large vessel obstructions, se-triglycerol ≥2 mmol/L, etc. Cardioembolic stroke developed mainly because of cardiac thrombosis and valve pathology, which were often associated with chronic diseases of other organs, worsening the course and outcome of stroke. Despite of high prevalence of myocardial infarction in men, women were more likely to develop cardioembolic stroke.Conclusions: This study found simultaneous influence of many risk factors (multifactorial disease) in the development of ischemic stroke. The more course and influence of the underlying disease and risk factor, the higher stroke risk and severity, especially in the absence or inadequate previous therapy of underlying disease before the stroke index. We have noted a high prevalence of under-diagnosis of vascular risk factors at levels of primary and secondary care. We recommend for improved public awareness of vascular risk factors and better diagnostic and treatment facilities aimed at addressing those factors at levels of primary and secondary healthcare. Larger population-based studies may provide additional data on stroke incidence and outcome among Uzbeks.

Cardiac rhabdomyoma mimicking haemodynamics of hypoplastic left heart syndrome

Cardiac rhabdomyomas are rare and often regress spontaneously. However, the management of rhabdomyoma with severe inflow and outflow obstructions is a challenge. An infant with a massive left ventricular rhabdomyoma mimicking the haemodynamics of hypoplastic left heart syndrome is reported. Surgery could not be contemplated because the mitral valve leaflets and chordae were imbedded in the tumour mass. The arterial duct (AD) was kept open to perfuse the systemic circulation and palliations with pulmonary artery branch banding and AD stenting were planned. However; while waiting for spontaneous regression of the tumour, the child died of circulatory collapse when 4 weeks old.

Cardiac rhabdomyoma mimicking haemodynamics of hypoplastic left heart syndrome

Cardiac rhabdomyomas are rare and often regress spontaneously. However, the management of rhabdomyoma with severe inflow and outflow obstructions is a challenge. An infant with a massive left ventricular rhabdomyoma mimicking the haemodynamics of hypoplastic left heart syndrome is reported. Surgery could not be contemplated because the mitral valve leaflets and chordae were imbedded in the tumour mass. The arterial duct (AD) was kept open to perfuse the systemic circulation and palliations with pulmonary artery branch banding and AD stenting were planned. However; while waiting for spontaneous regression of the tumour, the child died of circulatory collapse when 4 weeks old.

Holmium:YAG laser bronchoscopy ablation of benign and malignant airway obstructions: an 8-year experience

Patients suffering from severe tracheobronchial obstruction are vulnerable to dyspnea, respiratory failure, obstructive pneumonia, and death. Treatment with a holmium:YAG laser, an alternative to the neodymium:YAG laser, may provide symptomatic relief. This is the largest case series to date describing the application of the holmium:YAG laser via bronchoscopy for benign and malignant obstructive disease. The data were retrospectively collected from 99 patients, with either benign or malignant tracheobronchial obstruction, who underwent 261 interventional bronchoscopy procedures in the operating room with laser ablation between January 2004 and November 2011. Categorical variables were analyzed with the chi-square and Fisher's exact tests as appropriate in contingency tables, whereas Student's t-test was performed for comparison of continuous variables. Patient follow-up was concluded on September 15, 2013. The holmium:YAG laser was used in 261 procedures performed on 99 patients with either benign or malignant disease. Symptomatic improvement was demonstrated in 90 % of all benign etiology cases and 77 % of all malignant etiology cases. Within the benign and malignant subgroups, improvement was dependent on anatomical location rather than etiology of the lesion. Complications occurred in 2.3 % of the procedures, with mortality in less than 1 % of procedures. Results confirm the usefulness and safety of the holmium:YAG laser in the treatment of patients with severe benign and malignant obstructive tracheobronchial obstructions. The holmium:YAG laser is an appealing alternative to the neodymium:YAG laser.

Methylene blue 1% solution on the prevention of intraperitoneal adhesion formation in a dog model

Intraperitoneal adhesions usually are formed after abdominal surgeries and may cause technical difficulties during surgical intervention, chronic abdominal pain and severe obstructions of the gastrointestinal tract. The current study aimed to evaluate the efficacy of methylene blue (MB) 1% solution on the prevention of intraperitoneal postsurgical adhesion formation in a canine surgical trauma model. Twenty bitches were submitted to falciform ligament resection, omentectomy, ovariohysterectomy and scarification of a colonic segment. Prior to abdominal closure, 10 bitches received 1mg kg-1 MB intraperitoneally (MB group) and 10 bitches received no treatment (control group, CT). On the 15th postoperative day the bitches were submitted to laparoscopy to assess adhesions. The mean adhesion scores were 13.9 (±5.6) for MB group and 20.5 (±6.4) for the CT group (P=0,043). In conclusion, the 1% MB solution was efficient on the prevention of intraperitoneal postoperative adhesion formation in bitches, especially those involving the colonic serosa.

The effect of partial outlet obstruction on calpain and phospholipase-2 activities: analyzed by severity and duration

In an attempt to better understand the two pathways that lead to bladder decompensation following partial obstruction in rabbits one of which is caused by calcium-activated enzymes and the other by oxidative stress, calpain and phospholipase A2 (PLA2) biochemical assays were conducted to see how bladder decompensation is mediated by these two calcium-activated enzymes. Partial outlet obstructions of varying durations (4, 8, and 12 weeks plus controls) were performed on 32 New Zealand white rabbits. The rabbits were also grouped by severity: control, mild, intermediate, and severe. The activities of Calpain and PLA2 on the muscle tissue of the bladders were analyzed. A stronger correlation was seen between activities and severities as opposed to between activities and durations for both PLA2 and calpain. The activity for PLA2 increased dramatically from control to mild and then stayed constant for both intermediate and severe obstructions. Calpain activity increased steadily from control to mild to intermediate to severe. Based on the increase in levels of the calcium-dependent enzymes, it was clearly shown that calcium levels increased in all stages of bladder decompensation most notably with the mild obstructions. Based on previous studies in which nitrotyrosine and dinitrophenol levels did not increase in mildly obstructed rabbits, the calcium overload pathway may predominate in mild decompensation because cells in mildly obstructed bladders are better able to cope with oxidative stress than increased calcium levels.

Contribution of arousal from sleep to postevent tachycardia in patients with obstructive sleep apnea.

Heart rate increases after obstructive events in patients with obstructive sleep apnea (OSA). This response is generally attributed to arousal from sleep. Opening of the obstructed airway, however, is associated with ventilatory and hemodynamic changes that could result in physiologic responses unrelated to arousal. Our objective was to determine the contribution of these physiologic responses to postevent tachycardia. Analysis of data obtained during previous research protocols. Academic sleep laboratory. Twenty patients with severe OSA. Patients were placed on a continuous positive airway pressure (CPAP) device. CPAP was reduced during sleep to different levels (dial-downs), producing obstructive events of varying severity. Some dial-downs with severe obstruction were maintained until spontaneous airway opening. In others, CPAP was increased after three obstructed breaths, terminating the events approximately 10 sec before spontaneous termination in long dial-downs. Beat-by-beat heart rate (HR) was measured for 20 sec following airway opening. Spontaneous opening during sustained dial-downs occurred 21.9 ± 8.4 sec after dial-down, was associated with arousal, and resulted in the greatest postevent tachycardia (7.8 ± 4.0 min(-1)). However, deliberate termination of events (12.2 ± 2.6 sec after dial-down) was also followed by tachycardia that, in the absence of cortical arousal, showed a dose-response behavior, increasing with severity of obstruction and without apparent threshold. ΔHR following deliberately brief, severe obstruction (3.8 ± 3.0 min(-1)) was approximately half the ΔHR that followed spontaneous opening of equally severe obstructions despite the shorter duration and absence of cortical arousal. Postevent tachycardia is due in large part to physiologic (arousal-unrelated) responses that occur upon relief of obstruction.

Metallic Stents for Tracheobronchial Pathology Treatment

To present the 7-year experience of the treatment of benign and malignant tracheobronchial stenoses using metallic stents. One hundred twenty-three stents were inserted in 86 patients (74 benign and 12 malignant stenoses). Ninety-seven stents were placed in the trachea and 26 in the bronchi. The procedures were performed under fluoroscopic and flexible bronchoscopic guidance with the patient under light sedation. In cases of severe stenotic lesions or obstructions, laser resection was performed before stent placement. Clinical and functional pulmonary data were recorded before and 3 months after the procedure. Follow-up involved clinical data and radiographic techniques at 48 h and at 1-, 3-, 6-, and 12-month intervals. The technical success was 100 %. Dyspnea disappearance, forced expiratory volume in the first second, and pulmonary functional data improvement was observed in all patients (p < 0.001). Complications were detected in 23 patients (26.7 %). Mean follow-up time was 6.3 ± 1.2 months in patients with malignant lesions and 76.2 ± 2.3 months patients with in benign lesions. By the end of the study, 100 % of patients with malignant pathology and 6.7 % of patients with benign lesions had died. Endoluminal treatment of tracheobronchial stenosis with metallic stents is a therapeutic alternative in patients who are poor candidates for surgery. In unresectable malignant lesions, the benefit of metallic stenting is unquestionable. In benign lesions, the results are satisfactory, but sometimes other interventions are required to treat complications. New stent technology may improve these results.

Duodenal Perforation as an Unusual Celiac Disease Presentation in Two Patients

Celiac disease (CD) is a common genetic autoimmune disease, triggered by gluten sensitivity. CD can present at any age in both children and adults after consuming gluten containing diet. Presentation of CD varies widely. There is paucity of data regarding emergency presentation of CD in the literature. Severe abdominal pain and gastric obstructions have been reported, but there are no reports of spontaneous duodenal perforation as of CD presentation. We searched the Mayo Clinic electronic medical records, between 1997 - 2011 for any cases of association between celiac disease and duodenal perforation. We identified two patients (7 yo M, 31 yo F). First patient presented with gastric obstruction due to duodenal perforation. Gastroduodenostomy was performed and elevated celiac serology few years after his initial presentation lead to the diagnosis of CD. Second patient had sudden acute RUQ abdominal pain and was found to have sign of visceral perforation on abdominal CT. Evaluation for anemia and rectal bleeding few years later showed positive CD markers that was confirmed by histology. Spontaneous duodenal perforation can be the presenting sign of CD. Celiac serology testing may be considered in patients presenting with spontaneous duodenal perforation. J Med Cases. 2013;4(2):109-113 doi: https://doi.org/10.4021/jmc1006e

Duodenal Perforation as an Unusual Celiac Disease Presentation in Two Patients

Celiac disease (CD) is a common genetic autoimmune disease, triggered by gluten sensitivity. CD can present at any age in both children and adults after consuming gluten containing diet. Presentation of CD varies widely. There is paucity of data regarding emergency presentation of CD in the literature. Severe abdominal pain and gastric obstructions have been reported, but there are no reports of spontaneous duodenal perforation as of CD presentation. We searched the Mayo Clinic electronic medical records, between 1997 - 2011 for any cases of association between celiac disease and duodenal perforation. We identified two patients (7 yo M, 31 yo F). First patient presented with gastric obstruction due to duodenal perforation. Gastroduodenostomy was performed and elevated celiac serology few years after his initial presentation lead to the diagnosis of CD. Second patient had sudden acute RUQ abdominal pain and was found to have sign of visceral perforation on abdominal CT. Evaluation for anemia and rectal bleeding few years later showed positive CD markers that was confirmed by histology. Spontaneous duodenal perforation can be the presenting sign of CD. Celiac serology testing may be considered in patients presenting with spontaneous duodenal perforation. doi: http://dx.doi.org/10.4021/jmc1006e

Quality of life and the venous function of the lower limb after harvest of autologous external iliac vein grafts: a clinical follow-up study

To investigate the quality of life and venous function of the lower limbs after right external iliac vein (REIV) grafting for digestive surgery. The study subjects included 66 patients treated surgically for hepatopancreatobiliary malignancy who underwent concomitant resection with REIV for use as autologous grafts. Fifteen patients completed the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ), and the venous function was assessed using air plethysmography (APG) and duplex ultrasound in 10 patients. The outcomes of the 15 patients were analyzed statistically. Postoperative morbidity related to graft harvest occurred in three of the 66 patients (5 %). The right legs of the follow-up patients were 6 ± 3 % larger than the left legs. The mean CIVIQ score was acceptably low at 27; however, moderate symptoms (e.g., pain upon long-time standing or walking) occurred in seven of the 15 patients. APG revealed moderate to severe outflow obstructions that did not improve during long-term observation. The blood flow depicted on duplex ultrasonography was significantly associated with the patients' symptoms. No deep venous reflux was encountered, and no right leg skin changes or venous claudication developed. The symptoms occurring after REIV resection can be unexpectedly prolonged. These unfavorable effects must be kept in mind and the possible sequelae should be carefully explained to patients preoperatively.

An approach to reliable rapid static GNSS surveying

This paper presents a methodology for reliable surveying and processing of GNSS observations in a rapid static survey conducted in open terrain as well as with the limited availability of satellites. The surveying and data processing technology presented allows reliable determination of coordinates under difficult observation conditions, e.g. in a forest with significant obstacles to satellite signal reception. The test GNSS surveys were conducted in two points with full availability of satellites and a point with a high intensity of obstructions. The test point coordinates were determined by three GNSS receivers positioned simultaneously in line on a special base at a distance of 0·5 m from one another. Given the possible gross errors of the determined baseline coordinates, the simultaneous application of three GPS/GLONASS receivers for a single point allows reliable determination of coordinates even in locations with severe obstructions. Test surveys were conducted using Topcon Hyper Pro receivers and the ASG-EUPOS system network of reference stations. The presented survey and data processing methodology allows users to obtain reliable coordinates with accuracies expressed in centimetres during a rapid static survey session of a few minutes or even just one minute.

Mandibular distraction osteogenesis: At what age to proceed

Objective To evaluate if there is a difference in mandibular distraction osteogenesis (MDO) treatment success rates and adverse outcomes in newborns, early infants, and older pediatric patients. Design Retrospective medical review spanning a nine-year period. Ten newborn (≤35 days old), five early infant (36 days–5 months) and eight older pediatric (>5 months) patients underwent MDO for treatment of micrognathia with a severe tongue-based obstruction. Success was defined as avoidance of tracheostomy or CPAP, and decannulation of patients with tracheotomies. Postoperative complications were grouped into minor and major. Results MDO successfully treated 90% of newborns, 100% of early infants and 100% of older pediatric patients. There was no difference in the rates of success ( p = 0.48), minor ( p = 1.00) and major ( p = 1.00) postoperative complications between newborns and early infants. Older pediatric patients had no treatment failures, tended to have fewer minor ( p = 0.18) and significantly fewer major ( p= 0.04) postoperative complications compared to younger patients. The distractor pin mobility (9%) and scar revisions (13%) were uncommon. Conclusions Mandibular distraction osteogenesis is a reliable method for relieving severe tongue-based obstructions in pediatric patients. When comparing newborns and early infant patients, treatment success rates and the occurrence of complications were not found to be different. Older pediatric patients had no treatment failures, and tended to have fewer postoperative complications compared to younger patients.