Trans-facial Minimal-Dissection External Mandibular Distraction Osteogenesis for Neonatal Airway Obstruction from Pierre Robin Sequence
Jeremie D. Oliver, MD, MS Candidate1, Christopher M. Runyan, MD, PhD2, Dominic Massary, MD2, Lyfong Lor, BS2, Shayan Jahanpanah, BS3, Brian S. Pan, MD3, Christopher B. Gordon, MD4, Haithem Elhadi Babiker, MD, DMD3.
1Mayo Clinic, Rochester, MN, USA, 2Wake Forest Baptist Medical Center, Winston-Salem, NC, USA, 3University of Cincinnati, Cincinnati, OH, USA, 4Dayton Children's Hospital, Dayton, OH, USA.
PURPOSE: Infants with Pierre Robin Sequence (PRS) often suffer from feeding difficulties, growth impairment and apnea of varying severity secondary to tongue-based airway obstruction (TBAO). Surgical management in those with moderate to severe obstruction includes tongue-lip adhesion, tracheostomy, and/or mandibular distraction osteogenesis (MDO). MDO has shown superior outcomes in many studies, but there is currently no standardized technique for distraction. This study describes a novel minimal-dissection trans-facial two-pin technique for MDO with external distractor.
METHODS: A retrospective review of medical record data and dental images was performed for all consecutive neonates (<1 year old) treated with this technique at a single institution from 2004-2014.
RESULTS: A total of 100 consecutive patients (male = 50, 50%) treated by two-pin trans-facial mandibular distraction were identified, including both those treated primarily (n = 68), and secondarily with MDO following initial tracheostomy (n = 32). Peri-operative complications requiring unplanned surgical revision (n = 14, 14%) included hardware failure (n = 8) and early consolidation (n = 6). Significant long-term complications included limited mouth opening (n=2), marginal mandibular nerve weakness (n=1), and TMJ ankylosis (n=2, both of whom were syndromic, Catel-Manzke and Cornelia de Lange). No patients required scar revisions.
CONCLUSION: The two-pin trans-facial technique for minimal-dissection external MDO is an effective tool for correction of severe airway obstruction in neonates with PRS, with favorable long-term outcomes and complication profile compared to traditional MDO. This technique has favorable or equivocal results for feeding and airway obstruction, measured by improved sleep studies or by tracheostomy avoidance.
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