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Jaw distraction surgery (mandibular distraction)

Jaw distraction is the name for a surgical method of lengthening a small or recessed (hollow or indented) jaw. The medical term for jaw distraction is mandibular distraction osteogenesis (man-dib-u­ lar dis-track-shon osti-oh-jen-esis). 

A small or recessed jaw can cause severe or ongoing breathing difficulties. Jaw distraction involves the surgical insertion of distraction (lengthening) devices into the jaw. These devices lengthen the jaw bone, which allows the airway to open and the child to breathe clearly. 

This procedure is only used in cases of severe, life-threatening breathing problems, and will not be undertaken to correct facial shape alone. 

Jaw distraction surgery is a very successful way of easing breathing problems and can prevent the need for a tracheostomy in most cases. Jaw distraction is proven to be a much safer alternative to tracheostomy in infants. 

Why does my child need a jaw distraction? 

Signs and Symptoms 

Some children are born with a very small or recessed lower jaw. 

In most cases this does not cause any problems, but in a small number of infants it can cause serious problems in the first few months of life. This is mostly due to the tongue moving back into the throat when the child breathes in, blocking the airway. This is known as upper airway obstruction and can cause serious disruption to breathing and feeding. 

If your child has an upper airway obstruction, they will need to stay in hospital for a period of time, so their breathing can be monitored and assessed. During this time, non-surgical methods of improving the airway obstruction will be tried, such as the insertion of a nasopharyngeal (nay-zo-far-an-jee tube (a tube down the nose that improves air flow to the breathing tubes and lungs). 

In a very small number of cases, these non-surgical methods are not successful and a childs breathing problems become life threatening. In other instances, the non-surgical methods may be required for a very long time, and this can be very difficult to sustain. In either of these cases, jaw distraction might be the best treatment. 

Tests 

If your child has severe or persistent upper airway obstruction, one or more of the following tests will be done to decide if the jaw distraction procedure is appropriate: 

  • Overnight Oximetry: will see if your childs oxygen levels drop, by how much, and how often. 
  • A sleep study: measures how effectively your child is breathing. A sleep study is one of the most reliable methods of measuring how serious your childs airway obstruction is. 
  • Endoscopy: a small flexible tube that has a camera and a light at the end will investigate your childs airway to see how serious the narrowing or blockage is. 
  • A CT (Computed Tomography) scan: will help the surgeons see the size and shape of your childs jaw before the surgery. This allows the surgeons to decide if jaw distraction will be possible and, if so, helps them plan the surgery. 

 

Treatment 

The decision to perform a jaw distraction procedure is made by a team of medical and surgical staff with a variety of expertise. Each member has skills and experience in various aspects of airway obstruction. After considering the results of the tests, the team will decide if jaw distraction is appropriate for your child. Jaw distraction will not be considered for an infant to correct facial dimensions alone but is only used to improve airway obstruction. 

What do I need to know? 

Before surgery 

You will be given instructions from your doctor or nurse on fasting before the surgery. It’s important to follow these directions. 

Your child will have a general anesthesia to put them to sleep before the surgery. The surgeon, anesthetist (a doctor who puts your child to sleep during the operation) and nurses will explain all the procedures to you before they begin. If you have any questions or anything is unclear, ask staff to explain as many times as needed. 

During surgery 

The surgery takes about two to three hours. An incision (cut) is made through the skin under the jaw line, and then the jaw bone is carefully separated so a distraction device can be attached to the bone. This happens on each side of the jaw. 

The distraction device is not visible after the operation, except for two small rods (called distractor arms) that will protrude (stick out) out from the chin or from behind the jaw line. 

After surgery 

The day after surgery, each distractor arm will be turned a full 360 degrees. This procedure is repeated. times a day for about days/weeks. During the time between turns, your child’s jawbone will grow to fill the space. As you turn the device you will hear a slight click”, this is a way for you to know that it has been turned a full resolution/ 360 degree. 

This gradually lengthens the jaw bone, allowing the tongue to move away from the back of the throat. This in turn makes the airway larger, and breathing will become easier. 

Your child will need to stay in hospital until their airway has opened up and they are breathing clearly and without assistance. 

Care at home 

The distraction device will stay in place for around six to eight weeks to support the new bone as it gains more strength. During this time your child can be at home and will be breathing and feeding normally. There should not be much disruption to daily life. 

  • The distractors are made of flexible titanium and there should not be a problem if they are knocked or grasped by your child. 
  • Take care to keep the area around the distractor arms clean to help prevent an infection. 
  • If you have any problems with the distraction device, or if you notice any signs of infection such as redness, pain or swelling, contact your doctor immediately. 

 

Follow-up 

Follow-up appointments will be made with the doctors and surgeons involved in the jaw distraction process during your child’s stay in hospital. 

The distraction device will be removed once the bone is strong enough. This involves another surgery, and your child will need to stay in hospital for another one or two nights. 

Key points to remember 

  • Wherever possible, non-surgical methods to ease airway obstruction will be tried to avoid surgery on a small infant. 
  • Jaw distraction is proven to be a much safer alternative to tracheostomy in an infant with severe upper airway obstruction. 
  • Jaw distraction will not be undertaken to correct facial shape alone. 
  • The distraction device will stay in place for around six to eight weeks to support the new bone. 

 

Questions/Problems: 

It is our desire that your recovery be as smooth and pleasant as possible. Following these instructions will assist you, but if you have any questions or concerns about your progress please call the office (251)471-3381 

Thank you for trusting us with your Oral and Maxillofacial needs.