Micrognathia

Abstract

A search of the literature on micrognathia reveals few suggestions for correction of this deformity other than appliances that have the disadvantages of being cumbersome, difficult of retention, insanitary and requiring a closed mouth.1 As dyspnea is an ever present symptom, any apparatus that causes pressure and decrease in size of the airways seems illogical. Considerable study has evolved the form of treatment suggested in the case report that follows. Early recognition and treatment over a long period of time (two years as a minimum) are imperative. REPORT OF CASEA boy, aged 3 weeks, was brought to the Stanford Children's Clinic for closure of a cleft palate, form 6, Brophy classification.1d On examination, the child was found to be normal in all respects except for the cleft involving the soft tissues of the palate and a marked distal relation of the mandible. The history was irrelevant, neither parent nor ancestors having had either type of deformity. The parents were well developed, normal, middle class people. The prenatal history gave no clue as to any interference in normal devel¬ opment ; the child was born at term. Oral examination showed the tongue placed far distal to normal, and apparently much smaller than usual. Difficulty in swal¬ lowing and some slight postural dyspnea were noted, but the presence of the cleft was no doubt responsible for the alleviation of the marked dyspnea so often present in these cases.Figures 1 and 2 reveal the characteristic birdlike type of profile, and figure 3 permits a study of the relationship of the soft structures to the bony development beneath. As will be noted, the mandible was the typical form of brachygnathia, with the incisor region meeting the maxillae very near the tuberosities. The chin,

The First Arch Syndrome

“…Apart from their occurrence in the Treacher Collins syndrome, these features may be present alone, comprising the Pierre Robin syndrome. As described by Lenstrup (1925), Ely and Farber (1930), Davis and Dunn (1933), Robin (1934) and Lapage (1937), the condition shows a remarkable tendency to spontaneous improvement; this, and the fact that the symphysis menti is nearly vertical and the angle of the mandible nearly a right angle (Walker, 1956), have diverted attention from the purely teratogenic theory of origin to that expressed by Llewellyn and Biggs (1943), viz., that the micrognathia is purely a mechanical effect produced by the pressure of the chin against the sternum in the vertex position of the foetus; these authors went even further: they claimed that the frequent complication of cleft palate may be the result of the tongue being pushed back into the mouth and preventing the fusion of the palatal processes. Mandibular Dysostosis.…”

Micrognathia in Newborns

“…He noted that respiratory obstruction was frequently present in infants with a receding jaw and that this was attributable to glossoptosis. The syndrome has been subsequently described by many writers: Lenstrup,4 Eley and Färber,5 Davis and Dunn, 6 Longmire and Sanford,7 Faillo,8 Sjolin,0 Pruzansky and Richmond.10 There is an obstructed sound to the baby's breathing. There may be history of choking and cyanotic attack.…”

A Qualitative Study on Family Meals in Western Samoa with Special Reference to Child Nutrition

“…The attractive, healthy children thus tended to be better fed than the listless ones. It is not intended to suggest that Samoan children are different from American children (Davis, 1933), and would not choose an adequate diet if they had the chance.…”