Neonatal Distraction Osteogenesis Research Articles

Tooth Development Following Mandibular Distraction Osteogenesis in Neonates With Pierre Robin Sequence.

Mandibular distraction osteogenesis is a widely utilized surgical procedure in the pediatric population for the treatment of mandibular retrognathia. Patients with congenital abnormalities may display severe mandibular hypoplasia and associated functional problems. Distraction osteogenesis is effective in alleviating airway obstruction for these patients and is performed early in life, often during the neonatal period and during infancy. However, problems in tooth development may arise as a surgical complication. A systematic search was conducted in PubMed and EMBASE to identify retrospective studies describing long term outcomes of mandibular distraction osteogenesis on tooth development. Each article was reviewed and relevant data were extracted, collected, and examined according to the type of dental injury, specific tooth effected, and frequency of occurrence. Tooth injuries include positional change (35%), shape alteration/fracture (24%), missing tooth (15%), root injury/malformation (14%), follicle/bud perforation (9%), delayed eruption (2%), and dentigerous cyst (1%). The most commonly affected tooth is the permanent first molar, followed by the primary second molar. The least common tooth affected is the third molar. Although tooth injuries exist following mandibular distraction osteogenesis in the pediatric population, the risk of pathology and major complications remain relatively low. Technological advancements in presurgical planning can be expected to continue reducing the risk of adverse effects to primary and permanent tooth development.

Treatment of congenital malformations of the mandible

Distraction osteogenesis (DO) has been one of the most innovative concepts in craniomaxillofacial syndromology and surgery through the last 25 years. After more than a quarter of century of extensive use DO has today specific indications for congenital craniofacial and cleft deformities. Technology has evolved from the first application of external devices to intraoral and hybrid or semi-buried techniques. In congenital craniomaxillofacial anomalies distraction is indicated during growth. Mandibular distraction osteogenesis can be safely and effectively used to avoid or remove tracheostomy in neonates with severe airway obstruction caused by micrognathia in Pierre Robin Sequence. 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 and aesthetic with consistent psychological and familiar positive effects. An increased incidence in TMJ complication during distraction osteogenesis in neonates has been recently reported, especially in syndromic patients.

Early mandibular distraction osteogenesis in neonates and paediatric age

Early mandibular distraction osteogenesis in neonates and paediatric age

Early Intervention

To determine benefits of early intervention in neonates with symptomatic micrognathia who underwent bilateral mandibular distraction osteogenesis within the first 90 days of life as relates to growth, need for supportive care, and further invasive procedures. Case series with chart review. Tertiary care, academic children's hospital. Review of neonates with symptomatic micrognathia who underwent bilateral mandibular distraction osteogenesis in the past 5 years. Inclusion criteria included mandibular distraction osteogenesis performed within the first 90 days of life. Outcome measures included hospital course, growth curves, supportive home care needs, and airway at cleft repair. Twenty-four patients met inclusion criteria. The mean age at distraction was 30 days, and the average discharge was postoperative day 14. One patient required home oxygen, 50% were able to feed exclusively by oral diet, and no patients required tracheotomy. In addition, airway results were substantial, with 90% of patients showing objective improvement in airway grade from time of mandibular distraction to time of cleft repair. We present our initial outcomes on mandibular distraction osteogenesis in neonates with symptomatic micrognathia. Early intervention allows discharge to home with minimal supportive care needs by avoiding tracheostomy and facilitating transition to oral feeds. The airway improvement is significant and is sustained and allows for easier intubation at time of cleft repair.

Mandibular Distraction for Amniotic Band Syndrome in the Neonate

Prior reports have advocated the use of distraction osteogenesis (DO) in the management of neonates with mandibular hypoplasia to avoid early tracheostomy and its associated morbidity. Our center recently reported on the successful use of DO in a neonate with muscular dystrophy, a condition which affects the bone as well as the adjacent skeletal muscle. Herein, we describe the use of neonatal DO for mandibular hypoplasia in the setting of amniotic band sequence (ABS). The child had significant soft tissue contracture in the region of the cheek, associated with bilateral transverse facial clefts. This report highlights the successful utilization of DO for the treatment of mandibular hypoplasia and airway compromise in a patient with ABS.

Mandibular distraction in neonates: a strategy to avoid tracheostomy.

Over the past 5 years, the authors developed an application of mandibular distraction osteogenesis to eliminate existing tracheostomy. That experience led the authors to attempt mandibular distraction osteogenesis in neonates as an alternative before tracheostomy. Success with this approach using supporting objective airway measurements has been reported previously. This report includes six neonates diagnosed with Pierre Robin sequence. Of the six, five neonates ranging in age from 6 to 26 days (mean, 14.5 days) were treated by the authors with mandibular distraction over a 22-month period. The sixth neonate was treated with tracheostomy, because of other airway abnormalities. Findings included retrognathia, glossoptosis, incomplete cleft palate, and airway obstruction in each patient. Birth weights ranged from 2.8 to 3.2 kg. All patients were unable to control their airway during feeding, as evidenced by repeated episodes of choking and obstruction. Resting oxygen saturations were in the 70 to 80 percent range in all patients, with further deterioration during attempted feeding. Bronchoscopy was performed in all patients under anesthesia before distraction. Recurrent near-complete and intermittent complete airway obstruction were present in all patients at the level of the tongue base. There was a consensus by a pediatric intensivist, a pediatric anesthesiologist, and a pediatric otolaryngologist in all cases. Each patient met all criteria requiring ventilation for life support. Tracheostomy would be required if mandibular distraction osteogenesis was not performed, or if it failed. Patients with other airway abnormalities were not considered for treatment. Maxillomandibular disharmony measured at the midline ranged from 8 to 15 mm (mean, 11.2 mm). Active distraction was performed at the rate of 1 to 2 mm a day, with a consolidation period of 4 weeks. Total time of treatment was less than 6 weeks in all cases. All patients were extubated by the completion of active distraction. Distraction distance ranged from 8 to 15 mm (mean, 12.4 mm). All patients were discharged to home on apnea monitors, the use of which was discontinued after 90 days with no further apneic events. Weight gains met or exceeded the average 500 g a month after distraction. Bronchoscopy at the time of distractor removal showed correction of airway obstruction at the tongue base. Radiographs showed bilateral ossification of the distraction sites. Tracheostomy was avoided in all cases selected for treatment by distraction. Patient follow-up range was 9 to 22 months. In selected Pierre Robin sequence patients with tongue base airway obstruction, mandibular distraction osteogenesis can successfully avoid the need for and the associated mortality and morbidity of indwelling tracheostomy.