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Outcome Following Surgical Interventions for Micrognathia in Infants With Pierre Robin Sequence: A Systematic Review
Insights
Mandibular distraction osteogenesis (MDO) shows the lowest rate of persistent airway obstruction in infants with Pierre Robin sequence (PRS) compared to tongue-lip adhesion (TLA). Standardized polysomnography (PSG) is crucial for assessing outcomes.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Sleep Medicine
Background:
- Pierre Robin sequence (PRS) infants often present with severe airway obstruction.
- Common surgical interventions include tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and subperiosteal release of the floor of the mouth (SPRFM).
Purpose of the Study:
- To evaluate the failure rates of TLA, MDO, and SPRFM in PRS infants.
- To compare postoperative airway obstruction using polysomnography (PSG) data across these procedures.
- To assess mortality and tracheostomy rates associated with each surgical approach.
Main Methods:
- A comprehensive literature search was conducted using PubMed (1981-2015).
- Data extracted included diagnosis, surgical procedure, mortality, tracheostomy need, and PSG results.
- Significant airway obstruction postoperatively was defined as an apnea-hypopnea index >15 events/h on PSG.
Main Results:
- Mortality and tracheostomy rates were low across all procedures.
- Mandibular distraction osteogenesis (MDO) demonstrated the lowest incidence of significant postoperative airway obstruction (3.6%).
- Tongue-lip adhesion (TLA) had a significantly higher rate (50%), with insufficient PSG data for SPRFM.
Conclusions:
- There is a lack of objective PSG data for assessing postoperative airway outcomes in PRS.
- MDO appears to be the most effective surgical technique based on available PSG data.
- Standardized PSG use can improve the identification and management of infants at risk for suboptimal airway outcomes.
Background:
Tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and subperiosteal release of the floor of the mouth (SPRFM) are the most commonly performed surgical procedures to treat severe airway obstruction in infants born with Pierre Robin sequence (PRS).
Objectives:
To determine the rate of failure of each type of procedure, in terms of mortality and the need for tracheostomy, and to determine what proportion of infants have significant airway obstruction postoperatively as determined by polysomnography (PSG) and compare the data by procedure type.
Method:
A comprehensive literature search (1981 through June 2015) was done of the National Library of Medicine database using PubMed. Extracted data included diagnosis, type of surgery, and outcome including mortality, need for postoperative tracheostomy and details of PSG. Persistence of significant airway obstruction was defined as an apnea-hypopnea index >15 events/h on PSG.
Results:
Both mortality rate and need for tracheostomy were low for all procedures. Many studies lacked sufficient detail to identify significant airway obstruction postoperatively. In studies with sufficient data, MDO was associated with the lowest percentage of significant airway obstruction postprocedure (3.6%) compared to 50% for infants who underwent TLA. Insufficient PSG data was available for patients who were treated with SPRFM.
Conclusions:
There is a paucity of objective PSG data to definitively assess postoperative airway outcomes for PRS. MDO appears to be the most effective technique based on the available PSG data. Standardized use of PSG may lead to better identification and treatment of patients at risk for suboptimal airway outcomes postoperatively.
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