Multidisciplinary Perioperative Management and Follow-Up After Mandibular Distraction Osteogenesis in a Neonate With Severe Pierre Robin Sequence: A Report

This case describes the multidisciplinary perioperative management and 7-month follow-up of a neonate with severe Pierre Robin sequence (PRS) who underwent mandibular distraction osteogenesis (MDO), with a particular focus on difficult-airway management, distraction-device care, nutritional support, and recovery of oral feeding. The clinical course, multidisciplinary perioperative management, and postdischarge follow-up of this neonate were retrospectively reviewed, and the case was prepared in accordance with the CARE case-report guideline. After surgery, mandibular advancement was achieved and upper-airway patency improved. The infant was successfully extubated on postoperative day 10, remained clinically stable on spontaneous breathing, and maintained an SpO₂ above 95%. No wound infection, pressure injury, or other major postoperative complication was documented during hospitalization. Follow-up at 1, 3, 6, and 7 months after discharge showed continued somatic growth and stable airway status; however, recovery of oral feeding was slower, and nasogastric tube feeding remained necessary for an extended period. This case suggests that perioperative care after MDO in severe PRS should address the difficult airway, distraction-device management, nutritional support, and functional rehabilitation in parallel. Improvement in airway anatomy and recovery of oral feeding may follow different time courses; therefore, airway recovery should not be used as the sole predictor of oral-feeding recovery. In infants with complex airway and feeding problems, multidisciplinary collaboration can provide a practical framework for integrating specialist assessment and longitudinal care.