New technique for airway correction in neonates with severe Pierre Robin sequence

To avoid tracheostomy in 11 neonates with severe Pierre Robin sequence, we used a technique of progressive elongation of the mandible (distraction osteogenesis) to correct tongue ptosis, increase pharyngeal airway, and correct micrognathia. All 11 patients were extubated within 3 to 6 days after beginning distraction. At 1 month 54.5% were oral feeders and at 1 year, 100%. Sleep studies were obtained on 7 patients and were normal 1 week to 1 month after operation. Growth was observed to be above the 50th percentile in all patients with no comorbidities. A 5-year clinical follow-up showed the operated mandible to maintain a normal shape and produce an undisturbed tooth eruption sequence. We conclude that distraction osteogenesis to increase the length of the short mandible is an effective alternative to tracheostomy in carefully selected patients.