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Two-pin External MDO for Neonatal Airway Obstruction from Pierre Robin Sequence: Long Term Outcomes
Christopher Runyan MD, PhD, Craig Gendron MD
Brian Pan MD
Christopher Gordon MD
University of Cincinnati
2015-03-15
Presenter: Christopher Runyan
Affidavit:
Dr Runyan collected the majority of the data with Dr. Gendron helping. The data analysis was performed by Dr. Runyan. Dr Pan and Dr. Gordon directed the project and provided critical analysis and oversight.
Director Name: W John Kitzmiller
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Mandibular distraction osteogenesis (MDO) has become an accepted treatment for severe airway obstruction in neonates with Pierre Robin Sequence (PRS). We hypothesized that a minimally invasive transfacial two-pin MDO-technique would minimize scars and complications but remain efficacious in correcting airway obstruction. We have utilized this technique for the past 11 years and now report our long-term outcomes.
Methods/Results
Two 2-mm transfacial Steinman pins are placed: one through bilateral coronoid processes and velum, and one through the lower mandibular border. Using an ultrasonic osteotome, angle corticotomies are performed through small buccal mucosal incisions. Uni-vector distractors are placed and activated on POD#1, distracting at 2 mm/day. No consolidation is performed, and closed remodeling of the callus is used to close the open bite at the time of distractor removal. A retrospective review was performed for consecutive neonates treated with this technique from 1994-2014.
Results
Sixty-eight patients were treated with current mean age of 5.6 years. The mean obstructive indices on sleep study improved from 43.3 to 9.2. Only 22.1% required G-tube feeds whereas all others were fed temporarily by nasogastric tube. Six patients had persistent airway obstruction necessitating tracheostomy (8.8%). These patients had significantly higher rates of syndromic status, neurologic impairment, and low birth weight. There were 10 complications (14.7%) requiring surgical intervention, including hardware failure (4), early consolidation (3) or molar anomalies (3).
Conclusion
The two-pin transfacial technique for external MDO is effective for correction of severe airway obstruction in neonates with PRS, with favorable long-term outcomes and complication profile.
