Background: Tracheostomy for treatment of neonatal airway obstruction may be life-saving but is associated with complications and developmental problems. Internal mandibular distraction osteogenesis is an alternative but it is not know if this is an effective treatment and indications for this procedure have not been defined. To study this, we used a series of preoperative tests to select or exclude patients for the procedure. Preoperative, postoperative and follow-up cephalograms, 3D-CT scans and laryngobronchoscopies were then compared. Methods: Newborns (less than 3 weeks of age) were seen in the neonatal intensive care unit with upper airway obstruction and micrognathia (n=44). A sleep study, direct laryngobronchoscopy and ‘milk scan’ or 24 hour pH probe (GI reflux) were used to select candidates. Excluded were patients with 1)central apnea, 2)severe reflux, 3)other airway lesions and 4)mild obstruction controlled by positioning. Selected patients underwent mandibular osteotomies and 12 to 15 mm of distraction over an 8 day period. Profilogram cephalometic tracings were used to access lower face changes. Follow-up was between 8 and 25 months. Results: Of the 44 newborns evaluated with micrognathia and upper airway obstruction, 19 underwent tracheosomy, 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 the 15 patients. Relative improvement in the posterior airway space was seen on 3D-CT scans and laryngobronchoscopies. One of these 15 patients required a tracheostomy for postoperative central apnea. Profilograms revealed a mean increase in the lower face area of 38.9% (27% to 49%). In an average of just 4.5 days following completion of distraction, patients were discharged home with improved oral feeding and no feeding tube. Conclusions: Our study suggests that for selected newborns the use of internal microdistractors allows for avoidance of a tracheostomy and improved oral feeding.
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