Mandibular Distraction Osteogenesis in Low-Weight Neonates with Robin Sequence

Tahiri, Youssef; Greathouse, S. Travis; Tholpady, Sunil S.; Havlik, Robert J.; Sood, Rajiv; Flores, Roberto L.

doi:10.1097/prs.0000000000001710

Cited by 29 publications

(39 citation statements)

References 30 publications

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“…There were no increased risks of transfusion, tracheostomy, or mechanical ventilation. Only 1 previous study indirectly compared MDO outcomes by surgical age (Tahiri et al, 2015). Those authors found that low distraction weight (<4 kg) did not decrease clinical success or increase complications (Tahiri et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Only 1 previous study indirectly compared MDO outcomes by surgical age (Tahiri et al, 2015). Those authors found that low distraction weight (<4 kg) did not decrease clinical success or increase complications (Tahiri et al, 2015). In that study, the mean age of low-weight patients was 23 days, whereas the mean age of controls was 2.7 years.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies showed that deviating from these values exponentially increased postoperative complication rates (Wilhelmsen et al, 1966). These criteria were initially developed for cleft lip repair; however, they have since been applied more broadly to other elective procedures (Scott et al, 2011; Tahiri et al, 2015). Because symptoms from RS frequently present at birth, the timing of MDO is often a difficult decision that is made following an appraisal of the relative risks and benefits.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications

Lee

Eisig

Chuang

et al. 2019

The Cleft Palate-Craniofacial Journal

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Objective: The purpose of this study was to determine whether performing mandibular distraction osteogenesis (MDO) during the neonatal period increased inpatient complications as measured through health-care burden. Materials and Methods: This was a retrospective cohort study of the Kids’ Inpatient Database from 2000 to 2011. Infants receiving MDO prior to 12 months of age were included. The primary study predictor was distraction age, classified as either neonatal or non-neonatal. Secondary predictors were patient demographics, hospitalization characteristics, diagnoses, and procedures. The outcomes were the number of procedures performed, postoperative length of stay (pLOS), hospital charges, and the discharge transfer rate. Outcomes were compared between the primary predictors using χ2 and independent 2-sample t tests. Multiple linear and logistic regression models were created using clinically relevant predictors to assess the independent effect of neonatal age on each outcome. Results: The study sample contained 102 patients, of who 50 (49.0%) were distracted in the neonatal period. Neonatal MDO patients were more likely to have a cleft palate (86.0% vs 55.8%; P < .001) and present with feeding difficulties (38.0% vs 19.2%; P = .036) that were treated through total parenteral nutrition (26.0% vs 9.6%; P = .030) but otherwise did not have significantly different characteristics compared to non-neonatal patients. The multiple regression models confirmed that neonatal age did not influence any of the study outcomes, although other secondary predictors were found to influence the pLOS, hospital charges, and number of inpatient procedures. Conclusions: Neonatal MDO was not associated with increased complications. At experienced centers, neonatal status should not be considered a contraindication to treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications

Lee

Eisig

Chuang

et al. 2019

The Cleft Palate-Craniofacial Journal

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“…Eighty-nine percent (289/323) of subjects treated with TLA avoided tracheostomy. In a large MDO cohort study (34% syndromic), tracheostomy was avoided in 93% (76/81) of subjects after 22 months of follow up 106 . Tracheostomy was avoided in 89% of a large TLA cohort study (45% syndromic) 36 .…”

Section: Airway Outcomesmentioning

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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“…Previous studies have advocated for advancing the mandible to the limit of the distractor or until a class III occlusion, or anatomical overcorrection, has been achieved. 10,11,6,24 At our institution, we have found success with titrating distraction based on comprehensive 16-channel bedside PSG studies obtained immediately after initial distraction to stratify patients with persistent OSA. We feel that such a titration measure is also critical to avoid unnecessary and potentially disfiguring “overcorrections,” which is no small matter considering a majority of these patients have associated cleft palate and poor midfacial growth potential.…”

Section: Discussionmentioning

confidence: 99%

Polysomnography in the Early Consolidation Phase of Mandibular Distraction as a Tool to Identify Residual Tongue-Based Airway Obstruction and Need for Further Distraction: A Follow-Up Study

Prescher

Mokhlesi

Mhlaba

et al. 2021

FACE

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Background: The objective of this study was to analyze and report our experience with using polysomnography (PSG) during the early consolidation phase of mandibular distraction osteogenesis (MDO) in patients with Pierre Robin Sequence and associated tongue-based airway obstruction with management decisions informed by the results. The secondary objective was to determine whether pre-operative PSG can predict which patients will have persistent obstructive sleep apnea (OSA) and require additional distraction. Methods: A single-surgeon, retrospective review was performed of all patients who underwent MDO for treatment of tongue-based airway obstruction over an 11-year period. Pre-operative and post-distraction 16-channel overnight bedside PSG was performed on all patients and scored according to the AASM Scoring Manual. Patients who demonstrated persistent OSA underwent further distraction and were reevaluated by PSG after final distraction length was achieved. Results: Pre-operative and post-distraction PSG was obtained and available for analysis in 37 patients. Apnea-Hypopnea Index (AHI) improved from 45.85 ± 34.41 to 9.73 ± 10.85 ( P < .001). There was evidence for persistent, severe OSA in 14 patients (38%) and persistent, moderate OSA in 6 patients (16%) in the early consolidation phase of MDO. Nine of these patients underwent additional distraction and demonstrated symptomatic resolution and quantitative improvement in all PSG measures. The group of patients that underwent additional distraction had significantly more severe baseline OSA as defined by preoperative AHI, oxygen desaturation index (ODI), and percentage of time spent below 90% SpO2. There was no significant difference in patient characteristics or pre-operative symptoms between the 2 groups. Conclusions: PSG can be performed at the bedside at the end of the distraction phase of MDO to assess for residual airway obstruction and inform the need for further distraction. Pre-operative PSG measures can help predict the need for further distraction and aid in operative planning and distractor placement.

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Mandibular Distraction Osteogenesis in Low-Weight Neonates with Robin Sequence

Abstract: Background: The aim of this study is to evaluate the efficacy, safety profile and the

Cited by 29 publications

References 30 publications

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications

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

Polysomnography in the Early Consolidation Phase of Mandibular Distraction as a Tool to Identify Residual Tongue-Based Airway Obstruction and Need for Further Distraction: A Follow-Up Study

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