Mandibular Distraction Osteogenesis in Robin Sequence Using Three-Dimensional Analysis and Planning

Abstract

Summary: The optimal management of patients with Robin sequence may include neonatal mandibular distraction osteogenesis, which has been used to achieve excellent functional and aesthetic outcomes in appropriate patients. This article and video vignette depict the treatment of micrognathia and airway obstruction secondary to Robin sequence, demonstrating the planning and surgical approach of the senior author (D.M.S.) using mandibular distraction osteogenesis.

Tracheostomy, the Not So Definitive Airway?: Tracheostomy Morbidity in Pediatric Craniofacial Patients

“…In a comprehensive literature review of 1209 patients, the tracheostomy avoidance rate was 94%, whereas the complication and mortality rates were a mere 28.9% and 0.99%, respectively 27 . In neonates, the complications of MDO may include bleeding, dental abnormalities, and injuries to the inferior alveolar or marginal mandibular nerves, which can be minimized with adequate surgical planning 29 …”

“…27 In neonates, the complications of MDO may include bleeding, dental abnormalities, and injuries to the inferior alveolar or marginal mandibular nerves, which can be minimized with adequate surgical planning. 29 The question remains, how does this apply to craniofacial patients with concomitant structural anomalies that may complicate their management? Craniofacial patients typically require planning for additional procedures to address their facial abnormalities.…”

Dental outcomes after neonatal mandibular distraction

“…Piezosurgery is recommended for performing a safer osteotomy [9 ▪ ,18 ▪▪ ,24]. A piezoelectric saw is a powerful ultrasonic device with tissue-selective cutting characteristics only active on mineralized tissue, reducing the risk to soft tissues such as the developing tooth buds and inferior alveolar nerve [31].…”

“…Initially introduced by McCarthy et al [8] in 1992, MDO gradually lengthens the mandible and pulls the tongue base forward thereby alleviating the airway obstruction. The goals of MDO include correcting the airway obstruction caused by the tongue base, improving oral intake and avoidance of a tracheostomy [9 ▪ ]. The surgical technique for MDO involves bilateral mandibular osteotomies, application of distraction hardware to both sides of each osteotomy and gradual distraction of the bone segments away from each other resulting in lengthening of the bone [10 ▪ ].…”

“…The surgical technique for MDO involves bilateral mandibular osteotomies, application of distraction hardware to both sides of each osteotomy and gradual distraction of the bone segments away from each other resulting in lengthening of the bone [10 ▪ ]. Detailed description of the procedure has been well described [9 ▪ ,11]. With superior respiratory and feeding outcomes, it has become the surgical treatment of choice for many centres [1 ▪▪ ].…”