distraction
Mandibular Distraction

What is mandibular distraction?

fingers holding ear tube

Mandibular distraction is a method used to increase the length of the jaw bone. It requires a surgical procedure to attach the distractors, one one each side of the jaw bone. The process of distraction occurs after surgery and usually takes between 10 and 14 days.

Why would a child need mandibular distraction?

Some children are born with an abnormally small jaw bone (mandible is another name for the lower jaw.) This condition is called micrognathia [my-kroh-NATH-ee-ah] and can be associated with a number of problems. Infants with a small jaw can have trouble eating and breathing. This is because the small jaw pushes the baby's tongue into the back of the throat causing blockage of breathing and swallowing.

The idea of mandibular distraction can seem complex and may be difficult to grasp. The following presentations may make the topic easier to understand.

Why mandibular distraction?

How mandibular distraction works

Joe's story

Joe is one of many children who have undergone mandibular distraction. Although every child who needs distraction is different, Joe's story is fairly typical. Joe's parents were kind enough to share their personal photos as well as their thoughts and experiences to help other parents understand what to expect if their child needs to have this procedure.

Are there any instructions I need to follow before surgery?

Most children who undergo mandibular distraction are still in the hospital when the procedure is performed. However, in some cases like Joe, the surgery is performed on children who are living at home. If your child is at home before having surgery your child must have a physical examination by his or her pediatrician or family doctor within 7 days before surgery to make sure he or she is in good health. The doctor you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.

For your child’s safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines. If you do not follow these guidelines, your child's surgery will be cancelled.

What can I expect after surgery?

The procedure usually takes between 2 and 4 hours. Your child will be taken to the pediatric intensive care unit (PICU) following surgery. It is common for your child to remain on a ventilator after surgery. The amount of time your child will need to stay on the ventilator depends on how much trouble your child had breathing before surgery. But don't worry...your child will soon breathe without the ventilator.

The distraction process will begin 3 days after surgery. It important to wait a few days before starting the distraction process. On post-operative day 3, your surgeon will begin moving the jaw forward by turning a screw on the front of each distractor. The nurses will learn how to continue the distraction process. You may also learn how to perform the distractions yourself if your child will be discharged from the hospital before the distraction is complete. Yes, some children don't need to stay in the hospital during the distraction process! Don't worry...it is not difficult to learn how to distract your child's jaw.

Does it hurt?

Your child will certainly have pain and discomfort for a few days after surgery. This will be controlled with pain medication. After just a few days, the pain will subside and only mild pain medication like Tylenol® may be required from time to time.

U.S. quarterMany parents and nurses are concerned that the process of distracting the jaw is painful; however, this is not the case. The jaw bones are separated less than 1 mm each time the screws are turned. This is less than the thickness of a United States quarter! We know that distraction is not painful—many older children have had this procedure done and report no significant pain during the daily distractions.

Answers to other frequently asked questions…

Mandibular distraction is a very specialized surgical treatment for infants and children with special problems. It is not a routine part of most surgeons' practice. The doctors at Children's ENT and Facial Plastic Surgery have specialized knowledge and experience caring for children in need of mandibular distraction. We have performed more of these procedures than any other surgeons in the region, and possibly the country. But more importantly, we know when and when not to recommend this procedure.

Every child is unique and mandibular distraction is a major surgical procedure with potential risks. Your doctor will spend as much time as necessary to discuss your child's particular problems and why distraction may or may not be an option worth consideration.

If you have any questions or would like further information specific to your child, please call our office at (612) 874-1292.

This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child's physician.

Ben's Story

Ben Locker

Ben was born with severe micrognathia. His family invites you to read his story...

Slide 1

Why distraction?

The most common reason to consider mandibular distraction is for babies born with a small jaw.

“Mandibular distraction” is also called “jaw distraction”. (“Mandible” is just another name for the lower jaw.)

Slide 2

Micrognathia

This baby has “micrognathia” (my-kroh-NATH-ee-ah). Micrognathia means “small jaw”.

 | 

Slide 3

What's the problem?

Let's take a look at the problems caused by a small jaw...

 | 

Slide 4

A look inside...

This diagram shows what it looks like inside the mouth and throat of a baby born with a small jaw.

 | 

Slide 5

The tongue

Note how the jaw's small size and position pushes the tongue back into the baby's throat.

 | 

Slide 5

In fact, if you look closely you'll notice how the tongue is sticking up through the palate.

This baby was born with a cleft palate as a result of his small jaw.

 | 

Slide 7

Airway obstruction

The position of the tongue blocks airflow through the nose and mouth.

Problems caused by this tongue position range from minor feeding difficulties to severe, life-threatening airway obstruction.

 | 

Slide 8

Solving the problem

Let's take a look at what happens to the tongue position and the airway obstruction if we can somehow move the jaw forward...

 | 

Slide 9

Moving the jaw

As the jaw is moved forward, the tongue is pulled forward too. This is because the front of the tongue is attached to the front of the jaw.

Now the airway is clear and breathing and feeding is easier.

 | 

Slide 10

The solution

The way to move the jaw forward in an infant or small child is a surgical procedure called “Mandibular Distraction”.

To learn more about how distraction works, view the slide presentation below.

Slide 1

How it works

Before we start, it is important to remember that mandiublar distraction is effective.

However, it requires major surgery and should only be considered when recommended by a physician experienced in caring for these children.

Slide 1

Facial bones and mandible

This is what the facial skeleton looks like in a child with a small jaw.

The mandible, or lower jaw, is highlighted in red.

 | 

Slide 1

Mandibular osteotomy

The mandible is cut as shown. Actually, two cuts are made—one on each side of the jaw bone.

 | 

Slide 1

The distractor

Small pins are placed through the skin into the two pieces of the jaw bone.

A device, called a distractor, is attached to these pins.

 | 

Slide 1

Distraction

In the days following surgery, the distractor is slowly lengthened. This slowly pulls the two pieces of the jaw bone apart.

The next slide shows what happens as the mandible is distracted...

 | 

Slide 1

Distraction

Notice that the gap that opens up between the bone doesn't last for long.

The space that is created by the distraction is quickly filled in with new bone, called “regenerate”.

Let's finish the distraction...

 | 

Slide 1

Distraction completed

When the distraction is finished, the front of the jaw is in its new position. The tongue has been brought forward and the airway obstruction is gone.

But that's not the end...

 | 

Slide 1

Consolidation

The regenerate is still soft. If the distractor is removed too soon, the bone will not become soild and the jaw will collapse back again.

Watch the regenerate harden, or “consolidate”.

 | 

Slide 1

Consolidation

Approximately 6 weeks after surgery the bone has become solid and the consolidation phase is complete.

Now the distractor and pins can be removed.

 | 

Slide 1

Pin removal

The distractor pins are removed in a short, outpatient surgical procedure.

 | 

Slide 1

That's it! The mandible will continue to grow along with the rest of the child. No additional surgery is necessary.

Joe's Story

November 12

Joe was born with Pierre Robin sequence. He had difficulty breathing and feeding. A small nasal tube, call a trumpet, was used to help him breathe.

Joe's Story

November 21

Joe was discharged from the hospital. We were excited to get him home. Here he is relaxing on the couch. He still needed the nasal trumpet to help him breathe.

 | 

Joe's Story

December 17

Joe was managing well with the feedings until he was around 5 weeks old, then it started to get a little tough for him. It felt like he lost interest in eating.

 | 

Joe's Story

December 24

At his 6 week check up with Dr. Sidman we decided to schedule distraction surgery for December 29. Joe was able to spend his first Christmas at home.

 | 

Joe's Story

December 29

Joe is ready for surgery. We will be glad to be done with the nasal trumpet. Check out the tape job...much better than on November 21!

 | 

Joe's Story

December 29

Post op, Joe looks a little rough. We were thankful to Dr. Sidman and Dr. Sampson ~ they did a terrific job, and all went well. I was glad to see there was not much swelling.

 | 

Joe's Story

December 30

Joe's dad Matt was the first to feed him, a little tricky at first with the extra hardware.

 | 

Joe's Story

December 30

We were amazed how well he did after such a major surgery.

 | 

Joe's Story

December 31

New Years Eve at Children's Hospital. Joe still needs the nasal trumpet because the distraction hasn't started yet.

 | 

Joe's Story

January 1

New Years Day. We started the distraction process today. Dr. Sidman taught us how to turn the distraction screws twice a day. It was really simple to learn and do.

 | 

Joe's Story

January 2

Joe was discharged from the hospital today. We're hoping he won't need the nasal trumpet much longer. His breathing should get better once his chin moves foward far enough.

 | 

Joe's Story

January 8

I can breathe without my trumpet! Success!

 | 

Joe's Story

January 8

I can breathe without my trumpet! Success!

 | 

Joe's Story

January 16

Joe experienced mild discomfort towards the end of distraction. Tylenol and Motrin helped out.

 | 

Joe's Story

February 13

Distraction went well, now Joe just has to wait until the bone hardens up enough, so the distractors can come off.

 | 

Joe's Story

February 21

Joe's mom Kara holding Joe before his distractor removal surgery.

 | 

Joe's Story

February 21

Yeah! They're off! The removal procedure only took about 10 minutes.

 | 

Joe's Story

October 3

Joe had his cleft palate repaired. Here he is with his dad before surgery. All went well and he was discharged after 2 nights in the hospital.

 | 

Joe's Story

October 7

Joe with his dad sporting his no-no's and a puree diet for two weeks. This did not slow him down.

 | 

Joe's Story

October 26

At Joe's three week post-op check up, Dr. Sidman said all looked good.

Here is Joe with his brothers and sisters shortly before his first birthday.

 | 

Joe's Story

Thank You!

Thanks to Dr. Sidman and his wonderful staff for helping Joe past the hurdles he faced in his first year of life.

We appreciate all you have done!

Kara & Matt