title: Early intervention: distraction osteogenesis of the mandible for severe airway obstruction.
abstract: OBJECTIVE
  To determine benefits of early intervention in neonates with symptomatic micrognathia who underwent bilateral mandibular distraction osteogenesis within the first 90 days of life as relates to growth, need for supportive care, and further invasive procedures.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care, academic children's hospital.
  
  
  METHODS
  Review of neonates with symptomatic micrognathia who underwent bilateral mandibular distraction osteogenesis in the past 5 years. Inclusion criteria included mandibular distraction osteogenesis performed within the first 90 days of life. Outcome measures included hospital course, growth curves, supportive home care needs, and airway at cleft repair.
  
  
  RESULTS
  Twenty-four patients met inclusion criteria. The mean age at distraction was 30 days, and the average discharge was postoperative day 14. One patient required home oxygen, 50% were able to feed exclusively by oral diet, and no patients required tracheotomy. In addition, airway results were substantial, with 90% of patients showing objective improvement in airway grade from time of mandibular distraction to time of cleft repair.
  
  
  CONCLUSIONS
  We present our initial outcomes on mandibular distraction osteogenesis in neonates with symptomatic micrognathia. Early intervention allows discharge to home with minimal supportive care needs by avoiding tracheostomy and facilitating transition to oral feeds. The airway improvement is significant and is sustained and allows for easier intubation at time of cleft repair.
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado 80045, USA. pamela.mudd@ucdenver.edu
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Mudd
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Perkins
authors.forename: Jeri E F
authors.initials: JE
authors.lastname: Harwood
authors.forename: Sondra
authors.initials: S
authors.lastname: Valdez
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Allen
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D061345:Early Medical Intervention / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008334:Mandible / Q000002:abnormalities / Q000601:surgery*; D008844:Micrognathism / Q000150:complications / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome