Mandibular distraction osteogenesis for severe airway obstruction in Robin Sequence. Case report

Mandibular distraction osteogenesis (MDO) has been increasingly gaining interest over the last decade as a treatment alternative for the challenging airway management in infants with the Robin Sequence (RS). This paper is a case report of a male child diagnosed with RS, suffering from life-threatening airway obstruction and feeding difficulties, treated with tracheostomy and gastrostomy since infancy. After evaluation of the patient by a multidisciplinary team of specialists, MDO performed as soon as possible, was considered the optimal treatment, not only to address the severe micrognathia but also to allow early tracheal decannulation. As the lack of space intraorally contraindicated the use of internal distractors, they were placed externally bilaterally. The patient was successfully decannulated 3 weeks postoperatively and the gastrostomy was removed 1 month postoperatively. The mandibular expansion exceeded 20 mm bilaterally and the maxilla-mandible discrepancy was fully corrected. There were no complications related to device placement, activation or removal. Follow-up clinical and radiographic examinations of the patient 1 year after the removal of the distractors revealed improved mandibular projection and continued mandibular growth. No significant scarring occurred at the surgical site and the patient has normal respiratory and feeding function. (C) European Association for Cranio-Maxillo-Facial Surgery.