Packard Children's Hospital develops device to extend infants' lower jaws

The plastic and reconstructive surgery team at Lucile Packard Children's Hospital has developed a new tool to treat babies born with an abnormally small lower jaw. These infants have trouble breathing and eating - the crowded tongue tends to block the airway when they sleep or swallow.

In the past, an infant could spend two or three years with a tracheostomy and a feeding tube, said the hosptital's chief plastic surgeon Pete Lorenz, MD, professor of surgery. That could leave the child at risk for asphyxiation and make it hard to learn to eat. The new surgical device enlarges the jaw in just a few months, starting as early as 1 week of age. It was invented by Lorenz's colleague, Stephen Schendel, MD, emeritus professor of surgery.

The new device refines older tools for mandibular distraction, a bone-enlargement technique in which the lower jaw bones are cut in two places behind the teeth, and the bone ends are braced close together. The bone ends are then separated by 1 to 2 millimeters a day, and the body fills the space with new bone.

Unlike old brace models, the new device is attached to the jaw under the skin, minimizing facial scarring. Another advantage is that it holds the bone in place more securely, and it has a curved shape that mimics the natural contour of the jaw.

As a result, the team at Packard Children's Hospital can reconstruct much larger defects and generate much more new bone with the new technique compared with conventional surgery, Lorenz said. And, once the jaw is enlarged, its growth seems to keep up with the rest of the face.