Micrognathia is a congenital anomaly that can result in glossoptosis, cleft palate and upper airway obstruction. The resultant anatomical disruptions often lead to respiratory and feeding difficulties in the newborn and acute events in and out of the operating room that could be avoidable.
There are a variety of surgical and non-surgical options for airway management in a child with micrognathia. Conservative measures include prone positioning, placement of a nasal pharyngeal airway (nasal trumpet), and positive pressure mask ventilation. Surgical options include tongue-lip adhesion, glossopexy or hyomandibulopexy, and tracheotomy.More recently, Mandibular Distraction Osteogenesis (MDO) has been introduced for relieving tongue based airway obstruction. Multiple studies have demonstrated the relief of upper airway obstruction using MDO.
MDO involves gradually lengthening the mandible after the initial osteotomy. Bony segments are separated by small increments during the distraction phase, and this process induces new bone formation in the resulting gap. Related muscles, nerves, blood vessels and mucosa are also elongated in the process.