title: Controversies in the management of neonatal micrognathia:  to distract or not to distract, that is the question.
abstract: Symptomatic micrognathia, as seen in syndromic and isolated presentations of the Robin sequence (RS), can pose immediate an ongoing threats to the well-being of neonates. Upper airway obstruction can manifest as acute respiratory insufficiency requiring postpartum intubation and mechanical ventilation or as a mild irregularity in the oropharyngeal airflow that can be managed by positioning the newborn in a prone or decubitus position. Clinically significant micrognathia is often accompanied by some degree of feeding difficulty, obstructive sleep apnea, and gastroesophageal reflux disease, all of which should be evaluated by a multidisciplinary team of specialists before a definitive treatment plan is formulated. Numerous surgical and nonsurgical options have been described for airway management in RS; there is no single agreed-upon therapy. Most recently, our expanding experience with craniofacial distraction has resulted in greater application of distraction osteogenesis to the congenitally hypoplastic mandible. Rather than serve as a panacea, however, the practice of neonatal mandibular distraction for infants with upper airway obstruction has probably given rise to more questions than it has answered. The debate over its most appropriate indication in the micrognathia patient is quite current. In this article, we consider some of the controversies surrounding the use of distraction compared with other techniques in the management of the neonatal airway.
authors.affiliation: Division of Plastic and Reconstructive Surgery, School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA. rjarrahy@mednet.ucla.edu
authors.forename: Reza
authors.initials: R
authors.lastname: Jarrahy
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis / Q000628:therapy; D003191:Comprehensive Health Care; D003657:Decision Making; D004435:Eating / Q000502:physiology; D004724:Endoscopy; D005764:Gastroesophageal Reflux / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007400:Interprofessional Relations; D007442:Intubation, Intratracheal; D008334:Mandible / Q000601:surgery; D008844:Micrognathism / Q000175:diagnosis / Q000601:surgery*; D009060:Mouth Floor / Q000601:surgery; D009305:Nasopharynx / Q000502:physiology; D019857:Osteogenesis, Distraction / Q000379:methods*; D010102:Oxygen Inhalation Therapy; D010347:Patient Care Planning; D010348:Patient Care Team; D010855:Pierre Robin Syndrome / Q000175:diagnosis / Q000601:surgery*; D011187:Posture / Q000502:physiology; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy; D012138:Respiratory Therapy / Q000295:instrumentation; D020181:Sleep Apnea, Obstructive / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014059:Tongue / Q000601:surgery; D014139:Tracheostomy; D057832:Watchful Waiting