The Surgical Treatment of Robin Sequence

Greathouse, S. Travis; Costa, Melinda A.; Ferrera, Alessandra G.; Tahiri, Youssef; Tholpady, Sunil S.; Havlik, Robert J.; Flores, Roberto L.

doi:10.1097/sap.0000000000000630

Cited by 33 publications

(14 citation statements)

References 36 publications

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“…To that end, some surgeons have advocated for simultaneous coronoidectomy and MDO. 17 The Kaplan-Meier survival analysis is a novel approach to study this patient population. While other studies have performed similar analyses using Fisher's exact or Chisquared tests, few have assessed the temporality of MDO failure.…”

Section: Face 1(1)mentioning

confidence: 99%

Alternative Factors Associated With Failure of Mandibular Distraction Osteogenesis

Ramirez-Garcia

Humphries

Reid

2020

FACE

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Introduction: Mandibular Distraction Osteogenesis (MDO) is an alternative to tracheostomy and works via lengthening the mandible in order to reduce glossoptosis and airway obstruction. While many patients who undergo mandibular distraction avoid the use of a tracheostomy, some patients will require re-distraction or tracheostomy, often due to recurrence of sleep apnea. This paper explores the potential factors that are associated with MDO failure, defined as requiring re-distraction or tracheostomy over other patients who succeed with the initial procedure. Methods: A retrospective review of all patients who had an obstructed airway, 0 to 18 years of age, and underwent MDO at a single institution from 2008 to 2019 was performed. Fisher’s exact analysis, log-rank analysis, and Kaplan-Meier estimates were used to identify associated factors to failure post-MDO. Results: Forty-five patients satisfied the inclusion criteria, of which 11 patients required re-distraction or tracheostomy post-MDO. Of the parameters assessed, postoperative complications and age >1 month were associated with increased odds of failure ( P < .05). Syndromic status trended toward significance as an associated factor ( P < .1). Tonsillectomy & adenoidectomy before initial MDO was associated with postoperative complications ( P < .05). Conclusion: Our retrospective analysis not only corroborates the results of others in regards to the natural association of postoperative complications and syndromic status with MDO failure, but also suggest that prior tonsillectomy & adenoidectomy, and age at surgery in our series may play a role as well.

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Section: Face 1(1)mentioning

confidence: 99%

Alternative Factors Associated With Failure of Mandibular Distraction Osteogenesis

Ramirez-Garcia

Humphries

Reid

2020

FACE

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“…The estimated prevalence of PRS ranges between 1 in 8000 to 1 in 14000 live births (Robin, 1994; Printzlau & Andersen 2004; Maas & Poets, 2014). The sequelae of untreated airway obstruction and feeding difficulty can result in severe complications; however, the optimal workup and management strategy is not universally accepted (Hoffman et al, 1965; Parsons & Smith, 1982; Greathouse et al, 2016). Treatment targets the obstructive tongue base and depends on disease severity.…”

Section: Introductionmentioning

confidence: 99%

Impact of Hospital Characteristics on Mandibular Distraction Osteogenesis Outcomes Among Patients With Pierre Robin Sequence Utilizing a National Inpatient Database

Marston

Patel

Pecha

et al. 2021

The Cleft Palate-Craniofacial Journal

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Objectives: This study collected national inpatient data to investigate the impact of hospital specialty and size on patient outcomes following mandibular distraction osteogenesis (MDO). Design: Kids’ Inpatient Database was used to identify patients less than 12 months of age with Pierre Robin sequence (PRS) who underwent MDO in one of the following years: 2006, 2009, and 2012. Setting: Inpatient database from the United States. Participants: Two hundred seventy-six patients with PRS underwent MDO with 134 (48.6%) identified as nonsyndromic and 142 (51.4%) as syndromic. Interventions: Mandibular distraction osteogenesis. Main Outcome Measures: Length of hospital stay, adjunct airway and nutritional interventions and disposition. Results: The average length of stay was 24 and 30 days for patients with nonsyndromic and syndromic PRS, respectively ( P = .066). Patients with a syndromic as compared to nonsyndromic diagnosis had a higher incidence of gastrostomy tube placement (21.8 vs 12.7%, P = .045). Univariate analysis showed that a lower proportion of patients at children’s hospitals as compared to non-children’s hospitals necessitated 1 or more airway or nutrition-related intervention (19/148 [12.8%] vs 31/127 [24.4%]; P = .012) and had a lower incidence of a nonroutine discharge (transfer or patient death; 7.4% vs 40.0% nonroutine; P < .001). Multivariable analysis additionally revealed that patients at children’s hospitals were less likely to discharge nonroutine (OR = 0.07, 95% CI: 0.02-0.32). Conclusions: Results from this national cohort demonstrated that at children-specific hospitals patients with PRS were less likely to require additional airway and nutritional procedures and more likely to discharge to home.

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“…A proper mandibular development is key for clearance at the base of the tongue in order to prevent subsequent URTOs. [3][4][5] Distraction osteogenesis is a de novo biological bone formation process where traction pressure is applied.…”

Section: Introductionmentioning

confidence: 99%

Pierre Robin Sequence: airway management via mandibular distraction. Case report

et al. 2019

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La secuencia de Pierre Robin es una afección congénita caracterizada por la presencia de micrognatia, glosoptosis, paladar hendido y obstrucción de la vía aérea, siendo ésta una de las principales características de la cual derivan varias complicaciones, entre ellas, dificultad respiratoria, apnea, pérdida de peso y hasta la muerte. En la actualidad la distracción ósea mandibular es la técnica quirúrgica de elección, que tiene como finalidad el alargamiento mandibular corrigiendo la posición posterior de la lengua, con la consecuente desobstrucción de la vía aérea en pacientes con hipoplasia mandibular. Se reporta caso clínico de paciente masculino con 26 días de nacido, que presentó obstrucción de la vía aérea superior, retromicrognatismo mandibular, retracción de la lengua y hendidura palatina, relacionado con la secuencia de Pierre Robin, con antecedentes de intubación orotraqueal por dificultad respiratoria, al cual se le realizó distracción ósea mandibular con vector horizontal, destacando resultados satisfactorios en la resolución de la obstrucción de la vía aérea.Palabras Clave: Osteogénesis por distracción; micrognatismo; Síndrome de Pierre Robin; obstrucción de las vías aéreas.

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The Surgical Treatment of Robin Sequence

Abstract: In the heterogeneous population of Robin sequence, MDO demonstrates superior outcomes measures at 1 month and 1 year compared to TLA. Fewer complications occurred in the MDO group compared to the TLA.

Cited by 33 publications

References 36 publications

Alternative Factors Associated With Failure of Mandibular Distraction Osteogenesis

Alternative Factors Associated With Failure of Mandibular Distraction Osteogenesis

Impact of Hospital Characteristics on Mandibular Distraction Osteogenesis Outcomes Among Patients With Pierre Robin Sequence Utilizing a National Inpatient Database

Pierre Robin Sequence: airway management via mandibular distraction. Case report

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