Tracheostomy for management of neonatal
airway obstruction may be life saving but is associated with complications and developmental problems. As an alternative, the effectiveness of internal mandibular
distraction osteogenesis was investigated in select neonatal patients with
micrognathia and upper
airway obstruction. Preoperative tests (sleep study, direct laryngobronchoscopy, and "milk scan" for GI reflux) were used to select appropriate candidates for the procedure. Excluded were patients with 1)
central apnea, 2) severe reflux, 3) other airway lesions, and 4) mild to moderate obstruction controlled by positioning. Of 44 newborns (aged <3 weeks) with upper
airway obstruction and
micrognathia seen in the neonatal intensive care unit, 19 underwent
tracheostomy, 10 were discharged with home monitoring and positional instructions, and 15 underwent bilateral mandibular lengthening with microdistractors. Of those who underwent mandibular distraction, a
tracheostomy was avoided in 14 of 15 patients. Relative improvement in the posterior airway space was seen on 3D CT scans, cephalograms, and laryngobronchoscopies obtained preoperatively, postoperatively, and during follow-up evaluation. One of these 15 patients required a
tracheostomy for postoperative
central apnea. In an average of just 4.5 days following completion of distraction, patients were discharged home with improved oral feeding and no
feeding tube. This study suggests that for selected newborns, the use of internal microdistractors allows for avoidance of a
tracheostomy and improved oral feeding.