Does Mandibular Distraction Vector Influence Airway Volumes and Outcome?

Zellner, Elizabeth; Mhlaba, Julie M.; Reid, Russell R.; Steinbacher, Derek M.

doi:10.1016/j.joms.2016.07.034

Cited by 36 publications

(26 citation statements)

References 24 publications

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“…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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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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“…The concept of OPS was adapted from “posterior airway space,” a cephalometric measurement that correlates with obstructive sleep apnea in adults . The oropharyngeal airway has also been shown to be abnormally narrow on cephalometric and CT studies of children with RS . OPS correlated with the presence of RS and may continue to play a role in prenatal diagnosis, but did not stand alone as an independent predictor variable.…”

Section: Discussionmentioning

confidence: 99%

An algorithm for predicting Robin sequence from fetal MRI

et al. 2018

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“…Pierre Robin sequence (PRS) is a condition characterized by the triad of micrognathia, glossoptosis, and upper airway obstruction (UAO) that may also occur with a cleft palate. The associated UAO and collapse may result in potentially life-threatening breathing and feeding difficulties (Zellner et al, 2017). Treatment of PRS includes both nonsurgical and surgical management, depending on the severity of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Airway Morphological Changes in Pierre Robin Sequence: A Retrospective Study

Humphries

Roy

Huang

et al. 2020

The Cleft Palate-Craniofacial Journal

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Objective: To investigate airway morphology changes in patients with Pierre Robin sequence (PRS) pre–/post–mandibular distraction osteogenesis (MDO) and to compare morphologic changes to age-matched controls. Design: Retrospective case–control study. Setting: Urban, academic, tertiary medical center. Patients, Participants: Fifteen patients with PRS after MDO to relieve upper airway obstruction (UAO) (2008-2018); age-matched controls for post-MDO patients. Interventions: Mandibular distraction osteogenesis, curvilinear internal mandibular distractors. Main Outcome Measures: (1) Physiologic improvement after MDO (apnea–hypopnea index; minimum oxygen saturation); (2) airway size (volume, surface area, length, mean/minimum cross-sectional area), shape (lateral:anterior–posterior ratio, cross-sectional area ratios, uniformity, sphericity), and changes with MDO; and (3) post-MDO airway size, shape versus age-matched controls. Results: Airway size increased after MDO (volume, P = .01; surface area, P = .02; length, P = .01), as did cross-sectional area (mean, P = .02; minimum, P = .02; minimum retropalatal, P = .05, mid-retroglossal, P = .02). Post-MDO PRS airways were larger than controls (volume, P < .01; surface area, P < .01; length, P < .01, cross-sectional area, P = .03). Airway shape remained nonuniform and flat post-MDO; control airways were round. Two syndromic patients required repeat MDO and had subphysiologic post-MDO airway cross-sectional area. Post-MDO PRS patients with supraphysiologic cross-sectional area along the entire airway had no UAO recurrence. Conclusions: In this small, heterogenous patient sample, MDO increases airway size, may preferentially affect the retropalatal airway, and often results in supraphysiologic airway dimensions. These retropalatal changes may be important in relieving severe UAO in patients with PRS. Generalizability of our results is limited by small cohort size and patient heterogeneity.

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Does Mandibular Distraction Vector Influence Airway Volumes and Outcome?

Cited by 36 publications

References 24 publications

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

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

An algorithm for predicting Robin sequence from fetal MRI

Airway Morphological Changes in Pierre Robin Sequence: A Retrospective Study

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