Faculty Collaboration Database

The surgical correction of Pierre Robin sequence: mandibular distraction osteogenesis versus tongue-lip adhesion. Plast Reconstr Surg 2014 Jun;133(6):1433-1439

Date

02/27/2014

Pubmed ID

24569425

DOI

10.1097/PRS.0000000000000225

Scopus ID

2-s2.0-84902284274 (requires institutional sign-in at Scopus site)   117 Citations

Abstract

BACKGROUND: The authors present an outcomes analysis of mandibular distraction osteogenesis versus tongue-lip adhesion in the surgical treatment of Pierre Robin sequence.

METHODS: A retrospective, 15-year, single-surgeon review was undertaken of all nonsyndromic neonates with Pierre Robin sequence treated with mandibular distraction osteogenesis (2004 to 2009; n = 24) or tongue-lip adhesion (1994 to 2004; n = 15). Outcomes included time of extubation, length of intensive care unit stay, incidence of tracheostomy, and surgical complications. Polysomnography data were collected 1 month and 1 year postoperatively. Sleep study data included changes in oxygen saturation and apnea-hypopnea index.

RESULTS: There were no postprocedure tracheostomies in the mandibular distraction osteogenesis group and four tracheostomies in the tongue-lip adhesion group. The preoperative oxygen saturations were significantly lower in the mandibular distraction osteogenesis group compared with tongue-lip adhesion (76.5 percent versus 82 percent; p < 0.05). Preoperative apnea-hypopnea index was significantly higher in the mandibular distraction osteogenesis group compared with the tongue-lip adhesion group (47 versus 37.6; p < 0.05). Despite these preoperative differences, patients undergoing mandibular distraction osteogenesis demonstrated significantly higher oxygen saturation levels at 1 month (98.3 percent versus 87.5 percent; p < 0.05) and 1 year postoperatively (98.5 percent versus 89.2 percent; p < 0.05) and lower apnea-hypopnea index at 1 month (10.9 versus 21.6; p < 0.05) and 1 year postoperatively (2.5 versus 22.1; p < 0.05) compared with tongue-lip adhesion. Surgical complications were comparable between the two groups.

CONCLUSIONS: In nonsyndromic patients with Pierre Robin sequence, mandibular distraction osteogenesis demonstrates superior outcome measures regarding oxygen saturation, apnea-hypopnea index, and incidence of tracheostomy compared with tongue-lip adhesion.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Author List

Flores RL, Tholpady SS, Sati S, Fairbanks G, Socas J, Choi M, Havlik RJ

Author

Robert Havlik MD Chair, Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Airway Obstruction
Endoscopy
Female
Humans
Infant
Infant, Newborn
Length of Stay
Lip
Mandible
Osteogenesis, Distraction
Pierre Robin Syndrome
Polysomnography
Retrospective Studies
Suture Techniques
Tongue
Tracheostomy
Treatment Outcome