Mandibular Distraction Osteogenesis for Upper Airway Obstruction in Infants and Neonates: Airway Outcomes, Hospitalization Burden and Procedure Application in the Polish Population

Objectives: This study retrospectively evaluated the respiratory outcomes and hospitalization burden of infants and neonates diagnosed with upper airway obstruction who underwent bilateral mandibular distraction osteogenesis in the Polish population. Methods: The study analyzed 40 patients aged 0–12 months who underwent bilateral MDO for respiratory insufficiency associated with mandibular hypoplasia between 2013 and 2025. Successful airway management was defined as tracheostomy avoidance, without the need for further respiratory support in non-tracheostomized patients, or successful decannulation, with no requirement for additional respiratory support in patients with pre-existing tracheostomy. Duration of hospitalization and intensive care unit stay were also evaluated. Results: Twenty three patients had iPRS and 17 had sPRS. An overall successful airway outcome was achieved in 30/40 patients (75.0%), with a significantly higher success rate in iPRS than sPRS (95.7% vs. 47.1%, p < 0.001). MDO prevented tracheostomy in 28/30 (93.3%) patients, including all 20 patients with iPRS. In contrast, only 2/10 (20.0%) previously tracheostomized patients were successfully decannulated, both with iPRS. Patients with successful airway outcomes were younger at MDO (median 54 vs. 138 days, p = 0.015). The multivariable analysis indicated sPRS as an independent predictor of respiratory failure after adjustment for age. Conclusions: Bilateral MDO provided effective airway management, particularly in patients with iPRS, and was highly effective in avoiding a new tracheostomy. Syndromic diagnosis and pre-existing tracheostomy characterized patients with substantially less favorable airway outcomes, highlighting clinically important differences within this heterogeneous population.