Mandibular Distraction in the Neonate With Obstructive Apnea: Experience with a Modified Internal Device

Mandibular distraction is an accepted technique in the treatment of patients with Pierre Robin Sequence with moderate to severe airway obstruction.  There are various technical strategies to advance the neonatal mandible, utilizing external and internal distractors combined with varying osteotomy designs and a host of distraction vectors.  The purpose of this presentation is to describe a mandibular distraction technique utilizing a modified neonatal internal mandibular distractor.

10 consecutive patients with Pierre Robin Sequence (mean age 14 days) and severe obstructive sleep apnea were treated with mandibular distraction.   Medical modeling was utilized to plan and execute the surgical plan in all cases.  Distraction was started on postoperative day one and continued at a rate of 1-2 mm/day until the desired amount of mandibular overcorrection was achieved, typically 20-30 mm. 

All patients underwent successful distraction with resolution of obstructive apnea, confirmed by postoperative polysomnography.  There were no device failures.   Four patients had transient marginal mandibular facial nerve weakness that returned after several months.  

The modified internal distractor allows improved visualization of osteotomy lines once the distractor is applied and facilitates proper vector placement, offering specific technical advantages over conventional designs.

Hammoudeh J et al.  Neonatal mandibular distraction as an alternative to tracheostomy in severe obstructive sleep apnea.  Cleft Palate Craniofac J 49: 32, 2012

Flores RL.  Neonatal mandibular distraction osteogenesis. Semin Plas Surg 28: 199, 2014