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Outcome Analysis of Tongue-Lip Adhesion versus Mandibular Distraction Osteogenesis in the Treatment of Pierre Robin Sequence Associated with Obstructive Sleep Apnea
S Sati, J Socas, G Fairbanks, G Varkarakis, R Flores, R Havlik
Indiana University
2010-03-23
Presenter: J Socas
Affidavit:
Director Name:
Author Category: Resident/Fellow
Abstract Category: Craniomaxillofacial
Introduction:
The benefits of tongue-lip adhesion (TLA) versus mandibular distraction osteogenesis (DO) in the treatment of Pierre Robin sequence (PRS) continue to be debated. There is little scientific data comparing the two techniques.
Method:
Retrospective, single-surgeon review of all non-syndromic surgically treated neonates with PRS from 1994 to 2009 (n=39) with a 1 year minimum follow-up. Patients were treated by either TLA (n=15) (1994 - 2004) or DO (n=24) (2004 - 2009).
Criteria assessed: age at surgery; age at palatoplasty; length of ICU stay; time of extubation; incidence of tracheostomy; complications; and multi-channel polysomnography pre-operatively and at one and twelve months post-operatively (oxygen saturation rates and apnea-hypoapnea index (AHI)).
Results:
There was no statistically significant difference in the age at surgery (32 days versus 39 ) age at palatoplasty (17 months versus 17.5) or length of ICU stay (13.3 days versus 12.2). The DO group demonstrated decrease in the time of post-surgical extubation (p<0.05). There were no post-procedure tracheostomies in the DO group compared to 4 in the TLA group. There were 12 complications in the TLA group compared to 4 in the DO group.
DO TLA P Value
Pre-Op Sats 76.5 82 <0.05
Sats 1 Month 98.3 87.5 <0.05
Sats 1 year 98.5 89.2 <0.05
AHI Pre-Op 47 37.6 >0.05
AHI 1 Month 10.9 21.6 <0.05
AHI 1 Year 2.5 22.1 <0.05
Conclusion:
Neonates with Pierre-Robin sequence associated with obstructive sleep apnea demonstrate significantly shorter times to extubation, lower tracheostomy rates, and improved AHI and O2 saturations when undergoing DO compared to TLA.
