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Dos Santos MO, Manica D, Cauduro Marostica PJ, Kuhl LP, Collares MV, Schweiger C. Mid-term effect of mandibular distraction osteogenesis on clinical and polysomnography findings of patients with Robin sequence. J Craniomaxillofac Surg 2024; 52:55-58. [PMID: 37884434 DOI: 10.1016/j.jcms.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/06/2023] [Accepted: 08/09/2023] [Indexed: 10/28/2023] Open
Abstract
The study aimed to evaluate the mid-term effect of MDO in children with Robin sequence (RS). In this case series, 13 patients with RS who underwent MDO were followed up for more than 5 years. Data were collected using clinical history and physical examination. Polysomnography was performed and endoscopic evaluations of the airway was performed if patients still presented obstructive signs of upper airways and/or dysphagia. The patients' clinical signs improved in the mid-term after versus before MDO (inspiratory noise, 92,3% vs 30,8%; apnea, 84,6% vs 7,7%; cyanosis, 76,9% vs 0%; desaturations, 69,2% vs 0%; and suprasternal/intercostal retractions, 61,5% vs 0%; p < 0.05). Statistically significant improvement was noted in the following polysomnographic parameters evaluated in the pre and postoperative mid-term: apnea-hypopnea index, total sleep time and desaturation index (p < 0.05). Within the limitations of the study it seems that MDO is an effective surgical option for children with RS, not only in the short term as previously demonstrated, but also in the mid-term.
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Affiliation(s)
- Marcele Oliveira Dos Santos
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otorhinolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Pediatric Pulmonology Unit, HCPA, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - Leonardo Palma Kuhl
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil
| | | | - Cláudia Schweiger
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, RS, Brazil; Otorhinolaryngology Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
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Bakeman AE, Shaffer AD, Tobey ABJ, Jabbour N, Ford MD, Goldstein JA, Simons JP. Prevalence and Management of Laryngomalacia in Patients With Pierre Robin Sequence. Cleft Palate Craniofac J 2023; 60:1395-1403. [PMID: 35668613 DOI: 10.1177/10556656221107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the prevalence and presentation of laryngomalacia and efficacy of supraglottoplasty (SGP) in a cohort of patients with Pierre Robin Sequence (PRS). DESIGN Retrospective cohort study. SETTING Tertiary-care children's hospital. PATIENTS, PARTICIPANTS Consecutive patients with PRS born between January 2010 and June 2018. MAIN OUTCOME MEASURES Chart review included demographics, comorbid airway obstruction including laryngomalacia, timing of surgical interventions, clinical symptoms, sleep study data, and modified barium swallow study data. 126 patients with PRS were included; 54% had an associated syndrome, 64% had an overt cleft palate, and 22% had a submucous cleft palate. 64/126 were noted to have laryngomalacia (51%). Patients with concurrent PRS and laryngomalacia were significantly more likely to have submucous cleft palate (P = .005) and present with aspiration with cough (P = .01) compared to patients with PRS without laryngomalacia. Patients with concurrent laryngomalacia and PRS showed a significant decrease in apnea-hypopnea index (AHI) and obstructive AHI (OAHI) after mandibular distraction, with a median AHI and OAHI improvement of 22.3 (P = .001) and 19.8 (P = .002), respectively. Patients who underwent only SGP did not show significant improvement in these parameters (P = .112 for AHI, P = .064 for OAHI). The prevalence of laryngomalacia in our PRS cohort was 51%. Patients with PRS and laryngomalacia are more likely to present with overt aspiration compared to patients with PRS without laryngomalacia. These data support that laryngomalacia does not appear to be a contraindication to pursuing MDO.
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Affiliation(s)
- Anna E Bakeman
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Allison B J Tobey
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Noel Jabbour
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matthew D Ford
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jeffrey P Simons
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Safety of Mandibular Osteotomies in Infants with Pierre Robin Sequence: Computer-Aided Modeling to Characterize the Risks of Various Techniques. Plast Reconstr Surg 2022; 149:1169-1177. [PMID: 35286286 DOI: 10.1097/prs.0000000000009032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mandibular distraction osteogenesis is effective for the correction of severe tongue-based airway obstruction in infants with Pierre Robin sequence. Involved osteotomies may damage developing tooth buds and/or the inferior alveolar nerve. The authors evaluated the theoretical safety of various osteotomy techniques to better define infantile mandibular anatomy using computer-aided modeling. METHODS Seven mandibular osteotomy techniques (oblique, inverted-L, multiangular, walking stick, high oblique, vertical/high inverted-L, and horizontal) were simulated using computed tomography studies from infants with Pierre Robin sequence and without other associated conditions. Software was used to manually segment the mandibular bone, inferior alveolar nerve, and tooth buds. RESULTS Sixty-five computed tomography scans were included, yielding 130 hemimandibles. The horizontal osteotomy pattern had significantly lower theoretical risk of tooth bud (p < 0.001) and inferior alveolar nerve involvement (p < 0.001) than all other patterns. Osteotomies with high vertical components (i.e., vertical, walking stick, and multiangular) had lower theoretical tooth bud involvement than the more proximal oblique and inverted-L osteotomies (p < 0.001). Average lingula location was measured at a point 65 percent of the mandibular width from anterior mandibular border and 63 percent of the mandibular height from the inferior mandibular border. CONCLUSIONS Surgical planning with computed tomography scans can help evaluate an infant's mandibular anatomy to select an osteotomy that reduces morbidity risks. Regardless of technique, tooth buds and the inferior alveolar nerve are often included in osteotomies. The lingula location in this study demonstrates a position more superior and posterior than that previously described. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Crowder HR, Mantilla-Rivas E, Kapoor E, Manrique M, Stein J, Nasser JS, Chang T, Rogers GF, Oh AK. Timing and Duration of Facial Nerve Dysfunction After Mandibular Distraction Osteogenesis for Robin Sequence. Cleft Palate Craniofac J 2022; 60:706-715. [PMID: 35167397 DOI: 10.1177/10556656221077591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Collect data from craniofacial surgeons to analyze mandibular distraction osteogenesis (MDO) protocols, and facial nerve dysfunction (FND) to characterize this common, but poorly documented complication after MDO in infants with Robin Sequence (RS). Design, Setting, and Participants A 16-question anonymous survey designed through REDCap was digitally distributed to members of the American Cleft Palate-Craniofacial Association and International Society of Craniofacial Surgery (ISCFS). Main Outcome Measure(s) Demographic information, MDO perioperative variables, surgeon experience with FND after MDO for patients with RS, and the timing and duration of FND were analyzed. Results Eighty-four responses were collected, with 80 included for analysis. Almost two-thirds of respondent surgeons reported FND as a complication of MDO in patients with RS (51, 63.8%); 58.8% (n = 47) transient FND and 5% (n = 4) with permanent facial nerve palsy only. Both transient and permanent FND was documented by 13 (16.3%) respondents. Among respondents, FND was observed immediately following initial device placement/osteotomies in 45.1%, during distraction in 45.1%, during consolidation in 19.6%, and following device removal in 43.1%. Twenty-five of these respondent surgeons reported resolution of FND between 1 and 3 months (53.2%, n = 25). Conclusions FND after MDO in patients with RS was noted by most respondents in this survey study. While most surgeons noted temporary FND, one-fifth reported long-term dysfunction. FND was documented most commonly following device placement/osteotomies or during active distraction. Further research should seek to establish risk factors associated with FND and identify surgical and perioperative prevention strategies
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Affiliation(s)
- Hannah R. Crowder
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Elina Kapoor
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Jason Stein
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Jacob S. Nasser
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Taeun Chang
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Gary F. Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
| | - Albert K. Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, D.C., USA
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Khansa I, Aldabbeh S, Pearson GD, Baylis A, Madhoun LL, Schoenbrunner A, Splaingard M, Kirschner RE. Airway and Feeding Outcomes in Pierre Robin Sequence: A Comparison of Three Management Strategies. Cleft Palate Craniofac J 2022; 60:689-694. [PMID: 35098759 DOI: 10.1177/10556656221076345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Controversy remains regarding optimal management of Pierre Robin sequence (PRS). The goal of this study was to compare airway and feeding outcomes in infants with PRS who underwent surgical intervention, specifically mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA), or who had conservative management (CM) without surgery. METHODS All consecutive patients treated for PRS at a pediatric academic medical center, with at least one year follow-up, were included. Patients who underwent tracheostomy as an index procedure were excluded. Patients were divided into those who underwent MDO, TLA or CM. Feeding status and data from initial and follow-up polysomnograms were collected. Comparisons between groups were made using the Kruskal-Wallis test, followed by Mann-Whitney pairwise comparison with a Bonferroni correction, when appropriate. RESULTS 67 neonates were included. 19 underwent TLA, 29 underwent MDO and 19 underwent CM. The proportions of syndromic patients were similar between groups. Patients undergoing CM had the lowest baseline AHI (9.1), but there were no significant differences between TLA (20.1) and MDO (25.4). At follow-up, the three groups had similar mean AHI (MDO 1.3, TLA 4.2, CM 4.5). A similar proportion of patients achieved AHI 5 or less (TLA 89.5%, MDO 96.6%, CM 84.2%). At one year, there were no significant differences in weight percentiles or in risk of failure-to-thrive between groups. One patient from the TLA group required a tracheostomy. CONCLUSION The three treatment modalities achieved high airway and feeding success rates. All three modalities should have a place in the armamentarium of the craniofacial surgeon.
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Affiliation(s)
- Ibrahim Khansa
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, 12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Summer Aldabbeh
- 2647The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gregory D Pearson
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, 12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Adriane Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, 12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lauren L Madhoun
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, 12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anna Schoenbrunner
- Department of Plastic and Reconstructive Surgery, 12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Splaingard
- Sleep Disorder Center, Division of Pulmonary Medicine, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard E Kirschner
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, 12305The Ohio State University College of Medicine, Columbus, OH, USA
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Kosyk MS, Carlson AR, Zapatero ZD, Kalmar CL, Cielo CM, Lioy J, Bartlett SP, Taylor JA, Swanson JW. Mandibular Distraction Osteogenesis for Tongue-Based Airway Obstruction Without Micrognathia. Ann Plast Surg 2022; 88:54-58. [PMID: 34176894 DOI: 10.1097/sap.0000000000002891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Mandibular distraction osteogenesis (MDO) effectively treats tongue-based airway obstruction (TBAO) in micrognathic patients with Robin Sequence. Mandibular distraction osteogenesis may also address TBAO in certain nonmicrognathic patients who have severe obstructive apnea, although there is no current literature to guide MDO use in these atypical patients. This study describes outcomes of MDO in a series of patients with TBAO without micrognathia. METHODS Patients who underwent MDO for TBAO from 2013-20 were reviewed, and patients with micrognathia were excluded. Study subjects received baseline/follow up polysomnography. Polysomnography variables, including Obstructive Apnea Hypopnea Index, oxyhemoglobin saturation nadir (SpO2 nadir), percent sleep time end tidal CO2 greater than 50 mm Hg (%ETCO2 > 50), and respiratory-related arousals were compared before and after MDO. Demographics, syndromic/cleft palate status, airway anomalies, respiratory support, and feeding outcomes were collected. RESULTS One hundred and twenty-four patients underwent MDO during this study period; 5 were nonmicrognathic and included in analysis. Sixty percent (n = 3) of the cohort was syndromic: 1 patient each had Trisomy 9, Beckwith Wiedemann syndrome, and duplicated pituitary gland plus syndrome. Forty percent (n = 2) of patients had a cleft palate, 60% (n = 3) had laryngomalacia, and 40% had tracheomalacia. Median (range) age at MDO was 53 days (47-167 days), and median length of distraction was 16 mm (14-20 mm). After MDO, median Obstructive Apnea Hypopnea Index decreased from x̃ = 60.7/h (11.6-109.4) to x̃ = 5.3/h (3.5-19.3) (P = 0.034). SpO2 nadir increased (69% [58-74] to 85% [80-88], P = 0.011), and median %ETCO2 > 50 mm Hg decreased (5.8% [5.2-30.1] to 0.0% [0.0-1.3], P ≤ 0.043). Continuous positive airway pressure was used by all patients immediately after MDO, and at 6 months postoperatively, 1 patient remained on continuous positive airway pressure and 1 patient required supplemental oxygen. At last follow up, no patients had significant residual airway obstruction or required a tracheostomy. CONCLUSIONS Mandibular distraction osteogenesis can effectively treat severe TBAO in some patients without micrognathia that would otherwise be candidates for tracheostomy. When used in select patients, MDO significantly improves obstructive sleep apnea and reduces need for ventilatory support, although feeding support is still needed in most patients at 6 months. Further study in a larger cohort will help identify appropriate candidates for MDO and characterize outcomes of unique patient populations.
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Affiliation(s)
| | | | | | | | | | - Janet Lioy
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA
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The Surgical Treatment of Robin Sequence: Neonatal Mandibular Distraction Osteogenesis in the Unfavorable Patient. J Craniofac Surg 2021; 32:2326-2329. [PMID: 34705382 DOI: 10.1097/scs.0000000000007670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Neonates with severe Pierre Robin sequence (PRS) can be treated by mandibular distraction osteogenesis (MDO), tongue-lip adhesion, or tracheostomy; however, there is an active debate regarding the indications of MDO in this patient population. Published algorithms identify tracheomalacia, bronchomalacia, laryngomalacia, hypotonic syndromes, and central sleep apnea as contraindications for MDO and indications for tracheostomy, but these comorbidities may exist along a spectrum of severity. The authors propose that appropriately selected neonates with PRS who concurrently express 1 or more of these traditional contraindications may be successfully treated with MDO. METHODS The authors performed a 5-year retrospective chart review of all neonates who underwent MDO for treatment of severe PRS. All patients expressed a comorbidity previously identified as an indication for tracheostomy. Pre- and postoperative characteristics were recorded. Apnea/hypopnea index (AHI) before and after MDO were compared using 2-tailed repeated measures t-test. RESULTS The authors identified 12 patients with severe PRS and conditions associated with contraindications to MDO: 9 (75.0%) patients had laryngomalacia, 6 (50.0%) patients had tracheomalacia, 2 (16.6%) patients had bronchomalacia, 1 (8.3%) patient had central sleep apnea, and 3 (25.0%) patients had hypotonia. Five (41.7%) patients underwent concurrent gastrostomy tube placement due to feeding insufficiency. Average birthweight was 3.0 kg. Average pre-op AHI was 34.8. Average post-op AHI was 7.3. All patients successfully underwent MDO with avoidance of tracheostomy. CONCLUSIONS By employing an interdisciplinary evaluation of patient candidacy, MDO can safely and effectively treat upper airway obstruction and avoid tracheostomy in higher-risk neonatal patients with traditional indications for tracheostomy.
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Carlson KJ, Bharadwaj SR, Dougherty WM, Dobratz EJ. Early Adverse Events Following Pediatric Mandibular Advancement: Analysis of the ACS NSQIP-Pediatric Database. Cleft Palate Craniofac J 2021; 59:1176-1184. [PMID: 34405717 DOI: 10.1177/10556656211037852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to assess early adverse events and patient factors associated with complications following mandible distraction osteogenesis (MDO). MATERIALS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) database, years 2012 to 2019, was queried for patients undergoing mandible advancement via relevant Current Procedural Terminology and postoperative diagnosis codes. Thirty-day adverse events and co-morbidities are assessed. RESULTS A total of 208 patients were identified with 17.3% (n = 36) experiencing an adverse event, reoperation (n = 14), and readmission (n = 11) being most common. Patients < 365 days old at the time of operation were more likely to experience an adverse event (26.1% vs 10.8%; P = .005). However, among patients less than 1 year of age, differences in the complication rates between patients ≤ 28 days and >28 days (30.2% vs 22.2%; P = .47) and those weighing ≤ 4 kg and >4 kg (31.7% vs 11.5%; P = .063) did not reach statistical significance. CONCLUSIONS Adverse events following mandible advancement are relatively common, though often minor. In our analysis of the NSQIP-Pediatric database, neonatal age ( ≤ 28 days) or weight ≤ 4 kg did not result in a statistically significant increase in complications among patients less than 1 year of age. Providers should consider early intervention in patients who may benefit from MDO.
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Abstract
Pierre Robin sequence is defined by the clinical triad: mandibular hypoplasia, glossoptosis, and airway obstruction. Mandibular distraction osteogenesis (MDO) is a standard treatment of Robin sequence associated with severe airway obstruction and is the only intervention that directly corrects the underlying anatomic pathologic condition. Compared with tongue-lip adhesion, MDO has demonstrated more success in treating airway obstruction in infants with Pierre Robin sequence, including patients with syndromic diagnoses and concomitant anomalies. This article provides a current, comprehensive review of neonatal mandibular distraction and offers treatment guidelines based on a combined surgical experience of more than 400 patients.
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Affiliation(s)
- Kerry A Morrison
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 222 East 41st Street, New York, NY, 10017, USA
| | - Marcus V Collares
- Rio Grande do Sul Federal University Medical School, Hospital de Clinicas de Porto Alegre, Rio Grande do Sul Federal University, Rua Hilário Ribeiro 202, cj 406, Porto Alegre, Brazil
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, Cleft and Craniofacial Surgery, NYU Langone Health, 222 East 41st Street, 22nd floor, New York, NY, 10017, USA.
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Roth DM, Bayona F, Baddam P, Graf D. Craniofacial Development: Neural Crest in Molecular Embryology. Head Neck Pathol 2021; 15:1-15. [PMID: 33723764 PMCID: PMC8010074 DOI: 10.1007/s12105-021-01301-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/02/2021] [Indexed: 12/22/2022]
Abstract
Craniofacial development, one of the most complex sequences of developmental events in embryology, features a uniquely transient, pluripotent stem cell-like population known as the neural crest (NC). Neural crest cells (NCCs) originate from the dorsal aspect of the neural tube and migrate along pre-determined routes into the developing branchial arches and frontonasal plate. The exceptional rates of proliferation and migration of NCCs enable their diverse contribution to a wide variety of craniofacial structures. Subsequent differentiation of these cells gives rise to cartilage, bones, and a number of mesenchymally-derived tissues. Deficiencies in any stage of differentiation can result in facial clefts and abnormalities associated with craniofacial syndromes. A small number of conserved signaling pathways are involved in controlling NC differentiation and craniofacial development. They are used in a reiterated fashion to help define precise temporospatial cell and tissue formation. Although many aspects of their cellular and molecular control have yet to be described, it is clear that together they form intricately integrated signaling networks required for spatial orientation and developmental stability and plasticity, which are hallmarks of craniofacial development. Mutations that affect the functions of these signaling pathways are often directly or indirectly identified in congenital syndromes. Clinical applications of NC-derived mesenchymal stem/progenitor cells, persistent into adulthood, hold great promise for tissue repair and regeneration. Realization of NCC potential for regenerative therapies motivates understanding of the intricacies of cell communication and differentiation that underlie the complexities of NC-derived tissues.
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Affiliation(s)
- Daniela Marta Roth
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 7020N Katz Group Centre for Pharmacy & Health Research, 11361-87 Avenue, Edmonton, Alberta, AB T6G 2E1 Canada
| | - Francy Bayona
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 7020N Katz Group Centre for Pharmacy & Health Research, 11361-87 Avenue, Edmonton, Alberta, AB T6G 2E1 Canada
| | - Pranidhi Baddam
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 7020N Katz Group Centre for Pharmacy & Health Research, 11361-87 Avenue, Edmonton, Alberta, AB T6G 2E1 Canada
| | - Daniel Graf
- Alberta Dental Association & College Chair for Oral Health Research, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, 7020N Katz Group Centre for Pharmacy & Health Research, 11361-87 Avenue, Edmonton, Alberta, AB T6G 2E1 Canada
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Susarla SM, Mercan E, Evans K, Egbert MA, Hopper RA. Short-term condylar and glenoid fossa changes in infants with Pierre Robin sequence undergoing mandibular distraction osteogenesis. Int J Oral Maxillofac Surg 2020; 50:171-178. [PMID: 32814654 DOI: 10.1016/j.ijom.2020.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/05/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022]
Abstract
The purpose was to evaluate short-term changes in condylar and glenoid fossa morphology in infants with Pierre Robin sequence (PRS) undergoing early (age <4 months) mandibular distraction osteogenesis (MDO) for the management of severe airway obstruction. Computed tomography data from infants with PRS who had MDO were compared to those of age-matched control infants without facial skeletal dysmorphology. Surface/volume, linear, and angular measurements of the condyle and glenoid fossa were obtained and compared between infants with PRS and controls. Eleven infants with PRS met the inclusion criteria. There were five female and six male subjects with a mean age at the time of MDO of 41±32 days. Prior to MDO, PRS mandibles had a smaller condylar articulating surface area and volume than age-matched control mandibles, with a more laterally positioned condylar axis (P≤0.05). Following MDO, there were significant increases in condylar articulating surface area and volume, approaching those of normal controls, with further lateral translation of the condylar axis (P≤0.05). Condyle and glenoid fossa morphology is largely normalized following early MDO in infants with PRS. The condylar axis translates laterally as a result of MDO; this change is not observed with mandibular growth in infants without PRS.
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Affiliation(s)
- S M Susarla
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Oral and Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.
| | - E Mercan
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - K Evans
- Division of Craniofacial Medicine, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - M A Egbert
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Oral and Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - R A Hopper
- Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
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Tomic J, Metzler P, Alcon A, Jakse N, Zemann W, Schanbacher M, Zrnc TA. Weight gain in infants with Pierre Robin sequence. J Craniomaxillofac Surg 2020; 48:555-559. [DOI: 10.1016/j.jcms.2020.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/20/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022] Open
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钟 建, 罗 向, 黄 振, 仇 书, 程 超, 杨 李, 易 新, 曾 锦, 刘 大. [The significance of evaluation of sleep respiration in infants with Pierre Robin sequence]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:496-498. [PMID: 32842177 PMCID: PMC10128329 DOI: 10.13201/j.issn.2096-7993.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 06/11/2023]
Abstract
Objective:This study aimed to evaluate the sleep disorders of infants with Pierre Robin sequence by PSG, and to understand the sleep breathing characteristics of them. Method:Seventeen patients with Pierre Robin sequence underwent polysomnography lasting over 7 hours. Sleep apnea and oxygen index was recorded and analyzed. Result:14(82.35%) patients with Pierre Robin sequence presented with apnea, hypopnea and hypoxemia with varying degree. The apnea-hypopnea index(12.39±9.86) and lowest arterial oxygen saturation(84.12±8.12) %were not significantly different between sexes. However, age showed a negative impact with apnea-hypopnea index, which was worse in younger infants. Conclusion:Most patients with the Pierre Robin sequence have sleep apnea and hypoxemia, and appropriate management should be implemented in an early age. Polysomnography can provide objective analysis of the treatment.
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Affiliation(s)
- 建文 钟
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 向前 罗
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 振云 黄
- 广州市妇女儿童医疗中心耳鼻咽喉科Department of Oto1aryngology, Guangzhou Women and Children's Medical Center
| | - 书要 仇
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 超 程
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 李强 杨
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 新华 易
- 广州市妇女儿童医疗中心耳鼻咽喉科Department of Oto1aryngology, Guangzhou Women and Children's Medical Center
| | - 锦鸿 曾
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
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Yen S, Gaal A, Smith KS. Orthodontic and Surgical Principles for Distraction Osteogenesis in Children with Pierre-Robin Sequence. Oral Maxillofac Surg Clin North Am 2020; 32:283-295. [DOI: 10.1016/j.coms.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Skirko JR, Pollard SH, Slager S, Hung M, Weir C. Family Experience With Pierre Robin Sequence: A Qualitative Study. Cleft Palate Craniofac J 2020; 57:736-745. [PMID: 32174155 DOI: 10.1177/1055665620910331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify concepts and constructs important to parents of children with Pierre Robin Sequence (PRS). DESIGN Qualitative study. SETTING All children received some care at a tertiary hospital with additional care at outside facilities. Interviews were conducted in nonclinical locations, including remote locations. PARTICIPANTS Parents of children <5 years old with a diagnosis of PRS. Prior treatments included observation, positioning, nasal trumpet, mandibular distraction osteogenesis, tracheostomy, and gastrostomy. INTERVENTION Semi-structured interviews with individuals (4) and with groups (focus groups, 4) were conducted using open-ended questions and non-leading prompts. Transcripts were analyzed with iterative open and axial coding. Concepts and constructs were identified and refined into codes and central themes. Interviews were conducted until thematic saturation was achieved. RESULTS Sixteen parents were interviewed. Their experiences were coded into 5 main themes, which can be summarized as: (1) child's symptoms/well-being, (2) parents' grief/isolation, (3) family stress, (4) relationships with providers, and (5) psychological and technical growth. Difficulty with feeding, weight gain, and breathing problems were core physical issues described by participants with associated intense fear. Participants described frustration from not only lack of care coordination, slow diagnoses, and poor communication but also gratitude for providers who served as advocates. Participants described gradual development of knowledge/competencies. CONCLUSIONS Families of children with PRS have experiences that profoundly affect their lives. Child's physical symptoms/well-being and parents' psychosocial well-being provide content for a future PRS-specific quality-of-life instrument. Concepts that emerged also provide a framework to improve parents' experience and enhance their children's quality of care.
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Affiliation(s)
- Jonathan R Skirko
- Division of Pediatric Otolaryngology--Head & Neck Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Sarah Hatch Pollard
- Division of Pediatric Otolaryngology--Head & Neck Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Stacey Slager
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Man Hung
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, USA.,Department of Orthopaedic Surgery Operations, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
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Resnick CM, Calabrese CE. Is Obstructive Apnea More Severe in Syndromic Than Nonsyndromic Patients With Robin Sequence? J Oral Maxillofac Surg 2019; 77:2529-2533. [DOI: 10.1016/j.joms.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
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Zhang N, Mao Z, Cui Y, Tan Y, Zhang H, Ye X, Xu Y. Optimal duration of mechanical ventilation and influencing factors following mandibular distraction osteogenesis in infants with Pierre Robin sequence. Medicine (Baltimore) 2019; 98:e18339. [PMID: 31860988 PMCID: PMC6940173 DOI: 10.1097/md.0000000000018339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mandibular distraction osteogenesis (MDO) is an effective treatment for tongue-based airway obstruction in infants with severe Pierre Robin sequence (PRS). Most infants receiving MDO require postoperative mechanical ventilation (MV) to assist breathing. Optimal MV time for each individual patient and factors influencing the time must be identified to guide clinical decision-making.A retrospective analysis was performed on 75 infants with PRS receiving MDO from November 2016 to August 2018. Twenty-six were females and 47 were males. Data extracted from the hospital information system included sex, age, weight, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscope exposure classification, anesthesia duration, operation duration, postoperative treatment site, situation of distraction, postoperative complications and MV duration. Statistical analyses were conducted to investigate the potential associations of these factors with MV time.Seventy-three PRS syndrome patients received anesthesia for MDO device procedures were considered eligible for study. Patient sex, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscopy exposure difficulty, postoperative treatment site (neonatal or pediatric intensive care unit), ventilator-associated pneumonia, age, weight, anesthesia duration, and operation duration had no significant influence on postsurgical MV time (P > .05). Amount of distraction at the time of extubation had statistically significant influence on postoperative MV time (P < .05). In addition, scatter plots revealed linear relationships between postoperative MV time and amount of distraction at extubation.According to this analysis, amount of distraction was associated with MV time following MDO for severe PRS and roughly 6 days post-surgery is a generally safe extubation time.
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Affiliation(s)
- Na Zhang
- Department of Anaesthesia and Prioperative Medicine, Guangzhou Women and Children Medical Center
| | - Zhe Mao
- Department of Stomatology, Guangzhou Women and Children Medical Center, Guangzhou, Guangdong, PR China
| | - Yingqiu Cui
- Department of Stomatology, Guangzhou Women and Children Medical Center, Guangzhou, Guangdong, PR China
| | - Yonghong Tan
- Department of Anaesthesia and Prioperative Medicine, Guangzhou Women and Children Medical Center
| | - Huanhuan Zhang
- Department of Anaesthesia and Prioperative Medicine, Guangzhou Women and Children Medical Center
| | - Xiaoxin Ye
- University of New South Wales, Sydney, NSW, Australia
| | - Yingyi Xu
- Department of Anaesthesia and Prioperative Medicine, Guangzhou Women and Children Medical Center
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