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Critical Analysis of Feeding Outcomes After Surgical Intervention for Pierre Robin Sequence
Pooja Humar, BS; Anne Glenney, BA; Lucille Cheng, BS; Alexander Comerci, BS; Joseph Mocharnuk, BA; Lucas Dvoracek, MD; Jesse Goldstein, MD
University of Pittsburgh Medical Center
2023-01-31
Presenter: Pooja Humar
Affidavit:
All work on this project represents the original work of the included authors
Director Name: J. Peter Rubin
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Feeding and swallowing dysfunction pose significant morbidity to patients with Pierre Robin Sequence (PRS). We present an analysis of feeding and swallowing outcomes following mandibular distraction osteogenesis (MDO) or supraglottoplasty in pediatric PRS patients.
Methods: A retrospective review of PRS patients seen at a single institution from 2010-2016 was conducted. Patients were separated into categories including MDO, supraglottoplasty, and no surgical intervention. Medical history, pre- and post-intervention modified barium swallow (MBS) studies, and polysomnography data was collected.
Results: This cohort includes 93 patients with PRS; 47 (50.5%) underwent MDO, 13 (14.0%) underwent supraglottoplasty, 3 patients underwent both (3.22%), and 30 patients had no surgical intervention. 54.8% of patients had a congenital cardiac anomaly and 61.3% had an airway anomaly. Post-procedure MBS demonstrated significant improvement in sucking tongue movements (p=0.048) and vallecular space obliteration (p=0.001) in patients who underwent MDO while patients who underwent supraglottoplasty had significant improvements in laryngeal penetration (p=0.003). 16.7% of patients were deemed unsafe for oral feeding after supraglottoplasty compared to only 6.82% after MDO. Average post-operative total Apnea-Hypopnea Index (AHI) was significantly smaller in patients who underwent surgical intervention compared to those who did not (16.32 vs. 23.2, p<0.01), but there was no significant difference in post-operative total AHI between operative groups (p=0.54).
Conclusions: Patients who underwent MDO or supraglottoplasty showed improvements in post-procedure MBS. However, patients with PRS who underwent supraglottoplasty had a higher rate of adverse feeding outcomes. These findings support additional research on outcomes associated with treatment modality for PRS patients.
