Biomechanical and morphological analysis of Pierre Robin sequence mandible: Finite element and morphometric study

Humphries, Laura S.; Reid, Russell R.; Ross, Callum F.; Taylor, Andrea B.; Collins, John M.; Freire, Alexandre Rodrigues; Rossi, Ana Cláudia; Prado, Felippe Bevilacqua

doi:10.1002/ar.24543

Cited by 2 publications

(2 citation statements)

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“…Mandibular distraction osteogenesis effects the facial skeletal structure as well as the soft tissue profile. 13,14 Skeletal changes can be predicted based on the length of distraction and the vector of the specific distractor device used. However, modeling soft tissue changes is more challenging by virtue of multiple attachments points and resulting vector forces.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Cleft Palate on Tongue-Based Upper Airway Obstruction in Pierre Robin Sequence: Implications for Mandibular Distraction Osteogenesis and Timing of Cleft Palate Repair

Prescher

Froimson

Haravu

et al. 2021

Journal of Craniofacial Surgery

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Introduction:The objectives of this study are to analyze the impact of cleft palate (CP) on upper airway obstruction using polysomnography in patients with Pierre Robin Sequence (PRS) undergoing mandibular distraction osteogenesis (MDO) and subsequent CP repair. Methods: A single-surgeon, retrospective chart review was performed of all patients with nonsyndromic PRS treated with MDO. Severity of upper airway obstruction was evaluated preand post-distraction via polysomnography. Details of MDO and CP repair were collected and any complications recorded.Results: Twenty-one nonsyndromic PRS patients with CP and 6 patients without CP met inclusion criteria. There was no significant difference in predistraction apnea-hypopnea index between the 2 groups (53.4 AE 42.1 versus 34.4 AE 18.9; P ¼ 0.3). Patients with CP had significantly higher predistraction SpO 2 saturation (94.5 AE 1.6% versus 91.0% AE 4.8%; P ¼ 0.01), SpO 2 nadir (74.5% AE 9.1% versus 63.6% AE 11.6%; P ¼ 0.03) and lower percentage time spent below 90% SpO 2 (6.0% AE 7.2% versus 23.6% AE 29.9%; P ¼ 0.04). The rate of oronasal fistulas formation was 38%. The time between MDO and CP repair was shorter for patients with complications (250.8 AE 3.3 versus 370.8 AE 191.9 days; P ¼ 0.08). Five patients experienced relapse of respiratory difficulties after CP repair. Conclusions: The presence of CP in nonsyndromic PRS patients decreases the severity of obstructive sleep apnea by oxygen parameters on PSG. Palatal fistulas and relapse of respiratory distress are common complications of CP repair following MDO. Delaying CP repair may help to decrease complication rates.

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Section: Discussionmentioning

confidence: 99%

“…Mandibular distraction osteogenesis effects the facial skeletal structure as well as the soft tissue profile 13,14 . Skeletal changes can be predicted based on the length of distraction and the vector of the specific distractor device used.…”

Section: Discussionmentioning

confidence: 99%

Impact of Cleft Palate on Tongue-Based Upper Airway Obstruction in Pierre Robin Sequence: Implications for Mandibular Distraction Osteogenesis and Timing of Cleft Palate Repair

Prescher

Froimson

Haravu

et al. 2021

Journal of Craniofacial Surgery

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Mandibular Distraction in Robin Sequence – A Systematic Review of Morphologic Changes and Implications for Long-Term Growth

Prescher,

Nathan,

Ghosh

et al. 2024

FACE

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Robin Sequence (RS) is a collection of distinct morphologic features involving the face and upper airway that results from the abnormal development of the neonatal mandible. Typically described as the triad of micrognathia, glossoptosis, and upper airway obstruction, it is frequently associated with a cleft palate and can be found in isolation or as part of a syndromic presentation. Owing to the intimate relationship between the mandible and its soft tissue attachments, micrognathia manifests clinically with respiratory and feeding difficulties. There is significant heterogeneity in both the degree of anatomic aberration and the associated physiological compromise, which dictates the medical and surgical treatment plan. In severe cases requiring surgical intervention, mandibular distraction osteogenesis (MDO) has been shown to be successful in relieving airway obstruction by correcting the morphologic deficiency of the mandible. However, controversy persists regarding the best treatment method as the exact relationship between the anatomic changes affected by MDO and the physiologic improvement remains poorly understood. This controversy is fueled by differing opinions about the natural growth potential of the abnormal mandible in patients with RS and the lack of long-term data on the maxillomandibular relationship at skeletal maturity of patients who underwent MDO in infancy. The objective of this systematic review is to provide a comprehensive summary of the morphologic changes to the mandible, upper airway, and hyoid bone affected by MDO and the impact of these changes on physiologic improvement and long-term growth.

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Biomechanical and morphological analysis of Pierre Robin sequence mandible: Finite element and morphometric study

Cited by 2 publications

References 31 publications

Impact of Cleft Palate on Tongue-Based Upper Airway Obstruction in Pierre Robin Sequence: Implications for Mandibular Distraction Osteogenesis and Timing of Cleft Palate Repair

Impact of Cleft Palate on Tongue-Based Upper Airway Obstruction in Pierre Robin Sequence: Implications for Mandibular Distraction Osteogenesis and Timing of Cleft Palate Repair

Mandibular Distraction in Robin Sequence – A Systematic Review of Morphologic Changes and Implications for Long-Term Growth

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