A Multidisciplinary Approach to Mandibular Distraction Osteogenesis

Newborns with micrognathia and upper airway obstruction undergoing mandibular distraction osteogenesis (MDO) should be properly selected to minimize adverse outcomes. We aim to describe the outcomes of patients undergoing MDO who were evaluated through an interdisciplinary approach by the surgical and medical subspecialties of an American Cleft Palate Association-accredited team.

This descriptive, retrospective cohort study included all patients diagnosed with glossoptosis, micrognathia, or Pierre Robin sequence who underwent MDO between 2017 and 2022 at our center. A protocol review and retrospective review of each patient's electronic health record were conducted. The primary outcome was the incidence of tracheostomy. Secondary outcomes included postoperative major and minor complications, the incidence of gastrostomy tube dependence, and the presence of feeding difficulties.

Fifteen patients who underwent bilateral MDO between January 1, 2017, and December 31, 2022, were included. Fourteen patients avoided tracheostomy. One patient underwent tracheostomy at the time of MDO and was eventually decannulated. There were no instances of conversions to tracheostomy, postoperative hardware loss, nonunion, malunion, or need for repeat distraction. There were 5 instances of pin-site cellulitis and 3 instances of postoperative gastrostomy tube use. Postoperatively, 47% of patients demonstrated improvement in feeding difficulties.

This case series illustrates the outcomes of newborns with micrognathia and upper airway obstruction who underwent MDO and were evaluated perioperatively by an interdisciplinary team. In this series, most patients avoided tracheostomy, and postoperative complications were minimal. These findings may inform institutional protocols for multidisciplinary patient management in MDO planning and execution.