Evaluation of Micrognathia With Emphasis on Late Development of the Mandible

Bromberg, Bertram E.; Pasternak, R; Walden, Richard H.; Rubin, Leonard R.

doi:10.1097/00006534-196111000-00002

Cited by 16 publications

(9 citation statements)

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“…57,58 Although controversial, mandibular catch-up growth likely correlates with the etiology of the sequence or underlying syndrome. 14,59 Studies of the craniofacial skeleton of subjects with RS have uncovered more than mandibular involvement. 60 Maxillary hypoplasia has also been well described in children with RS, which supports a role for primary and persistent dysgenesis of both jaws.…”

Section: Morphometry Of Mandibular Growthmentioning

confidence: 99%

Robin Sequence: From Diagnosis to Development of an Effective Management Plan

et al. 2011

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The triad of micrognathia, glossoptosis, and resultant airway obstruction is known as Robin sequence (RS). Although RS is a well-recognized clinical entity, there is wide variability in the diagnosis and care of children born with RS. Systematic evaluations of treatments and clinical outcomes for children with RS are lacking despite the advances in clinical care over the past 20 years. We explore the pathogenesis, developmental and genetic models, morphology, and syndromes and malformations associated with RS. Current classification systems for RS do not account for the heterogeneity among infants with RS, and they do not allow for prediction of the optimal management course for an individual child. Although upper airway obstruction for some infants with RS can be treated adequately with positioning, other children may require a tracheostomy. Care must be customized for each patient with RS, and health care providers must understand the anatomy and mechanism of airway obstruction to develop an individualized treatment plan to improve breathing and achieve optimal growth and development. In this article we provide a comprehensive overview of evaluation strategies and therapeutic options for children born with RS. We also propose a conceptual treatment protocol to guide the provider who is caring for a child with RS. Pediatrics 2011;127:936-948

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Section: Morphometry Of Mandibular Growthmentioning

confidence: 99%

Robin Sequence: From Diagnosis to Development of an Effective Management Plan

et al. 2011

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“…2,3 Although the majority of children born with micrognathia are either asymptomatic or can be treated conservatively (eg, prone positioning and nasopharyngeal airways ), 4,5 up to 23% of children with PRS may have major respiratory obstruction, necessitating more aggressive intervention. 5 Some, but not all, patients may outgrow their micrognathia.…”

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confidence: 99%

“…thia and glossoptosis are most commonly seen in patients with Pierre Robin sequence (PRS), 1,2 but may also be associated with disorders such as Treacher Collins syndrome, Nager syndrome, and hemifacial microsomia. 2,3 Although the majority of children born with micrognathia are either asymptomatic or can be treated conservatively (eg, prone positioning and nasopharyngeal airways ), 4,5 up to 23% of children with PRS may have major respiratory obstruction, necessitating more aggressive intervention. 5 Some, but not all, patients may outgrow their micrognathia.…”

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confidence: 99%

“…5 Some, but not all, patients may outgrow their micrognathia. 3,4 Tracheotomy is traditionally the safest and most effective treatment option in patients with PRS and severe upper airway obstruction and is performed in as many as 12% of cases. 1 Tracheotomy, however, is associated with high cost, frequent morbidity, and occasional mortality, 2 with an average age of 3.1 years at decannulation.…”

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confidence: 99%

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Mandibular Distraction for Micrognathia and Severe Upper Airway Obstruction

Mandell¹,

Yellon²,

Bradley³

et al. 2004

Arch Otolaryngol Head Neck Surg

121

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To determine whether the use of mandibular distraction osteogenesis (DOG) can help to avoid tracheotomy or achieve decannulation in patients with mandibular hypoplasia and severe upper airway obstruction.Design: Retrospective medical record review (spanning a 27-month period).Setting: Tertiary care children's hospital. Subjects: Group A (n=8) was composed of infants with Pierre Robin sequence and no tracheotomy (mean age, 2.5 months); group B (n = 6), older nontracheotomized micrognathic children with obstructive sleep apnea (OSA) (mean age, 69 months); and group C (n = 12), tracheotomized children with complex congenital syndromes (mean age, 33 months).Intervention: Bilateral mandibular DOG with endoscopic (n = 24) and/or radiographic (n = 17) airway evaluation (mean follow-up, 16 months [range, 2-42 months]).Outcome Measures: Group A, tracheotomy avoidance; group B, resolution of OSA (clinically or on polysomnography); and group C, decannulation.Results: Group A, 7 patients (88%) successfully avoided tracheotomy; group B, 5 patients (83%) had resolution of OSA; and group C, 2 patients (17%) underwent decannulation.Conclusions: Mandibular DOG (1) allows tracheotomy avoidance in infants with isolated Pierre Robin sequence and (2) relieves OSA in older micrognathic children without tracheotomy. However, mandibular DOG does not frequently lead to decannulation in tracheotomized patients with complex congenital syndromes.

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“…Excellent studies from respected authors and institutions have shown that growth to normal dimensions is rare in the Pierre Robin population. [5][6][7][8] Tongue-lip adhesion must be recognized for the temporizing effect it produces and contrasted to mandibular distraction osteogenesis, which can produce lasting skeletal correction and, as a result, resolution of airway obstruction. Few would argue that mandibular distraction osteogenesis is the more challenging technique to use, but in my experience, it is much to the benefit of the patient.…”

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confidence: 99%

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Denny¹

2014

Plastic &Amp; Reconstructive Surgery

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Evaluation of Micrognathia With Emphasis on Late Development of the Mandible

Cited by 16 publications

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Robin Sequence: From Diagnosis to Development of an Effective Management Plan

Robin Sequence: From Diagnosis to Development of an Effective Management Plan

Mandibular Distraction for Micrognathia and Severe Upper Airway Obstruction

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