The neonate with upper airway obstruction secondary to micrognathia can be treated with non-operative therapy or surgical intervention. Patients with severe obstructive sleep apnea (OSA) and/or those who have failed alternative measures have historically been managed with a tracheostomy. Although tracheostomy may be life saving, it is associated with high complication rates and can lead to developmental delays. More recently, mandibular distraction osteogenesis (DO) has been used to treat neonates with OSA who have airway obstruction at the tongue base. However, for this treatment to be successful, it is importance that there are no other sites of obstruction (e.g., laryngotracheomalacia, choanal atresia, etc.). In addition, infants with complex syndromes do not consistently have complete alleviation of airway obstruction with DO.
Older children with OSA or a tracheostomy may also benefit from mandibular DO. Documentation of the site of obstruction with bronchoscopy and/or functional MRI prior to DO is recommended, and adenotonsillectomy should be considered as first line treatment. Children with syndromic craniosynostosis and midfacial hypoplasia who have a tracheostomy or OSA that cannot be managed with continuous positive airway pressure (CPAP) can have dramatic improvement in airway obstruction following midfacial DO, assuming there are no other sites of obstruction and no significant central apnea.
New distraction devices and 3-dimensional treatment planning software facilitate precise placement of bony segments and can be used to treat teenagers and young adults with complex dentoskeletal deformities that require large mandibular advancements, counter clockwise rotation of the mandible, and/or lengthening of the ramus-condyle unit.