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Defining failure and its predictors in mandibular distraction for Robin sequence.

Roberto L Flores1, S Travis Greathouse1, Melinda Costa1

  • 1Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA.

Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
|July 25, 2015
PubMed
Summary

Predicting mandibular distraction osteogenesis (MDO) failure in Robin sequence (RS) is crucial. This study developed a scoring system using variables like age, neurologic anomalies, and pre-operative intubation to identify patients at higher risk for MDO complications.

Keywords:
Avoidance of tracheostomyMandibular distraction osteogenesisPierre Robin sequencePredictors of failure

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Area of Science:

  • Craniofacial Surgery
  • Pediatric Otolaryngology
  • Neonatal Care

Background:

  • Robin sequence (RS) is characterized by micrognathia, glossoptosis, and airway obstruction.
  • Mandibular distraction osteogenesis (MDO) is a common surgical intervention for RS.
  • Defining MDO failure is complex and impacts outcome assessment.

Purpose of the Study:

  • To identify variables associated with MDO failure in patients with Robin sequence.
  • To develop and evaluate a scoring system for predicting MDO failure.
  • To improve the reporting of surgical outcomes for MDO in RS.

Main Methods:

  • Retrospective analysis of a neonatal MDO patient database.
  • Defined failure outcomes: tracheostomy, persistent apnea-hypopnea index (AHI) >20, and mortality.
  • Utilized bivariate and regression analyses to identify significant predictors and construct scoring systems.

Main Results:

  • Gastroesophageal reflux, age >30 days, neurologic anomalies, certain airway anomalies, intact palate, and pre-operative intubation were associated with MDO failure.
  • Developed multiple predictive scoring systems with good sensitivity, specificity, and predictive values.
  • Incomplete improvement of AHI represented a significant failure outcome in half of the patients.

Conclusions:

  • When reporting MDO outcomes in RS, consider both tracheostomy avoidance and AHI improvement.
  • The developed scoring systems can aid in predicting MDO failure and guiding clinical management.
  • Further validation on a prospective dataset is planned to refine the predictive models.