Outcome Analysis of Tongue-Lip Adhesion Versus Mandibular Distraction Osteogenesis in the Treatment of Pierre Robin Sequence Associated with Obstructive Sleep Apnea

The benefits of tongue-lip adhesion (TLA) versus mandibular distraction osteogenesis (DO) in the treatment of neonatal airway obstruction associated with Pierre Robin sequence continue to be debated. There is little scientific data, however, comparing the two techniques using a standardized method for evaluation. We present an outcome analysis comparing TLA and DO in the treatment of 39 consecutive neonates with Pierre Robin sequence associated with obstructive sleep apnea. Method: Retrospective, single-surgeon review of all surgically treated neonates with Pierre Robin sequence from 1994 to 2009 (n=39). All study patients were non-syndromic and the minimum follow-up period was one year. All patients underwent treatment by either TLA (n=15) (1994 -- 2004) or DO (n=24) (2004 – 2009). Patient outcomes using both techniques were compared. Criteria assessed included: age at the time of intervention; age at the time of cleft palate closure; length of ICU stay; time of extubation; incidence of tracheostomy; complications; and multi-channel polysomnography outcomes pre-operatively and at one and twelve months post operatively. Polysomnography data included: oxygen saturation rates and apnea-hypoapnea index (AHI).

Results: Comparison of DO to TLA demonstrated no statistically significant difference in the age at the time of surgery (32 days versus 39 ) age at palatal closure (17 months versus 17.5) or length of ICU stay (13.3 days versus 12.2). The DO group demonstrated statistically significant decreases 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. Mandibular Distraction Tongue-Lip Adhesio P Value Pre-Op Sats 76.5 82 <0.05 Sats at 1 Month 98.3 87 <0.05 Sats at 1 year 98.5 89.2 <0.05 AHI Pre-Op 47 37.6 >0.05 AHI at 1 Month 10.9 21.6 <0.05 AHI at 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, and improved AHI and O2 saturations when undergoing DO compared to TLA. There appears to be a lower tracheostomy and complication rate in patients undergoing DO compared to TLA.