AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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AAPS 85th Annual Meeting
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Neonatal Internal Mandibular Distraction for upper airway management in Pierre Robin and other Syndromic Infants- Short term follow up
Virender K. Singhal, MD.
Children's Mercy Hospital, Kansas City, MO, USA.

Majority of infants born with PRS and Syndromic micrognathia can be managed with positioning, NPA and sometimes with glossopexy. In severe cases tracheostomy with gastrostomy is required for management of airway and nutrition. Many severely micrognathic newborns present with symptoms of GER and also receive surgery for GER with gastrostomy. The success rate is variable and unpredictable. Many of these children require prolonged hospitalization with increased burden of care. Moreover, the underlying process remains untreated.
Role of distraction osteogenesis of the mandible in early decannulation and or prevention of tracheostomy has been well documented. There are genuine concerns with neonatal distraction such as damage to the growth centers of the mandible, injury to the inferior alveolar nerve and vessels, injury to the teeth, difficulty in maintaining pins in the mandible, care of the external devices, parental anxiety, intra oral or external scarring, over correction to the point of creating unaesthetic prognathism and most importantly the benefit to risk ratio.
Over the last 4 years I have performed 40 neonatal mandibular distractions with several modifications in the existing techniques to address the above concerns. Injury to the inferior alveolar nerve, vessels and teeth is avoided with stair-step osteotomy of the mandible. Other concerns such as external scars from the pins, parental anxiety have been reduced with placement of internal micro devices. Prognathism associated with over correction has been avoided by vector adjustment despite 15mm elongation of the mandible. The presentation will include the immediate and short term outcomes ,complications & recommendations.


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