Pearls and Pitfalls in Pediatric Mandibular Distraction

Pediatric mandibular distraction osteogenesis (MDO) is commonly utilized to treat neonatal airway obstruction in Robin sequence (RS) patients. Newborns with RS have a triad of findings, including the posterior position of the tongue, which obstructs the airway making breathing and feeding difficult. These patients are often managed conservatively; however, if conservative modalities fail, then the neonates may require more invasive treatments such as tongue-lip adhesion, intubation, MDO, or tracheostomy. When the obstruction is from the tongue, at the level of the hypopharynx above the level of the vocal cords, MDO is a highly successful treatment for neonatal airway compromise because it addresses the etiology of the obstruction. By lengthening the mandible slowly, the body’s own healing mechanisms are utilized to create bone under the incremental traction, and the tongue is pulled forward, relieving the obstruction. Numerous studies have shown that with MDO the need for tracheostomy or supplemental airway support is low.