Focused Investigation of Facial Nerve Dysfunction After Mandibular Distraction Osteogenesis for Robin Sequence

Facial nerve dysfunction (FND) is a well-recognized but poorly documented complication of mandibular distraction osteogenesis (MDO) for Robin sequence (RS). This study aims to document the authors' experiences with FND and identify risk factors associated with this adverse event. A retrospective review of a prospectively gathered database was performed to identify patients with RS who underwent MDO at the authors' institution from March 2016 to June 2023. The authors included all infants with at least 3 months of follow-up after device removal. Data collected included patient demographics, incidence, laterality and onset of FND, and time to resolution. Thirty-six patients met the inclusion criteria. The median age at MDO was 2.7 (interquartile range: 0.7, 129) months. The median latency, distraction, and consolidation phases were 3.0 days, 17.5 days, and 77.5 days, respectively. The median length of distraction was 19.8 (interquartile range: 11, 30) mm. Thirteen infants (36.1%) demonstrated FND. While the majority (n = 10, 27.8%) experienced temporary palsy with a mean time to resolution of 98.6 (± 124.3) days, 3 infants (8.3%) had persistent FND at a mean of 29.3 (±35.6) months after hardware removal. The majority of FND occurred during the distraction phase and involved the marginal mandibular nerve. The current study demonstrated that over 1/3 of patients with RS experience FND after MDO. Most cases of FND were transient and occurred during the active distraction phase.