A Non-Syndromic, Non-Micrognathic Neonate Presenting With Persistent Glossoptosis Who was Successfully Treated With Mandibular Distraction Osteogenesis

Abstract

Most causes of upper airway obstruction are rare in the nonsyndromicneonatal period. However, if present, such as in cases of glossoptosis, they may cause major respiratory problems during the first few weeks of life. Historically, the subset of patients with severe glossoptosis resulting in respiratory distress have been dependent on tracheostomies to obtain a secure airway. Mandibular distraction osteogenesis (MDO) is a procedure in which osteotomies are performed in the mandible and a distraction device is fixated. After an optional latency phase, distraction is performed in order to lengthen the mandible and increase the airway diameter. MDO has been shown to improve airway diameter, eliminate desaturations, and reduce tracheostomy dependency in neonates who are prone to airway distress. Additionally, MDO has been shown to be more effective than other surgical alternatives. In this article, a case is presented of a non-syndromic, non-micrognathic neonate who presented with persistent glossoptosis of unknown origin resulting in sustained desaturations. The patient was treated with mandibular distraction osteogenesis using bilateral distractors. After a 10 days distraction period, the mandible was successfully advanced by 8.5 mm bilaterally. The airway diameter increased by 6 mm and airway resistance decreased from 82% to 0.3%. As a result of the surgical intervention, desaturations were eliminated and a tracheostomy was avoided. This case is unique in that the patient had repeated desaturations without evidence of an underlying syndrome or micrognathia. Other clinicians may use this case report as a guide to treat patients who have similar presentations.