Mandibular Lengthening in Micrognathic Infants With the Internal Distraction Device

Abstract

Mandibular distraction osteogenesis can play an important role in the management of upper airway obstruction in infants with Pierre Robin sequence. These infants are characterizedbymicrognathia,glossoptosis,andupperairwayobstruction. 1-3 Asmall jawwitharelativelylargetongueresultsinretropositioningofthetonguebaseagainst theposteriorpharyngealwall. 4 Mandibularlengtheningthroughdistractionosteogenesisrelievesupper airway obstruction by moving the tongue base anteriorly with its muscular attachments to the mandible. 4 Distraction osteogenesis provides an alternative to tracheotomy in managing upper airway obstruction and allows earlier decannulation in infants with Pierre Robin sequence who previously have undergone tracheotomy. Pierre Robin sequence is often associated with Stickler and velocardiofacialsyndromes.Thus,pediatricophthalmologic,pediatriccardiologic,andgeneticevaluations are imperative in addition to cleft palate management. 5 We use distraction osteogenesis techniques in the management of mandibular, maxillary, cranial vault, and cranioorbital bony deficiencies. We use internal microdistractors in the management of mandibular deficiencies in neonates and infants with nonsyndromic Pierre Robin sequence, as well as in syndromes with mandibulofacial dysostosis such as Nager, Treacher Collins, and Goldenhar syndromes.