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 Vol. 10 No. 10, October 2009
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NeoReviews Vol.10 No.10 2009 e488
© 2009 American Academy of Pediatrics

Management of Micrognathia

Brinda Thimmappa, MD*
Elena Hopkins, RN, MS, PNP{dagger}
Stephen A. Schendel, MD, DDS{ddagger}

* Division of Plastic and Maxillofacial Surgery, Southwest Medical Group, Vancouver, Wash
{dagger} Craniofacial Coordinator, Lucille Packard Children's Hospital, Palo Alto, Calif
{ddagger} Professor Emeritus, Division of Plastic Surgery, Stanford University, Palo Alto, Calif

Micrognathia and the associated retroposition of the tongue into the oropharynx (glossoptosis) can obstruct the upper airway, producing obstructive apnea. The primary management of respiratory compromise in patients who have micrognathia is controversial. Numerous modalities have been used, including prone positioning, nasopharyngeal airways, tongue-lip adhesion, mandibular distraction, and tracheostomy. The goal of any intervention is to relieve airway obstruction, with secondary goals reported in the literature including avoidance or early removal of tracheostomy, improvement in feeding, and accelerated growth. This review examines nonsurgical and surgical therapeutic options and their outcomes. The diagnostic and treatment algorithm employed at the senior author's institution is presented.

Abbreviations: AHI: apnea–hypopnea index • CT: computed tomography • OSA: obstructive sleep apnea • REM: rapid eye movement


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Copyright © 2009 by the American Academy of Pediatrics.