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Outcomes Analysis Of Mandibular Distraction Osteogenesis For The Treatment Of Pierre Robin Sequence Associated With Advanced Airway Obstruction
Kariuki P. Murage M.D., Sunil S. Tholpady MD PhD, Michael Friel, M.D,
Melinda Costa MD, Robert J. Havlik MD, and Roberto L. Flores MD
University, Hospital
2013-03-01
Presenter: Kariuki Murage
Affidavit:
This abstract represents the residents work
Director Name: John Coleman
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
Mandibular distraction osteogenesis (MDO) is an established technique used to treat infants with Pierre Robin Sequence (PRS) with severe airway obstruction. We report an outcomes analysis focusing on our failures and complications.
Methods:
7-year retrospective review of PRS patients treated with MDO. Recorded variables included: need for tracheostomy, complications, prematurity, low birth weight, cleft palate, genetic syndromes, heart and airway abnormalities, gastroesphageal reflux disease (GERD), need for feeding tube, Nissen fundoplication, late operation (2 weeks or greater at time of MDO) and pre-operatively intubated. MDO failure was defined as need for tracheostomy post MDO. Association of MDO failure with the variables was determined using Fisher exact test.
Results:
50 patients were identified. Characteristics included: mean gestational age 37wks; Prematurity (22%); mean birth weight 2.98kg; low birth weight (20%); cleft palate (84%); genetic syndrome (22%); cardiac anomalies (12%); pulmonary abnormalities (26%); GERD (26%); gastrostomy tube (58%); Nissen (12%), late presentation (76%); and pre-operatively intubated (4%). Most common complication was infection (22%) and all except one were successfully treated using antibiotics. Other complications included self extubation (4%) and device fracture (2%).
Four patients (8%) required tracheostomy post MDO. Variables demonstrating statistical association with MDO and tracheostomy were in patients with no cleft palate (p=0.0003), GERD (p=0.003) and Nissen fundoplication (p=0.00006).
Conclusion:
MDO can be safely applied to infants with PRS. The most common complication is infection and most cases can be treated non-surgically. Although effective, absence of a cleft palate, GERD, and need for Nissen fundoplication are associated with MDO failure.
