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Mandibular distraction osteogenesis in a neonate
B Judge1, D Hamlar, F L Rimell
1Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, USA.
Insights
Mandibular distraction osteogenesis effectively treated severe airway obstruction in a neonate with Pierre Robin sequence and Klippel-Feil syndrome. This surgical intervention allowed for adequate breathing and avoided tracheotomy, with positive outcomes at one year.
Area of Science:
- Pediatric surgery
- Craniofacial anomalies
- Airway management
Background:
- Craniofacial anomalies predispose children to airway obstruction, often necessitating interventions like tracheotomy.
- Tracheotomy, while effective for severe obstruction, carries significant morbidity.
- A trend exists towards earlier decannulation through structural mandibular changes.
Observation:
- A neonate presented with acute, severe airway obstruction at birth.
- The obstruction was attributed to a combination of Pierre Robin sequence and Klippel-Feil syndrome.
- The patient underwent mandibular distraction osteogenesis.
Findings:
- Mandibular distraction osteogenesis successfully alleviated the neonate's airway obstruction.
- The patient maintained an adequate airway one year post-procedure.
- No neurological sequelae were observed, with tolerable scarring.
Implications:
- Mandibular distraction osteogenesis is a viable and effective treatment for severe neonatal airway obstruction caused by craniofacial syndromes.
- This technique may reduce the need for tracheotomy and its associated complications.
- Early intervention with mandibular distraction osteogenesis can lead to favorable long-term airway outcomes in affected infants.
Abstract:
Children with craniofacial anomalies are predisposed to airway obstruction and frequently require airway intervention. Tracheotomy is performed when the airway obstruction is severe and refractory to other less invasive interventions. Tracheotomy is associated with significant morbidity, and there is a trend noted in the literature toward achieving earlier decannulation by the institution of definitive structural changes to the mandible. Mandibular distraction osteogenesis has been shown to alleviate airway obstruction in the pediatric population. We report a case in which mandibular distraction osteogenesis was successfully carried out in a neonate with acute airway obstruction at birth as a result of combined Pierre Robin sequence and Klippel-Feil syndrome. After 1 year, the patient still had an adequate airway with tolerable scarring and no neurologic sequelae.