Mandibular Distraction Osteogenesis vs. Tracheostomy in the Management of Pierre Robin Sequence: A Systematic Review...

Area of Science:

• Craniofacial Surgery
• Pediatric Airway Management
• Surgical Innovation

Background:

• Severe airway obstruction is a critical challenge in patients with Pierre Robin Sequence (PRS).
• Current management strategies include tracheostomy and mandibular distraction osteogenesis (MDO).
• Comparative effectiveness data for these interventions in PRS is limited.

Purpose of the Study:

• To systematically compare the efficacy of MDO versus tracheostomy in managing severe airway obstruction in PRS patients.
• To evaluate differences in airway management, feeding outcomes, and healthcare costs between MDO and tracheostomy.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Comprehensive literature searches across major databases (PubMed, Scopus, Web of Science, etc.) up to May 2024.
• Quality assessment of included studies using the Newcastle-Ottawa Scale.

Main Results:

• MDO, particularly the MDO-first approach, demonstrated significantly better airway outcomes compared to tracheostomy.
• MDO significantly reduced the requirement for gastrostomy tube (G-tube) placement.
• MDO was associated with substantially lower hospital costs, though hospital stay duration was not significantly different.

Conclusions:

• Mandibular distraction osteogenesis (MDO) presents a superior treatment option for severe airway obstruction in Pierre Robin Sequence (PRS) patients.
• MDO offers advantages in airway management, reduced need for feeding tubes, and significant cost savings.
• Further large-scale studies within homogenous syndromic groups are recommended to confirm these findings.