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Mapping the Mandibular Lingula in Symptomatic Pierre Robin Sequence: A Guide to the Inverted L Osteotomy
Wendy Chen, MD, M.S.
Edward H. Davidson, MA(Cantab) MBBS
Zoe M. Macisaac, MD
Anand Kumar, MD
University of Pittsburgh Medical CEnter
2014-03-14
Presenter: Wendy Chen
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: Joseph E. Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose
The inverted L osteotomy for mandibular lengthening in treatment of symptomatic Pierre Robin Sequence is a useful technique for avoiding injury to the tooth root and inferior alveolar nerve. The craniofacial anatomy of PRS patients is diverse, complex, and can be especially challenging in infants with severe upper airway obstruction requiring mandibular distraction. Identification of the position of the lingula relative to adjacent mandibular anatomic points is understudied and may decrease iatrogenic complications. This study aims to map the position of the lingula in the micrognathic mandible.
Methods
A retrospective cohort study of symptomatic PRS patients was performed comparing 3D CT data of relative lingula position between PRS patients and control patients. Data measured included overjet, the gonial angle, length of the horizontal ramus, height and width of the vertical ramus, and the distance of the lingula from the anterior ramus and from the gonion.
Results/Conclusions
PRS n=11, control n=4. The average overjet, gonial angle were greater and statistically significant (p<0.05) in PRS patients. The average horizontal length, vertical ramus length and width were lesser and statistically significant in PRS patients. Mandibles of PRS patients display globally smaller dimensions. There is a resultant decrease in distance vertically and horizontally of the lingula from gonion and from anterior the vertical ramus respectively. When the micrognathia is accounted for, the relative anatomic position of the lingula is maintained and equivalent to normal mandibles. However, PRS mandibles are diverse, complicated, and not merely small mandibles.
