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Jaw Distraction Surgical Technique for Pierre Robin Sequence

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Published on Feb 9, 2010

A new, specialized surgical technique for babies born with a craniofacial deformity that blocks the babys airway can fix the problem and alleviate the need for a tracheostomy.

Baby Paul Lucas was born in Oct. 2009. During pregnancy, his parents had no idea that he would be born with Pierre Robin Sequence resulting in a small jaw, cleft palate and big tongue. The critical problem was that when he was laid on his back, his tongue blocked his airway, causing him to turn blue and go into respiratory distress.

Traditionally, a tracheostomy placed in the throat would be required; however, the child would need the tracheostomy for years until about age 7 to 11 years of age. During that time period the child may often have complications like pneumonia or more rarely children have even died. When children have trachs, they cannot eat or speak normally. They may be developmentally delayed and need a feeding tube.

However, Dr. James Bradley, a UCLA pediatric plastic and reconstructive surgeon, is one of just a few surgeons nationwide that offers an alternative to trach—and it can actually fix the problem in a relatively short amount of time. As these children grow older, its practically impossible to know that they ever had a birth deformity.

During surgery, the bone of the jaw is separated and distractors are put in place on both sides. Then, the baby returns to the neonatal intensive care unit for two weeks and the distraction devices are turned twice a day which helps lengthen the jaw. Ideally, the jaw will grow 3 cm by the end of the 2 week period providing enough space for the tongue to lie properly and allow normal airway breathing. The baby goes home with the distractors in place ( but hidden under the cheek) while the bone continues to grow, although no additional turning is required. The baby has outpatient surgery about 3 months later to remove the device.

For parents who had no idea from prenatal scans or tests that their baby would be born with this deformity, most people are not aware of this surgery which can fix the problem and alleviate the need for a trach. For parents this process can be stressful. When they see their child change from a scary situation of not being able to breathe or feed, to a normal situation of feeding and breathing in a few weeks, they are elated.

Learn more at www.plasticsurgery.ucla.edu

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