Purpose:  To present a long-term analysis of a consecutive series of 103 neonatal mandibular distraction cases performed using minimally invasive techniques

 Methods: A retrospective analysis was performed on a cohort of infants operated upon between 2001 and 2009 in a single center for severe micrognathia.  The 3 surgeons utilzed a variety of distractor devices, but typically performed a modified sagittal osteotomy via an intraoral approach, followed by a rapid distraction sequence.   Mean age at surgery was 3.5 weeks, with mean follow-up of 4 years 6 months.  Pre- and postoperative imaging consisted of fine-cut CT with 3-d reconstructions and cine-MRI later in the series.  Lateral and AP cephalograms were obtained with a proprietary cephalostat interaoperatively.  Follow-up plain films were taken at monthly intervals for 3 months, then at 6 months, then yearly thereafter.  Mandibular landmarking was performed, followed by cephalometric analysis in 2d and/or 3d in selected cases.  Further follow-up involved serial MLB or sleep study, dental, ENT and genetic control. 
 Results:  Mean distraction of mandibular body was 42mm at time of initial device removal, followed by immediate callus remodelling.  Postmolding corpus elongation was 33mm.  Mean airway diameter at base of tongue increased by 37%, and was most predictive of decannulation or correction of apnea.  Of tracheostomized patients, more than 85% were decannulated within the next 6 months.  Complications were chiefly related to hardware loosening, with 7 patients requiring reoperation for pin displacement.  There were no facial nerve palsies, malunions, distraction failures, or more serious complications.  There were 11 patients who remained intubated longer than 5 days.  Dental complications included crown resorption of molars (n=8), distalization and rotation of teeth (n=16) and planned sacrifice of deciduous molars during osteotomy (n=3)  (p< 0.05)  Reoperation for growth failure occurred in 17 patients within the study period, correlating with severity of micrognathia and syndromic status.
Conclusion:  Evolution in technique in mandibular distraction has permitted this technique to be reliably applied to the neonate population.  This large series provides long-term evidence that supports its ongoing use in this population.  Further refinements in our technique show promising early results in term of enhanced growth after neonatal distraction.