Mandibular Distraction Osteogenesis in Patients with Pierre Robin Sequence: Preoperative Assessment Determines Success

Objectives: (1) Understand the importance of an interdisciplinary approach to the selection of patients with Pierre Robin sequence for mandibular distraction osteogenesis. (2) Recognize that unfavorable outcomes can be linked to inaccurate preoperative assessment. Methods: A retrospective review of...

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Bibliographic Details
Published in:Otolaryngology-head and neck surgery 2014-09, Vol.151 (1_suppl), p.P239-P239
Main Authors: Bodily, Nathan, Lypka, Michael, Teichgraeber, John F., Yuksel, Sancak, Oy, Soham
Format: Article
Language:English
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Summary:Objectives: (1) Understand the importance of an interdisciplinary approach to the selection of patients with Pierre Robin sequence for mandibular distraction osteogenesis. (2) Recognize that unfavorable outcomes can be linked to inaccurate preoperative assessment. Methods: A retrospective review of 10 consecutive patients with Pierre Robin sequence who underwent mandibular distraction from July 2011 to July 2013 at Children’s Memorial Hermann Hospital was performed. Age at distraction, associated syndromes and medical conditions, pre- and postoperative sleep studies, and complications were evaluated. Follow-up ranged from 6 months to 2 years. Results: A total of 10 patients with Pierre Robin sequence underwent mandibular distraction. Two had defined syndromal diagnoses and two had undefined chromosomal abnormalities. Average pre and postoperative AHI were 31.5 and 4.5, respectively. Average distraction length was 24 mm. Eight of the 10 patients who underwent distraction had successful outcomes defined by relief of obstructive apnea, reduction in AHl, and improved feeding at 2 months. Two patients had unfavorable outcomes. One did not respond to the distraction procedure and had a delayed diagnosis of spinal muscular atrophy, ultimately resulting in death. The other patient had multiple congenital anomalies and failed to respond to the distraction. The patient had significant laryngomalacia on post distraction repeat L and B, required tracheostomy, and later died of cardiac shunt failure. Conclusions: In the properly selected patient, mandibular distraction in patients with Pierre Robin sequence can be successful. Preoperative assessment involves both art and science, but ultimately determines the success or failure of the distraction procedure.
ISSN:0194-5998
1097-6817
DOI:10.1177/0194599814541629a322