Early mandibular distraction osteogenesis in neonates and paediatric age

Background : Distraction osteogenesis has been one of the most innovative concepts in craniomaxillofacial surgery through the last 25 years. Technology has evolved from the first application of external devices to intraoral and hybrid or semiburied techniques. After a quarter of century of extensive use Distraction Osteogenesis has today specific indications for congenital craniofacial and cleft deformities.

Methods : Seven infants with craniofacial syndromes and syndromic micrognathia underwent mandibular lengthening in neonatal age or during growth: 3 Pierre Robin Sequences (PRS), 1 Cerebro-Costo-Mandibular Syndrome (CCMS), 1 Auriculo Condylar Syndrome (ACS), 1 Craniofacial Microsomia–Tessier Cleft 7 (CFM), 1 Treacher–Collins Syndrome (TCS). All patients were evaluated by a multidisciplinary team, included fibroscopic assessment.

Results : Pre-distraction and post- distraction lateral CT scans demonstrated the significative improvement in the airway space. PRS babies were early decannulated after distraction. Improvement in feeding was seen following mandibular distraction and the nasogastric tube was removed. Direct visualization with flexible endoscope demonstrated the airway changes. The baby with CCMS and TMJ ankylosis still has deglutitory problem and tracheostomy for airways protection. The mean advancement of the TCS, OAS and CFM cases was 18 mm, with changes in maxillo-mandibular relationships and a slight overcorrection.

Conclusions : Mandibular distraction osteogenesis in the neonates with PRS is an effective treatment option to safely relieve the upper airway obstruction associated with micrognathia. For selected newborns, mandibular DO will allow for avoidance of a tracheostomy and improved oral feeding. A careful evaluation of the patient’s airway and feeding must be performed and evaluated by a multidisciplinary Team approach. In syndromic micrognathia early mandibular distraction seems to be an appropriate indication. Benefits are functional, morphological, aesthetic with consistent psychological and familiar positive effects.

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Early mandibular distraction osteogenesis in neonates and paediatric age
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