Defining failure and its predictors in mandibular distraction for Robin sequence

Flores, Roberto L.; Greathouse, S. Travis; Costa, Melinda A.; Tahiri, Youssef; Soleimani, Tahereh; Tholpady, Sunil S.

doi:10.1016/j.jcms.2015.06.039

Cited by 43 publications

(31 citation statements)

References 31 publications

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“…Given the mortality risk associated with tracheostomy, 15 and its comparatively poor feeding and airway outcomes in our study, we recommend considering MDO as the first-line therapy for those with severe TBAO due to PRS. Failure of MDO to avoid tracheostomy can be predicted with excellent specificity using the combined high-risk factors identified in this study (syndromic status, neurologic impairment, and low birth weight) or those reported by Flores et al 8 …”

Section: Discussionsupporting

confidence: 53%

Management of Airway Obstruction in Infants With Pierre Robin Sequence

Runyan

Uribe-Rivera

Tork

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Section: Discussionsupporting

confidence: 53%

Management of Airway Obstruction in Infants With Pierre Robin Sequence

Runyan

Uribe-Rivera

Tork

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…Syndromic diagnosis is similarly associated with an increased risk of failure of TLA, in addition to gastroesophageal reflux disease, preoperative intubation, late surgical intervention, and low birth weight (GILLS acronym) 36 . Gastroesophageal reflux and age >30 days were also associated with failure of MDO to avoid tracheostomy 79 . Definitive conclusions regarding the choice of intervention for PRS with associated syndromes or comorbidities cannot be drawn from this review.…”

Section: Discussionmentioning

confidence: 99%

“…In several instances, patients who failed initial intervention, ultimately requiring tracheostomy, were found to have concomitant airway anomalies, such as laryngomalacia, tracheal webs and vascular rings 36,48,52,79–83 . Patients with central apnea or neurologic disabilities also were likely to fail either MDO or TLA 36,56,66,79,84,85 . Most studies excluded patients with these comorbidities from their analysis, although one study on subjects with layrngomalacia treated with MDO reported 100% success in avoidance of tracheostomy or decannulation 86 .…”

Section: Discussionmentioning

confidence: 99%

Surgical Management and Outcomes of Pierre Robin Sequence: A Comparison of Mandibular Distraction Osteogenesis and Tongue-Lip Adhesion

Zhang

Hoppe

Taylor

et al. 2018

Plastic &Amp; Reconstructive Surgery

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There is a paucity of literature directly comparing tongue-lip adhesion versus mandibular distraction osteogenesis in surgical treatment of patients with Pierre Robin sequence. This study comprehensively reviews the literature for evaluating airway and feeding outcomes following mandibular distraction osteogenesis and tongue-lip adhesion. A search was performed using the MEDLINE and Embase databases for publications between 1960 and June of 2017. English-language, original studies subjects were included. Extracted data included prevention of tracheostomy (primary airway outcome) and ability to feed exclusively by mouth (primary feeding outcome). A total of 67 studies were included. Ninety-five percent of subjects (657 of 693) treated with mandibular distraction osteogenesis avoided tracheostomy, compared to 89% of subjects (289 of 323) treated with tongue-lip adhesion. Eighty-seven percent of subjects (323 of 370) treated with mandibular distraction osteogenesis achieved full oral feeds at latest follow-up. Seventy percent of subjects (110 of 157) treated with tongue-lip adhesion achieved full oral feeds at latest follow-up. The incidence of second intervention for recurrent obstruction ranged from 4 to 6 percent in mandibular distraction osteogenesis studies, compared to a range of 22 to 45 percent in tongue-lip adhesion studies. Variability of patient selection, surgical techniques, outcomes measurement methods, and follow-up length across studies precluded meta-analysis of the data. Both mandibular distraction osteogenesis and tongue-lip adhesion are effective alternatives to tracheostomy for patients who fail conservative management and improve feeding. Mandibular distraction osteogenesis may be superior to tongue-lip adhesion in long-term resolution of airway obstruction and avoidance of gastrostomy, but is associated with notable complications.

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“…In the first model, the dependent variable was the need for tracheostomy only, whereas in the second model, the dependent variable was the need for tracheostomy and death combined. The preoperative variables that could possibly affect the surgical outcome were chosen in a manner similar to that described by Flores et al 35 (Table 1). Given the relatively small sample size owing to the low incidence of this condition and large number of predictive variables, a forward-selection model was chosen for binary logistic regression to automatically remove the independent variables not having a statistically significant effect on the outcome.…”

Section: Discussionmentioning

confidence: 99%

“…A few authors have attempted to elucidate these predictors; however, the results are highly variable. Flores et al 35 suggested that CNS anomalies, GERD, need for Nissen fundoplication, and other airway anomalies except laryngomalacia; intact palate; age older than 30 days at MDO; and preoperative intubation all correlated with failure of MDO with respect to the need for tracheostomy. Only CNS anomalies, need for Nissen fundoplication, age older than 30 days at MDO, and preoperative intubation correlated with the total failure rate, characterized by the need for tracheostomy, high postoperative AHI, and/or death.…”

Section: Discussionmentioning

confidence: 99%