Use of Mandibular Distraction Osteogenesis to Correct Micrognathia and Airway Obstruction in Newborn Female with Pierre Robin Sequence and Neonatal Abstinence Syndrome in Rural Appalachia

We present a case of Pierre Robin sequence and Neonatal Abstinence Syndrome (NAS) in a newborn female patient to highlight the surgical technique of mandibular distraction osteogenesis to correct airway obstruction due to micrognathia. The patient presented as a transport after delivery due to respiratory distress. She was noted to have a cleft palate and micrognathia. The absence of other dysmorphic features diagnosed her with non-syndromic Pierre Robin sequence. To solve her upper airway obstruction, mandibular distraction osteogenesis was performed. This procedure allowed the patient to be weaned from all respiratory support and nasogastric tube feeds by the end of her hospitalization. She was able to be discharged home weeks before her internal hardware was surgically removed. Mandibular distraction osteogenesis was previously unavailable in rural Appalachia, making this case novel to the area. The patient also developed NAS during her hospitalization, highlighting the ongoing substance abuse epidemic in Appalachia.