What Is Mandible Distraction Osteogenesis?

What Is Mandible Distraction Osteogenesis?


Mandible distraction osteogenesis is a procedure that slowly stretches, lengthens, and rotates a short lower jawbone (also called mandible). Mandible distraction osteogenesis helps correct anatomic problems in a child’s jawbone that cause breathing and feeding issues.

Many babies who need mandible distraction osteogenesis surgery have a condition called Pierre Robin Sequence (PRS). PRS causes babies to be born with a lower jaw that’s smaller than normal.

Not all babies with PRS need mandible distraction. But nearly all babies that need mandible distraction are eligible for mandible distraction osteogenesis surgery.

Some children have more severe problems, like Nager Syndrome or Treacher Collins. These problems are best treated when children are toddlers.

Planning Your Child’s Surgery

Correcting a child's lower jawbone requires detailed planning to ensure the best outcomes— like most surgeries on children’s craniofacial skeletons. Our surgeons use imaging from an advanced computer program to carefully plan what type of device to use during treatment well as where to cut your child’s jawbone. Advance planning helps ensure the best outcome for your child.

What Happens During Mandible Distraction Osteogenesis Surgery?

If your child doesn't already have a breathing tube, a member of our surgical team will put a temporary breathing tube through your child’s nose. The breathing tube will help her breathe during surgery.

In the operating room, your child’s surgeon will make a small incision (cut) on your child’s neck, just below the jaw line. These incisions won’t be as noticeable as your child heals and gets older.

Next, surgeons place a device on your child’s jawbone called a distractor. Surgeons then carefully cut your child’s lower jawbone (mandible) into two pieces. The distractor slowly pulls the two pieces of bone apart. Over time, new bone grows to fill the space between the two bones.

Your child’s surgeon will use stitches to close the cut below your child’s neck. Your child will be carefully monitored in the ICU.

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What Happens After Surgery?

After a few days, your child’s jaw will start to form bone scar. The distractor device will slowly stretch the new bone scar. New bone grows in response to stress. Slowly stretching the bone scar helps your child to create new bone in her jaw.

After a few days, your medical team will remove your child’s breathing. Most babies stay in the hospital while the distractor device continues to stretch the bone scar.

Not all problems with small jaws are the same. We carefully analyze your child's jaw abnormality to determine the best treatment. Sometimes the jawbone is both short and has an abnormal shape. Our surgeons are experts in evaluating children with Pierre Robin Sequence and developing the best plan to fix your child’s jaw and allow them to breathe more easily.

Other Special Cases We Treat

Our pediatric ENT surgeons treat infants and children with a variety of problems including the following:

  • Abnormal rotation of the mandible
  • Nager Syndrome
  • Treacher Collins
  • Hemifacial microsomia

We also treat Pierre Robin Sequence in children who have a tracheotomy and older children with Pierre Robin Sequence and abnormal lower jawbones.

What To Expect After Surgery

  • Your child will use a breathing tube for several days after the surgery.
  • If your child needed oxygen support before surgery, we will try to safely wean your child off of oxygen support as the jawbone is stretched.
  • Distraction devices move your child’s jawbone a very small amount with each turn. Most babies have little pain with these adjustments. Sometimes the skin will feel funny while the device is being turned.
  • Your child will be on antibiotics until the distraction (stretching) is finished. If your child develops an infection in the area where she had surgery, she may need antibiotics until the device is removed. If your child gets an infection, it may take longer for the new bone to harden. This is because your child’s body is fighting the infection instead of building new bone.
  • In most cases, we’ll remove the arms that turn the device when your child’s distraction is finished.

Common Questions

Will I Be Able to See My Child’s Device?

Most infants can be treated with an internal distraction device. An internal distraction device is placed on the inside of a child’s jawbone, so no one will be able to see it.

But depending on the jaw problems your child has, she may need an external (visible) device. An external device can more easily rotate the front of the mandible (body of the mandible) and the back of the mandible (ramus of the mandible). This can help your child’s new jawbone grow faster.

If your child's jawbone is extremely short, an internal device may also be too large to help your child's jawbone grow correctly. Your surgeon will evaluate your child's jaw and help develop a treatment plan customized to their problem.

Older children who have mandible distraction or children with a tracheotomy may be able to leave the hospital sooner and slowly turn the device on their own at home. Your surgeon can discuss this option with you if your child is older.

How Do Surgeons Know How Much to Stretch My Child’s Jawbone?

Many surgeons use computer modeling to make sure they are using the best device for your child. Surgeons also use computer modeling to determine the direction (or vector) where the front part of your child’s jawbone will move. Our surgeons take measurements using these computer models, but how much your child’s jawbone grows will depend on how your child's upper and lower jaw line up.

Sometimes surgeons overestimate or overcorrect how much the lower jawbone will grow, usually by a few millimeters. This is because newly formed bone doesn't grow as well in the first few months. So, surgeons account for this with a small amount of overcorrection.

My Child Had a Tracheostomy For Their PRS. When Can their Tube Be Removed?

If your child has a tracheostomy and a short mandible, our surgeons will carefully examine your child’s airway to make sure it won’t collapse once the tracheostomy tube is removed.

If your child’s tongue and mandible are causing breathing problems, your surgeon might recommend a sleep study and a smaller tracheostomy tube. A sleep study will help surgeons figure out if there are other parts of the airway that need to be examined before removing the tube.

In children with more complicated airways, it might take several treatments before the tracheostomy tube can be removed. Your surgeon will do an in-depth examination and keep your family informed about your child’s treatment plan.

Will the Distraction Device Hurt My Child's Teeth?

Distraction devices use screws to fix onto your child’s jawbone. Sometimes these screws touch a child's developing teeth. There currently aren't any large studies looking at how mandible distraction affects infant teeth. But damage to your child’s developing teeth is possible. We don't yet know how severe these problems are.

Every surgery has risks and benefits. If we think of tooth damage as a risk—and improving your child’s breathing as the benefit—usually the risk of dental problems is a risk families are willing to take to improve their child’s breathing.

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