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Small Jaw (treatment options for)

My infant son has micrognathia and a high arched palate. Can a procedure do more harm than good? Can elongators work? The pediatrician thinks there is no urgency because he is accepting bottle-feeding quite well. However, another physician indicated that his micrognathia might become a problem later on when teething arises, and for speech. I was told it might be a good idea to take him to a maxillofacial surgeon right away while his bones are still cartilage.

As a pediatric dentist, I focus my specialty activities upon the proper growth and development of the infant and toddler. The micrognathia that is associated with CdLS is common and can play a role in many early, as well as later, aspects of the child's development. Treatment for the micrognathic jaw will come in many forms. Orthodontic appliances and retainers can assist in the growth of the jaw. If adequate changes do not take place, surgical intervention can follow, as needed. If feeding is going well, then no urgent intervention, especially surgical intervention, is necessary.

It is too early to intervene with the presentation of the lower jaw. If the airway is being compromised or affected by the backward position of the mandible, then emergent care is necessary. That is, if the infant is having trouble breathing, then various surgical approaches may be necessary to sustain life. Sometimes the surgeon will attach the tongue to the lower lip to prevent the tongue from closing the airway. Sometimes mere positioning of the infant can take care of airway closure when sleeping. These issues have undoubtedly been addressed already, and it doesn't sound as if the airway is a problem for your son. Forward fixation of the tongue or the placement of a tracheostomy tube should be the only surgical approaches to problems associated with micrognathia in infancy. Sometimes we make appliances (retainers) that also can position the jaw forward to keep a patent airway. Nevertheless, there should be no thought of surgical repositioning of the jaw at this time. Various growth sites could be damaged and prevent growth in the future. The risks do not outweigh any conjectured benefits.

We all look at present problems and want to approach them immediately. As time goes on, orthodontic and surgical interventions will all fall into place. Feeding can be enhanced by proper positioning of the infant in an almost upright posture so that gravity is helping in getting liquids down the throat and into the stomach. If the upper jaw is extremely narrow and high arched, a retainer will be used in a few years to start widening and reshaping it. All of these procedures are fairly standard to all pediatric dentists and the timing can be set as child's growth and progress are monitored.

RM/TK 7-13-10



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