Bilateral Mandibular Distraction Osteogenesis in the Neonate with Pierre Robin Sequence and Airway Obstruction: A Primary Option

Abstract

Children with craniofacial abnormalities associated with retromicrognathia and glossoptosis often have compromised upper airway flow. In severe cases, emergency intubation is necessary immediately after birth, and tracheostomy is advocated to manage the airway in the neonatal period and to allow for feeding. Early intervention with bilateral mandibular osteogenesis avoids the need for tracheostomy, along with its complications, and it targets the primary etiologic factor of the problem—the anomalous anatomy of the mandible. We report two neonates with severe Pierre Robin sequence managed with bilateral mandibular distraction osteogenesis on day 9 and day 11 of life. The surgical techniques and distraction and consolidation periods were similar apart from the distraction devices used. The procedures were successful with early extubation (day 5 and day 7), oral feeding tolerance (day 11 and day 13) and hospital discharge (day 19 and day 18). Total mandibular distraction was 19 mm and 23.45 mm, respectively. No major complications were reported. Medium to long-term results were good. Bilateral mandibular distraction osteogenesis in the neonate is a safe and accurate procedure and is the primary option in cases of selected severe Pierre Robin sequence.

Unusual Mandibular Distraction Complication in Two Neonatal Pierre Robin Sequence Patients

“…One of the complications with the greatest description in the literature is dental injuries, reported by Zenha et al 23 After an exhaustive review of the literature, we found no reports on complications of the salivary glands with the use of mandibular distractors. For this reason, we described these 2 cases, never described before in medical literature, relating clinical management, covering all differential diagnoses, and complications associated with the use of bone distractors.…”

Complications Associated With Neonatal Mandibular Distraction Osteogenesis in the Treatment of Robin Sequence

“…Longer-term dental outcomes were reported by Zenha et al 39 Two patients with RS underwent neonatal MDO with 2 and 6 years of follow-up. The 6-year-old patient was found to have normal tooth eruption.…”

Predictors of Failure in Infant Mandibular Distraction Osteogenesis

“…[37][38][39] Many authors have reported excellent outcomes of MDO, effectively relieving obstructive sleep apnea and preventing tracheostomies in up to 90 to 100% of children with micrognathia or retrognathia. 34,[40][41][42][43][44][45][46] In addition, MDO has been shown to be effective in terms of facilitating decannulation in tracheostomydependent children with severe micrognathia. 47 Although MDO is generally accepted as a safe and effective treatment modality in this patient population, the significant potential consequences of procedural failure highlight the importance of preoperatively identifying predictors of failure, thus avoiding unnecessary major surgery and possibly reducing the mortality rate.…”