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Mandible, tongue, and airway in Pierre Robin sequence: a longitudinal cephalometric study
A A Figueroa1, T J Glupker, M G Fitz
1Department of Pediatrics, University of Illinois College of Medicine, Chicago 60680.
Insights
Infants with Pierre Robin Sequence (PRS) show initial mandibular and tongue undergrowth but experience accelerated mandibular growth, improving airway dimensions. This "partial catch-up growth" aids respiratory distress resolution.
Area of Science:
- Craniofacial development
- Pediatric cephalometrics
- Congenital anomalies
Background:
- Pierre Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and airway obstruction.
- Early morphologic changes in PRS infants require detailed investigation.
- Understanding growth patterns is crucial for managing PRS-related complications.
Purpose of the Study:
- To analyze the size, growth, and relationships of the mandible, tongue, and airway in infants with isolated, nonsyndromic Pierre Robin Sequence (PRS).
- To elucidate early morphologic changes in these structures in PRS infants.
- To compare PRS infants with isolated cleft palate (CP) and normal controls (N).
Main Methods:
- Retrospective longitudinal cephalometric study.
- Analysis of lateral cephalometric radiographs from the first 2 years of life.
- Inclusion of 17 PRS infants, 26 CP infants, and 26 N infants.
- Statistical comparison using univariate analysis of variance and discriminant function analysis (DFA).
Main Results:
- Distinct group differences observed throughout the study period, most pronounced at the earliest age between PRS and N infants.
- Initially, PRS infants presented with shorter tongue and mandibular length, narrower airway, smaller tongue area, and posterior/inferior hyoid position compared to N.
- Specific tongue shape and position were noted in PRS infants.
- Group distinctions diminished with age due to an increased mandibular growth rate in PRS infants.
- Airway dimensions improved in PRS infants, potentially resolving respiratory distress.
Conclusions:
- Findings support the hypothesis of partial mandibular catch-up growth in PRS infants.
- Accelerated mandibular growth in PRS infants improves airway dimensions and may contribute to the resolution of respiratory distress.
- Despite catch-up growth, craniofacial structures in PRS infants do not reach normal values.
Abstract:
The purpose of this retrospective longitudinal cephalometric study was to analyze size, growth, and relations of the mandible, tongue, and airway in the isolated, nonsyndromic Pierre Robin Sequence (PRS) infant. The objective was to understand better the early morphologic changes that occur in these structures. The data were obtained from lateral cephalometric radiographs taken in the first 2 years of life on 17 PRS infants, 26 isolated cleft palate (CP), and 26 normal control (N) infants. Mean values of each variable were compared using a univariate analysis of variance. A multivariate discriminant function analysis (DFA) was also used to characterize group differences. The three groups were distinct throughout the period of study. Differences were greater at the earliest age and the distinction was greater between the PRS and N infants with the CP infant in between, but having more similarity to the PRS infant. Initially, the PRS infant had a shorter tongue and mandibular length, narrower airway, smaller tongue area and the hyoid position was more posterior and inferior as compared to N. The tongue shape and position were specific to the PRS infants. This group distinction diminished with age and resulted from an increased mandibular growth rate in the PRS infant. These findings support the hypothesis of "partial mandibular catch-up growth" in the PRS infant. The increased growth rate in the PRS infant improved the airway dimension, which might be partly responsible for the natural resolution of the respiratory distress. This increased growth rate did not allow for the various structures to reach values equal to normal.