Setting the Stage: Preoperative Diagnostics for Infant Mandibular Distraction Candidates

Monday, October 13, 2025

2:48 PM - 2:54 PM EDT

Location: 233-234

Disclosure(s):

Chinelo J. Eruchalu, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nicole M. Favre, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Murilo W. de Santana Hager, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michele M. Carr, DDS MD PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Mandibular micrognathia can cause upper airway obstruction due to tongue retropositioning in newborns. Mandibular distraction osteogenesis can be performed to relieve airway obstruction and avoid tracheostomy. Although the success of this procedure is well-documented, guidance on preoperative evaluation in newborns is limited.

Methods: A retrospective chart review was conducted using the US collaborative network TriNetX. Patients ≤1 year of age with congenital facial malformations were identified (ICD-10 code Q87.0). Two subgroups were created: those who underwent mandibular distraction (CPT 20680), and those who did not. Incidence of flexible laryngoscopy, direct laryngoscopy, bronchoscopy, polysomnography, CT, MRI, intubation, and tracheotomy were tabulated for each group. Relative risk within a 95% confidence interval was calculated.

Results: 655 patients were included, 67 (10.2%) in the distraction group and 588 (89.8%) in the non-distraction group. The mean age was 0.6 years (SD=0.5) in the distraction group and 0.7 years (SD=0.5) in the non-distraction group. The distraction group was 3.13 times more likely to undergo bronchoscopy [N=15 (22.3%) vs. N=42 (7.1%); CI:1.84-5.34; p<.001)], 2.29 times more likely to undergo polysomnography [N=24 (35.8%) vs. N=92 (15.6%); CI:1.58-3.32; p<.001), 4.3 times more likely to undergo flexible laryngoscopy [N=28 (41.8%) vs. N=148 (25.2%); CI:1.21-2.28; p=.006), 4.3 times more likely to undergo direct laryngoscopy [N=24 (35.8%) vs. N=49 (8.3%); CI:2.83-6.53; p<.001), and 6.58 times more likely to have a CT scan [N=30 (44.8%) vs. N=40 (6.8%); CI:4.41-9.82; p<.001). No subjects in the distraction group underwent a tracheostomy, compared to 13 (2.2%) subjects in the non-distraction group.

Conclusions: Infants ≤1 year who underwent mandibular distraction received more extensive diagnostic evaluations compared to those who did not, but workup appears to be variable. No standard preoperative evaluation exists; establishing standardized protocols would reduce unnecessary procedures in these patients.

Presenting Author(s)

Chinelo J. Eruchalu, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Nicole M. Favre, MD

Resident Physician
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

CC

Chloe J. Cottone, BA

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Bufalo, NY, United States

Disclosure information not submitted.
BB

Beatrice R. Bacon, MD

Resident
University of Pittsburgh Medical Center Department of Otolaryngology- Head and Neck Surgery
Basom, NY, United States

Disclosure information not submitted.
Murilo W. de Santana Hager, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

MC

Michele M. Carr, DDS MD PhD

Professor
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Williamsville, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.