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Mandibular distraction for Robin sequence associated with laryngomalacia
Sunil S Tholpady1, Melinda Costa, Ivan Hadad
1*Division of Plastic Surgery †Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN ‡Department of Plastic Surgery, University of Wisconsin-Milwaukee, Milwaukee, WI §Department of Plastic Surgery, NYU Langone Medical Center, New York, NY.
Mandibular distraction osteogenesis (MDO) can successfully treat airway obstruction in infants with Robin sequence and laryngomalacia. This approach significantly reduces the need for tracheostomy, improving outcomes for affected infants.
Area of Science:
- Pediatric surgery
- Craniofacial surgery
- Otolaryngology
Background:
- Robin sequence (RS) management traditionally excludes mandibular distraction osteogenesis (MDO) in infants with laryngomalacia.
- This study investigates the institutional experience of MDO in infants with RS and concurrent laryngomalacia.
Purpose of the Study:
- To evaluate the efficacy and safety of MDO in infants with Robin sequence and laryngomalacia.
- To assess the impact of MDO on upper airway obstruction and tracheostomy requirements.
Main Methods:
- Retrospective review of 11 infants with RS and laryngomalacia who underwent MDO between 2005-2013.
- Exclusion of patients with airway anomalies other than laryngomalacia.
- Preoperative and postoperative apnea-hypopnea index (AHI) and tracheostomy status were primary outcome measures.
Main Results:
- MDO significantly reduced the mean AHI from 46.1 to 4.1 (P = 0.002).
- All patients initially without tracheostomy avoided it post-MDO.
- One patient with prior tracheostomy was successfully decannulated.
Conclusions:
- MDO is a viable treatment for upper airway obstruction in infants with RS and laryngomalacia.
- Collaborative care with pediatric otolaryngologists and laryngomalacia treatment are crucial for successful tracheostomy avoidance.
