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Surgical Technique
January 2006

Mandibular Lengthening in Micrognathic Infants With the Internal Distraction Device

Author Affiliations
 

Author Affiliations: Cleft & Facial Anomalies Program, Division of Pediatric Otolaryngology, Nemours Children’s Clinic, Jacksonville, Fla (Dr Roy); Divisions of Pediatric Plastic Surgery (Drs Roy and Patel) and Pediatric Otolaryngology (Dr Roy), Children’s Memorial Hospital, and Plastic, Reconstructive, and Maxillofacial Surgery, Shriners Hospital for Children (Drs Roy and Patel), Chicago, Ill.

Correspondence: Saswata Roy, MD, MS, Division of Pediatric Otolaryngology, Nemours Children’@s Clinic, 807 Children’s Way, Jacksonville, FL 32207 (roymd@mac.com).

Arch Facial Plast Surg. 2006;8(1):60-64. doi:10.1001/archfaci.8.1.60

Correspondence: Saswata Roy, MD, MS, Division of Pediatric Otolaryngology, Nemours Children’@s Clinic, 807 Children’s Way, Jacksonville, FL 32207 (roymd@mac.com).

Mandibular distraction osteogenesis can play an important role in the management of upper airway obstruction in infants with Pierre Robin sequence. These infants are characterized by micrognathia, glossoptosis, and upper airway obstruction.1-3 A small jaw with a relatively large tongue results in retropositioning of the tongue base against the posterior pharyngeal wall.4 Mandibular lengthening through distraction osteogenesis relieves upper 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 velocardiofacial syndromes. Thus, pediatric ophthalmologic, pediatric cardiologic, and genetic evaluations 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.

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