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Neonatal Mandibular Distraction Osteogenesis in Infants With Pierre Robin Sequence
Gustave K Diep1, Bradley S Eisemann, Roberto L Flores
1Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.
Insights
Neonatal mandibular distraction osteogenesis effectively treats severe Pierre Robin sequence airway obstruction, avoiding tracheostomy. This surgical technique requires precise execution for optimal outcomes in infants.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Neonatal Medicine
Background:
- Pierre Robin sequence involves micrognathia, glossoptosis, and airway obstruction, posing risks to infant feeding, growth, and respiration.
- Severe airway obstruction in Pierre Robin sequence often necessitates intervention to prevent critical complications.
Purpose of the Study:
- To detail the technique and outcomes of neonatal mandibular distraction osteogenesis for severe Pierre Robin sequence.
- To provide a guide for performing this uncommon but effective neonatal surgical procedure.
Main Methods:
- Overview of Pierre Robin sequence and its management challenges.
- Detailed description of neonatal mandibular distraction osteogenesis surgical technique with video demonstrations.
- Presentation of institutional protocol and long-term case outcome analysis.
Main Results:
- Neonatal mandibular distraction osteogenesis successfully alleviates tongue-based airway obstruction.
- The procedure can effectively avoid the need for tracheostomy in affected infants.
- Long-term outcomes demonstrate the efficacy and safety of the surgical approach.
Conclusions:
- Neonatal mandibular distraction osteogenesis is a crucial intervention for severe Pierre Robin sequence.
- Mastery of surgical technique is paramount for successful outcomes and complication avoidance.
- This procedure offers a viable alternative to tracheostomy, improving infant respiratory and developmental trajectories.
Abstract:
Pierre Robin sequence is the constellation of micrognathia, glossoptosis, and tongue-based airway obstruction. When airway obstruction is severe, feeding, growth, and respiratory demise are at risk. Neonatal mandibular distraction osteogenesis is a technique which improves tongue-based airway obstruction and avoids tracheostomy in patients with severe expressions of Pierre Robin sequence. Its efficacy in relieving airway obstruction is well documented, and it has become the surgical intervention of choice at many craniofacial centers. However, this is an uncommon procedure which can be performed within the first weeks of life, offering little space for a learning curve. The success of neonatal distraction and avoidance of complications is highly dependent on proper surgical technique. This report provides a brief overview of the disease, details the technique of the senior surgeon with captioned videos, describes the protocol used at our institution and reports long-term outcomes with a case description.
