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Bilateral mandibular distraction osteogenesis in the neonate with pierre robin sequence and airway obstruction: a
Horácio Zenha1, Luis Azevedo, Leonor Rios
1Plastic, Reconstructive & Craniomaxillofacial Surgery Unit, Centro Hospitalar Vila Nova Gaia/Espinho, Gaia, Portugal ; Plastic Surgery and Burns Unit, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Insights
Bilateral mandibular distraction osteogenesis is a safe and effective neonatal procedure for severe Pierre Robin sequence. This intervention resolves airway obstruction, avoids tracheostomy, and improves feeding, leading to good outcomes.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Neonatal Care
Background:
- Craniofacial abnormalities like Pierre Robin sequence cause airway compromise due to retromicrognathia and glossoptosis.
- Severe cases necessitate neonatal intubation and tracheostomy for airway management and feeding.
- Tracheostomy carries risks and complications in neonates.
Purpose of the Study:
- To evaluate the efficacy and safety of bilateral mandibular distraction osteogenesis in neonates with severe Pierre Robin sequence.
- To determine if early mandibular distraction can prevent the need for tracheostomy.
- To assess functional outcomes including extubation, feeding, and hospital discharge.
Main Methods:
- Two neonates with severe Pierre Robin sequence underwent bilateral mandibular distraction osteogenesis on days 9 and 11 of life.
- Standardized surgical techniques were employed, with variations in distraction devices.
- Distraction and consolidation periods were monitored closely.
Main Results:
- Successful airway management was achieved, allowing for early extubation on day 5 and day 7.
- Oral feeding tolerance was established by day 11 and day 13.
- Patients were discharged on day 19 and day 18, respectively.
- Total mandibular distraction achieved was 19 mm and 23.45 mm, with no major complications reported.
Conclusions:
- Bilateral mandibular distraction osteogenesis is a safe and accurate primary treatment option for selected neonates with severe Pierre Robin sequence.
- Early intervention effectively addresses the underlying mandibular anomaly, preventing tracheostomy.
- The procedure leads to favorable functional outcomes and medium to long-term results.
Abstract:
Children with craniofacial abnormalities associated with retromicrognathia and glossoptosis often have compromised upper airway flow. In severe cases, emergency intubation is necessary immediately after birth, and tracheostomy is advocated to manage the airway in the neonatal period and to allow for feeding. Early intervention with bilateral mandibular osteogenesis avoids the need for tracheostomy, along with its complications, and it targets the primary etiologic factor of the problem-the anomalous anatomy of the mandible. We report two neonates with severe Pierre Robin sequence managed with bilateral mandibular distraction osteogenesis on day 9 and day 11 of life. The surgical techniques and distraction and consolidation periods were similar apart from the distraction devices used. The procedures were successful with early extubation (day 5 and day 7), oral feeding tolerance (day 11 and day 13) and hospital discharge (day 19 and day 18). Total mandibular distraction was 19 mm and 23.45 mm, respectively. No major complications were reported. Medium to long-term results were good. Bilateral mandibular distraction osteogenesis in the neonate is a safe and accurate procedure and is the primary option in cases of selected severe Pierre Robin sequence.
