The effect of mandibular distraction osteogenesis on airway obstruction and polysomnographic parameters in children with Robin sequence

Costa, Amanda Lucas da; Manica, Denise; Schweiger, Cláudia; Kuhl, Gabriel; Sekine, Leo; Fagondes, Simone Chaves; Collares, Marcus Vinícius Martins; Maróstica, Paulo José Cauduro

doi:10.1016/j.jcms.2018.05.030

Cited by 19 publications

(15 citation statements)

References 22 publications

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“…While several other studies have reported the use of PSG pre- and post-operatively in their management of patients undergoing MDO, few have identified using the study results to affect decisions regarding distraction phase. 13,14,25 Repeat distraction rates have been reported in 6% of cases, while relapse rates are cited as high as 64%. 7,26-28 However, some argue that relapse is an inevitable consequence of operating on the skeletally immature patient who may continue to have asynchronous growth of the mandible and maxilla even after distraction.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…5-12 Comparison studies using post-distraction PSG have demonstrated the change in sleep architecture facilitated by this surgical intervention. 13,14…”

Section: Introductionmentioning

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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“…The inclusive criteria of this group were: (1) normal brain MRI of brain, as confirmed by two experienced pediatric radiologists. The admission history of these patients included pneumonia, trauma, brachial plexus injury, and facial hemangioma; and (2) age <3 months; (3) No definite brain developmental diseases were found during follow-up; (4) MRI images meet the diagnostic requirements (no obvious motion artifacts). The exclusion criteria include: (1) suspected or confirmed neurologic disease in labor; (2) children with known genetic abnormalities (e.g., Down syndrome) or other congenital diseases (e.g., congenital heart disease); and (3) other serious diseases that may have substantial effects on the brain; (4) MRI images cannot be diagnosed (there are obvious motion artifacts).…”

Section: Enrolled Patientsmentioning

confidence: 99%

“…The characteristics of PRs include: micrognathia, glossoptosis, and cleft palate. These defects can lead to airway obstruction and feeding difficulties (2), even life-threatening obstructive apnea and obstructive sleep apnea in neonates (3). Moreover, these structural abnormalities seriously affect the growth and development of children (4), placing a burden on their families as well as society.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning Models on ADC Features to Assess Brain Changes of Children With Pierre Robin Sequence

et al. 2021

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In order to evaluate brain changes in young children with Pierre Robin sequence (PRs) using machine learning based on apparent diffusion coefficient (ADC) features, we retrospectively enrolled a total of 60 cases (42 in the training dataset and 18 in the testing dataset) which included 30 PRs and 30 controls from the Children's Hospital Affiliated to the Nanjing Medical University from January 2017–December 2019. There were 21 and nine PRs cases in each dataset, with the remainder belonging to the control group in the same age range. A total of 105 ADC features were extracted from magnetic resonance imaging (MRI) data. Features were pruned using least absolute shrinkage and selection operator (LASSO) regression and seven ADC features were developed as the optimal signatures for training machine learning models. Support vector machine (SVM) achieved an area under the receiver operating characteristic curve (AUC) of 0.99 for the training set and 0.85 for the testing set. The AUC of the multivariable logistic regression (MLR) and the AdaBoost for the training and validation dataset were 0.98/0.84 and 0.94/0.69, respectively. Based on the ADC features, the two groups of cases (i.e., the PRs group and the control group) could be well-distinguished by the machine learning models, indicating that there is a significant difference in brain development between children with PRs and normal controls.

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“…Many infants with PRS suffer from tongue-based airway obstruction and feeding intolerance due to micrognathia and glossoptosis. In recent years, mandibular distraction osteogenesis (MDO) is increasingly used as a first-line surgical treatment of severe airway obstruction in patients with PRS (6)(7)(8). Mechanical ventilation is an important adjuvant therapy following MDO, but some patients require prolonged mechanical ventilation, because distraction was not enough and spontaneous breathing had not recovered which may increase the risk of ventilatorassociated pneumonia (VAP), prolong hospital stay, and increase mortality (9).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Prolonged Mechanical Ventilation in Infants With Pierre Robin Sequence After Mandibular Distraction Osteogenesis: A Retrospective Cohort Study

et al. 2021

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Background: After mandibular distraction osteogenesis (MDO), most infants with Pierre Robin sequence (PRS) require mechanical ventilation to assist their breathing. However, the optimal duration of intubation during early mandibular distraction osteogenesis activation is poorly understood. This retrospective study was carried out to identify perioperative risk factors of prolonged mechanical ventilation in infants undergoing MDO.Methods: A total of 95 infants with PRS underwent MDO at Guangzhou Women and Children's Medical Center between 2016 and 2018, and the clinical records of 74 infants who met the selection criteria were analyzed. Of the 74 infants, 26 (35.1%) underwent prolonged mechanical ventilation, 48 (64.9%) did not. t-test, Wilcoxon Sum Rank test or chi-squared test were performed to compare variables that might associate with prolonged mechanical ventilation between the two groups, and then, significant variables identified were included in the multivariate logistic regression model to identify independent variables.Results: Univariate logistic regression analysis revealed that age, preoperative gonial angle, and postoperative pulmonary infection were associated with prolonged mechanical ventilation (all P < 0.05). Multivariate logistic regression analysis confirmed that the preoperative gonial angle and postoperative pulmonary infection were independent risk factors of prolonged mechanical ventilation (both P < 0.05).Conclusions: Infants with PRS and smaller preoperative gonial angle or postoperative pulmonary infection may be more likely to undergo prolonged mechanical ventilation after MDO. For others, extubation may be attempted within 6 days after MDO.

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The effect of mandibular distraction osteogenesis on airway obstruction and polysomnographic parameters in children with Robin sequence

Cited by 19 publications

References 22 publications

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

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

Machine Learning Models on ADC Features to Assess Brain Changes of Children With Pierre Robin Sequence

Risk Factors of Prolonged Mechanical Ventilation in Infants With Pierre Robin Sequence After Mandibular Distraction Osteogenesis: A Retrospective Cohort Study

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