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Distraction osteogenesis and glossopexy for Robin sequence with airway obstruction

Alan T L Cheng1, Michelle Corke, Alison Loughran-Fowlds

  • 1Department of Otolaryngology, The Children's Hospital at Westmead, Australia. atlcheng@bigpond.com

ANZ Journal of Surgery
|April 27, 2011
PubMed

Insights

Mandibular distraction osteogenesis with glossopexy effectively treated severe obstructive sleep apnea in infants with Robin sequence who did not respond to continuous positive airway pressure (CPAP). This surgical approach avoided the need for tracheostomy.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Sleep Medicine

Background:

  • Robin sequence often presents with severe obstructive sleep apnea (OSA) in infants.
  • Continuous positive airway pressure (CPAP) is a common treatment, but can fail in severe cases.
  • Surgical intervention may be necessary to manage upper airway obstruction.

Purpose of the Study:

  • To evaluate the effectiveness of mandibular distraction osteogenesis with glossopexy in infants with Robin sequence and severe OSA.
  • To assess the role of polysomnography (PSG) and endoscopy in managing these patients pre- and post-operatively.

Main Methods:

  • Retrospective review of medical records for 20 infants with Robin sequence.
  • Analysis of preoperative and postoperative polysomnography (PSG) data.
  • Documentation of clinical progress, CPAP therapy, endoscopy findings, and respiratory parameters.

Main Results:

  • Six out of 20 infants (30%) with Robin sequence failed CPAP treatment for severe OSA.
  • Mandibular distraction osteogenesis with glossopexy successfully managed these six infants, avoiding tracheostomy.
  • Associated airway anomalies included hypoplastic epiglottis, laryngomalacia, choanal atresia, and tracheal stenosis.

Conclusions:

  • Mandibular distraction osteogenesis with glossopexy is an effective surgical treatment for severe upper airway obstruction in infants with Robin sequence.
  • Polysomnography and endoscopy are valuable tools for assessing and managing airway issues in this population.
  • Epiglottic maldevelopment was noted in a significant portion of the studied infants.
Abstract

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