Abstract: Outcomes Analysis of Mandinular Distraction Osteogenesis For The Treatment Of Pierre Robin Sequence Associated With Advanced Airway Obstruction (Plastic Surgery 2013)

Saturday, October 12, 2013: 10:40 AM

Kariuki P Murage, MD, , Surgery, Indiana University, Indianapolis, IN

Sunil Tholpady, MD, PhD , Plastic Surgery, Indiana University, Indianapolis, IN

Michael T Friel, MD , Plastic Surgery, Indiana University, Indianapolis, IN

Melinda Costa, M.D , Plastic Surgery, Indiana University, Indianapolis, IN

Robert J Havlik, MD , Plastic Surgery, Indiana University, Indianapolis, IN

Roberto L. Flores, MD , Plastic Surgery, Indiana University, Indianapolis, IN

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Background:

Mandibular distraction osteogenesis (MDO) is an established technique used to treat infants with Pierre Robin Sequence (PRS) associated with severe airway obstruction. Despite its widespread use, there is little information on the limitations and morbidity associated with MDO in this patient population.We report an outcomes analysis focusing specifically on our failures and complications.

Methods:

A 7-year retrospective review of all patients with PRS treated with MDO. Recorded variables included: need for tracheostomy, complications, prematurity, low birth weight, cleft palate, genetic syndromes, heart and airway abnormalities, gastroesphageal reflux disease (GERD), need for feeding tube, Nissen fundoplication, late operation (2 weeks or greater at the time of MDO) and pre-operatively intubated. Failure in MDO was defined as need for tracheostomy post MDO. The association of failure of MDO with the listed preoperative variables was determined using a Fisher exact test.

Results:

50 patients were identified for this study. Patient characteristics included: mean gestational age 37wks; Prematurity (22%); mean birth weight 2.98kg; low birth weight (20%); cleft palate (84%); genetic syndrome (22%); cardiac anomalies (12%); pulmonary abnormalities (26%); GERD (26%); gastrostomy tube (58%); Nissen (12%), late presentation (76%); and pre-operatively intubated (4%). The most common complication was infection (22%) and all cases except one were successfully treated using antibiotics alone. Other common complications included self extubation (4%) and device fracture (2%).

Four patients (8%) required tracheostomy post MDO. The only variables demonstrating statistical association with MDO and tracheostomy were in patients with no cleft palate (p=0.0003), GERD (p=0.003) and Nissen fundoplication (p=0.00006).

Conclusion:

MDO can be safely applied to infants with PRS. The most common complication is infection and most cases can be treated non-surgically. Although MDO is an effective technique, absence of a cleft palate, GERD, and need for Nissen fundoplication are associated with failure.

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