Jacksonville, FL, December 17, 2010 Newborns with a severely undersized jaw caused by a birth defect such as Treacher-Collins syndrome and other conditions may experience an upper airway obstruction. This condition, called micrognathia, affects their ability to breathe and be fed. An upper airway obstruction like this is seen in one in 9,000 live births. In the past, this condition could lead to death, as it did in 30% of cases of this condition.
Traditional treatment has been tracheostomy, in which the surgeon places a tube in the trachea to assist with breathing; often, in the event of a severely undersized jaw that leads to this upper airway obstruction, the baby may also require a feeding tube which is surgically implanted in the stomach. External devices such as these tubes require frequent surgery to change the tubes, daily maintenance and can lead to infection, including pneumonia; they also lead to scar tissue. The tubes usually cannot be removed from the child until he is at least 3 years old.
A newer procedure for rebuilding the jaw of an infant with micrognathia, which relieves the blockage permanently, is being performed at Wolfson Children’s Hospital by pediatric craniofacial surgeon Saswata Roy, MD, from Nemours Children’s Clinic, Jacksonville.
Called neonatal distraction osteogenesis, the procedure involves performing surgery on the baby within days of birth, before he leaves the neonatal intensive care unit (NICU). Through a 2-cm incision, Dr. Roy creates a small fracture in the lower jaw (called an osteotomy) and attaches a device known as a distractor to both sides of the bone on both sides of the cut.
“The distractor keeps the fracture alive and is slowly turned over weeks or days to stretch the break in the abnormal bone; then, new tissue fills the space and creates new bone,” says Dr. Roy. This method, which is usually not painful to infants, forms a longer bone from a shorter one in a period of about six weeks. Once the new bone is strong enough, the surgeon removes the distractor during a short second operation.
“The baby’s body, in effect, forms a new jaw,” says Dr. Roy.
Not only is this procedure safer and more effective for children, offering a permanent solution and a better outcome, but it’s more cost-effective in the long run. “An article in Plastic and Reconstructive Surgery, November 2010, showed that neonatal distraction osteogenesis, long-term, is less costly than tracheostomy,” says Dr. Roy.
The average cost per patient in this study who received distraction osteogenesis was nearly 50 percent lower than the cost per patient in the tracheostomy group. This includes the surgery, hospital stay, diagnostic tests, treatment for pneumonia and emergency room visits.
Following the procedure and recovery, the baby’s face looks normal and quality of life is restored.