Egypt, J. Plast. Reconstr. Surg., Vol. 35, No. 2, July: 191-197, 2011 Neonatal Mandibular Distraction Osteogenesis: A Technique for Treating Neonates with Micrognathia and Risk of Respiratory Obstruction KARAM A. ALLAM, M.D.*; SAMIA M.A. SAIED, M.D.*; TAREK A. ABULEZZ, M.D.*; HAZEM MAHER MOHAMMED ALI, M.D.**; HENRY K. KAWAMOTO, M.D.*** and JAMES P. BRADLEY, M.D.*** The Departments of Plastic & Reconstructive Surgery, Sohag*, Ain Shams** Universities and University of California, Los Angeles*** ABSTRACT Small lower jaw may be a reason of upper respiratory obstruction in neonates. Neonatal upper airway obstruction is a life threatening condition often requiring urgent interfer- ence. Typically, the treating neonatologist first stabilizes the patient’s airway via intubation, a nasal airway or proper patient positioning. Although the tracheostomy is a life-saving procedure in these circumstances, it is associated with numerous compli- cations. Distraction osteogenesis (DOG) offers an alternative to a tracheostomy for newborns with Pierre Robin sequence, Stickler syndrome, Treacher Collins syndrome, Nager syn- drome, and other craniofacial deformities. The study included 9 patients had micrognathia and upper respiratory obstruction who were managed at Mattel’s children hospital at UCLA over the period from 2006 to 2010, 4 males and 5 females, all were full term babies except for one who was born at 33 weeks. All patients had distraction done in the first two months of life. The diagnosis of airway obstruction was based on oxygen desaturations and duskiness and apnea on feeding. Tongue base collapse was confirmed as the primary site of obstruction by flexible nasolaryngoscopy and direct laryngobronchoscopy and other airway lesions were excluded. In summary, bilateral distraction osteogenesis is an effec- tive technique of elongating the micrognathic mandibles. Additional studies are indicated to study the long-term out- comes in different diagnostic subgroups of micrognathia with respiratory obstruction. INTRODUCTION Small lower jaw may be a reason of upper respiratory obstruction in neonates. Neonatal upper airway obstruction is a life threatening condition often requiring urgent interference. Typically, the treating neonatologist first stabilizes the patient’s airway via intubation, a nasal airway or proper 191 patient positioning. When necessary, the definitive management of upper airway obstruction in these neonates has traditionally been to place a tracheo- stomy. Although the tracheostomy is a life-saving procedure in these circumstances, it is associated with numerous complications [1]. These include pneumonia, tracheitis, laryngomalacia, subglottic stenosis, bleeding from granulation tissue and death. In addition, long term problems such as delayed speech, suboptimal growth, and develop- mental delay are common. Removal of tracheosto- mies placed or upper airway obstruction in the newborn often requires multiple procedures and may not be accomplished until 5-11 years of age [2]. Given these drawbacks, other modalities have been sought to manage neonatal upper airway obstruction. For newborns with Pierre Robin se- quence, Stikler syndrome, Treacher Collins syn- drome, Nager syndrome, and other craniofacial deformities, distraction osteogenesis (DOG) offers an alternative to a tracheostomy [3]. Distraction osteogenesis is a surgical technique involving the gradual lengthening of bones and has become an accepted procedure in the treatment of craniofacial anomalies in the growing patient [4]. Several series have documented lower jaw lengthening over a one-week period for newborns with micrognathia [3,5]. This successfully ameliorates upper airway obstruction by advancing the tongue and epiglottis [6]. The natural history of mandibular growth in syndromes with micrognathia is not clear. With isolated Pierre Robin sequence (not a syndrome), children can reach normal mandibular projection by six months of age. Many authors think this “catch-up” growth is a result of stimulation of the