Mandibular distraction in neonates: indications, technique, results

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Maxillofacial Surgery

Background:

• Pierre Robin Sequence (PRS) affects 1:8,500–20,000 newborns, characterized by micrognathia, glossoptosis, and respiratory distress.
• Upper airway obstruction and feeding difficulties are primary concerns in PRS patients.
• Mandibular Distraction Osteogenesis (MDO) is a viable treatment option for severe cases unresponsive to other interventions.

Purpose of the Study:

• To evaluate the efficacy of Mandibular Distraction Osteogenesis (MDO) in treating severe micrognathia and airway obstruction in pediatric patients.
• To assess the impact of MDO on respiratory distress, feeding, and the need for tracheotomy.

Main Methods:

• Ten pediatric patients (1 month–2 years) with severe micrognathia and airway obstruction underwent MDO.
• Diagnostic methods included airway fibroscopy and imaging (radiography/CT) to confirm posterior tongue displacement.
• Surgical approaches involved bilateral mandibular distraction using external or internal devices; two patients had pre-existing tracheotomies.

Main Results:

• All patients experienced symptom resolution, with successful tracheotomy removal in those who had them.
• One patient with Goldenhar Syndrome required a Montgomery device for 6 months post-surgery due to tracheomalacia.
• Improved airway patency, maxillomandibular relationship, and feeding were observed; no inferior alveolar nerve injury noted.

Conclusions:

• Mandibular Distraction Osteogenesis is a highly effective solution for pediatric respiratory distress secondary to severe micrognathia.
• MDO offers significant benefits when conventional treatments are inadequate, improving both airway and feeding functions.
• The procedure demonstrates a favorable safety profile with minimal long-term complications such as scarring or nerve damage.