Mandibular distraction in neonates: indications, technique, results

Abstract

BackgroundThe Pierre Robin Sequence features were first described by Robin in 1923 and include micrognathia, glossoptosis and respiratory distress with an incidence estimated as 1:8,500 to 1:20,000 newborns. Upper airway obstruction and feeding difficulties are the main concerns related to the pathology. Mandibular distraction should be considered a treatment option (when other treatments result inadequate).Patiants and methodsTen patients between the ages of 1 month and 2 years with severe micrognathia and airway obstruction were treated with Mandibular Distraction Osteogenesis (MDO).All patients underwent fibroscopic examination of the upper airway and a radiographic imaging and/or computed tomography scans to detect malformations and to confirm that the obstruction was caused by posterior tongue displacement. All patients were evaluated by a multidisciplinary team. Indications for surgery included frequent apneic episodes with severe desaturation (70%). Gavage therapy was employed in all patients since oral feeding was not possible. The two tracheotomy patients were 5 months and 2 years old respectively, and the distraction procedure was performed to remove the tracheotomy tube. All patients were treated with bilateral mandibular distraction: two cases with an external multivector distraction device, six cases with an internal non-resorbable device and two cases with an internal resorbable device. In one case, the patient with Goldenhar's Syndrome, the procedure was repeated.ResultsThe resolution of symptoms was obtained in all patients, and, when present, tracheotomy was removed without complications. Of the two patients with pre-existing tracheotomies, in the younger patient (5 months old) the tracheotomy was removed 7 days postoperatively. In the Goldenhar's syndrome case (2 years old) a Montgomery device was necessary for 6 months due to the presence of tracheotomy-inducted tracheomalacia. Patients were discharged when the endpoint was obtained: symptoms and signs of airway obstruction were resolved, PAS and maxillomandibular relationship improved, and tracheotomy, when present, removed. During the follow-up, no injury to the inferior alveolar nerve was noted and scarring was significant in only the two cases treated with external devices.ConclusionMandibular Distraction Osteogenesis is a good solution in solving respiratory distress when other procedures are failed in paediatric patients with severe micrognatia.

Improvement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia

“…(12). A previous study on children with severe micrognathia and airway obstruction undergoing bilateral mandibular distraction revealed improvement in respiratory distress when other procedures have failed (13). Several studies in agreement with our finding demonstrated the improvement of mouth opening with distraction osteogenesis.…”

“…Xiaofeng et al ., describe distraction osteogenesis as a reliable surgical method to alleviate the narrow upper airway in growing OSA patients, especially those with severe craniomaxillomandibular deformities . A previous study on children with severe micrognathia and airway obstruction undergoing bilateral mandibular distraction revealed improvement in respiratory distress when other procedures have failed .…”

Treatment of Ankylosis in Children Associated With Osteogenic Distraction: Literature Review and Case Report

“…With the advancement of miniaturized intraoral distractors, the distraction osteogenesis technique has drastically transformed the concept of correction of maxillofacial deformities [3][4][5][6][7], having multiple advantages over extraoral distractors, considering the patient's better acceptance and compliance during the activation and consolidation phases because they are discrete and easy to handle, the reduction of the scar of the skin caused by the traction of transcutaneous fixation pins, preventing injury to the neurovascular bundles, allowing the invisible distraction of the jaw, thus eliminating frequent monitoring and limitation in social life and improving the stability of the attachment to the bone [24][25][26][27].…”

“…As the technique evolved, other technologies have been developed and associated with surgical procedures, increasing predictability and final stability, as well as facilitating planning [27,28]. In 2010, Feiyun P et al, [8] described the use of three-dimensional craniofacial models in the planning of simultaneous surgical correction of atm ankylosis associated with mandibular micrognathia.…”

Functional outcomes of mandibular distraction for the relief of severe airway obstruction and feeding difficulties in neonates with Pierre Robin sequence

“…Even though an acceleration is observed in the postnatal period, in cases with 24 . demonstrated the benefit from mandibular distraction in PRS patients for relieving airway problems and preventing tracheotomy procedure.…”