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Updated: Jun 26, 2026
Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
CT analysis after distraction osteogenesis in Pierre Robin Sequence
Saswata Roy1, Patrick D Munson, Linping Zhao
1Division of Pediatric Otolaryngology, Nemours Children's Clinic, Jacksonville, FL 32207-8426, USA. saswataroy@mac.com
Insights
Mandibular distraction osteogenesis significantly improves airway obstruction in infants with Pierre Robin sequence (PRS). This technique enhances hypopharyngeal airway volume and posterior airway space, offering a viable alternative to traditional airway management.
Area of Science:
- Craniofacial Surgery
- Pediatric Airway Management
- Orthognathic Surgery
Background:
- Pierre Robin sequence (PRS) presents challenges in airway management due to micrognathia.
- Mandibular distraction osteogenesis is an alternative to conventional methods for airway obstruction in PRS.
- Limited quantitative data exists on skeletal and soft tissue changes following mandibular distraction in PRS.
Purpose of the Study:
- To quantitatively assess skeletal, soft tissue, and hypopharyngeal airway changes after mandibular distraction in infants with PRS.
- To evaluate the efficacy of internal, unidirectional distraction osteogenesis devices in managing airway obstruction.
Main Methods:
- Prospective analysis of three infants with PRS undergoing mandibular distraction using an internal, unidirectional device.
- Serial computed tomography (CT) scans were obtained and analyzed for mandibulo-maxillary arch harmony, symmetry, airway volume, and distances.
- Measurements included hypopharyngeal airway volume, geniohyoid distance, bone volume, and mandibular length.
Main Results:
- Mandibular lengthening increased total mandibular length by 26.2%.
- Hypopharyngeal airway volume increased by 192%, and the posterior airway space (tongue base to pharyngeal wall) increased by 198.9%.
- Good mandibulo-maxillary arch harmony was achieved, with corrected distances of 0.5 mm and no significant open-bite or cross-bite deformities.
Conclusions:
- Internal unidirectional microdistraction devices effectively improve mandibulo-maxillary arch harmony in PRS.
- Significant increases in hypopharyngeal airway volume and posterior airway space are achieved.
- Mandibular distraction osteogenesis represents a substantial advancement for managing airway obstruction in infants with micrognathia.
Objectives/Hypothesis:
Early mandibular lengthening by distraction osteogenesis provides an alternative to traditional methods of airway management in infants with Pierre Robin sequence (PRS). Little evidence in the medical literature quantitatively demonstrates the changes in skeletal, soft tissue, and hypopharyngeal spaces with mandibular distraction.
Study Design:
Prospective analysis of a cohort of three patients with PRS.
Methods:
We reviewed a series of infants with PRS and severe upper airway obstruction who underwent mandibular distraction. The infants underwent mandibular lengthening with the same internal, unidirectional distraction osteogenesis device. Standardized serial computed tomography (CT) scans were obtained according to established protocol. Computed tomography data were extracted and analyzed with medical image analysis software for mandibulo-maxillary arch harmony, symmetry, hypopharyngeal airway volume, geniohyoid distance, distraction osteogenesis bone volume, and mandibular length.
Results:
Mandibulo-maxillary alveolar ridge distances were corrected to 0.5 mm after distraction. Clinical examination showed good arch harmony without open-bite or cross-bite deformities. Mandibular ramus was lengthened by 19.5%; the body, 43.4%. After distraction, total mandibular length was increased by 26.2%; hypopharyngeal airway volume, 192%; posterior distance from pharyngeal wall to tongue base, 198.9%; and geniohyoid distance, 14.1%.
Conclusions:
Unidirectional internal microdistractors can achieve good mandibulo-maxillary arch harmony. Hypopharyngeal airway volume increases substantially, with an even greater increase in distance between tongue base and posterior pharyngeal wall. As the distal mandibular segment is distracted, the hyoid moves anteriorly, with minor increase in geniohyoid relationship. Internal mandibular microdistraction devices represent a substantial advance in airway obstruction management in infants with micrognathia.
