Laryngoscopy Grade Improvement and Difficult Airway Resolution in Infants With Robin Sequence Undergoing Mandibular...

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Pediatric Airway Management

Background:

• Robin Sequence (RS) is characterized by tongue-based airway obstruction, often leading to difficult airways and obstructive sleep apnea (OSA).
• Mandibular distraction osteogenesis (MDO) is a surgical technique used to advance the mandible, aiming to alleviate airway obstruction in infants with RS.

Purpose of the Study:

• To evaluate the effectiveness of MDO in improving direct laryngoscopy grade (DLG) and resolving difficult airway (DA) designations in infants with RS.
• To assess the impact of MDO on polysomnographic parameters for OSA and other clinical outcomes.

Main Methods:

• Retrospective cohort analysis of 64 infants with RS who underwent MDO in their first year of life across three tertiary care institutions.
• Primary outcome: DLG pre- and post-MDO. Secondary outcomes: DA designation, OSA assessment (apnea-hypopnea index), length of stay, gastrostomy, and adverse events.

Main Results:

• Median DLG improved from II to I post-MDO (n=43, P < .001).
• Difficult airway designation decreased from 47% to 18% (n=55, P < .01), with some cases potentially over-retained.
• Obstructive apnea-hypopnea index significantly improved from 38.6 to 2.9 (n=12, P = .002).

Conclusions:

• MDO leads to stable improvement in DLG and functional resolution of OSA in infants with RS, with minimal morbidity.
• While MDO is effective, careful review of electronic health records is needed to correct persistent difficult airway designations post-operatively.