Mandibular Distraction in Dual Syndromic Diagnosis

Mandibular distraction has variable outcomes in Treacher-Collins syndrome. Dual syndromic diagnosis is a rare occurrence that complicates management. Here, the authors present a patient with Treacher-Collins syndrome and severe retrognathia requiring tracheostomy who failed repeat mandibular distraction and decannulation. A genetic workup later revealed Angelman syndrome with severe developmental delay. We discuss explanations for difficulties encountered during mandibular distraction as well as surgical options for patients with Treacher-Collins who fail multiple attempts at decannulation. Overall, patients with dual diagnoses can exhibit an underlying problem in bone formation and mineralization, which challenges any attempt at craniofacial manipulation.