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Predictors of Failure in Mandibular Distraction for Robin Sequence
Roberto L. Flores MD, Shawn T. Greathouse MD, Melinda Costa MD, Youssef H. Tahiri
MD, Tahereh Soleimani MD, Sunil S. Tholpady MD PhD
Indiana University School of Medicine
2015-03-14
Presenter: S. Travis Greathouse
Affidavit:
The fellow is responsible for at least 50% of the original work
Director Name: Sunil Tholpady
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Robin Sequence is defined as the triad of micrognathia, glossoptosis and airway
obstruction. Treatment options include conservative and surgical measures. Of the surgical measures,
tongue-lip adhesion and mandibular distraction are two popular options. Variables associated with
failure of MDO have previously been reported. In this study, it is demonstrated that the associated
variables change dependent on the manner in which failure is defined. These multiple failure outcomes
are used to construct a scoring system to predict MDO failure.
Methods: A 10 year retrospective database of neonatal MDO patients was constructed. Patient
demographics and co-morbidities were collected. Failure outcomes studied included tracheostomy,
AHI > 20 despite improvement, and death. A combination of bivariate and regression analysis was used to produce significantly associated variables. A scoring system was produced from this data.
Results: Statistical analysis demonstrated the association of GERD, age > 30 days, neurologic anomaly,
airway anomalies other than laryngomalacia, intact palate, and pre-operative intubation on the
outcome variables studied. Multiple scoring systems were produced with reasonable sensitivity,
specificity, positive and negative predictive value.
Conclusions: When reporting surgical outcomes of MDO in the setting of RS, it is important to consider
AHI as well as avoidance of tracheostomy as an outcome variable. Incompletely ameliorated AHI
accounts for half of patients with a problem after MDO and requires further study. The predictive
scores presented will be utilized and validated on a larger prospectively collected dataset.
