Aim: To present the outcome of the management of 40 neonatal, infant and young children with micrognathia and severe upper airway obstruction who have undergone mandibular distraction.
Background: Infants and children with craniofacial anomalies often present with varying degrees of upper airway obstruction due to micrognathia.
Methods: All patients underwent mandibular distraction with internal appliances. The age at the time of surgery ranged from 5 weeks to 36 months. One patient was intubated, three patients were tracheostomy dependent, two managed CPAP, thirty-three patients were naso-pharyngeal tube dependent and one positionally managed. All patients have more than 12 months of follow-up since surgery. Polysomnography studies were undertaken pre-operatively when possible and post-operatively.
Results: Of the tracheostomy dependent group; one was decannulated after distraction and two were delayed. Thirty-three patients had no further obstructive symptoms following mandibular distraction. Six patients had continuing or developed further obstructive symptoms in the follow-up period, and one patient underwent further mandibular distraction at 7-year old. Feeding responses varied post-distraction from early conversion to slow progress to oral feeds and four continue to require supplemental nasogastric feeds.
Conclusion: In selected neonates and infants mandibular distraction appears to be a good modality for the correction of upper airway obstruction due to micrognathia and to facilitate oral feeding.
Conflict of interest: None declared.