Surgical Management Options for Infants with Pierre Robin Sequence: Establishing a Standard.

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Pediatric Airway Management

Background:

• Pierre Robin sequence (PRS) management lacks a definitive surgical standard.
• Infants with PRS often experience significant airway obstruction and feeding difficulties.

Purpose of the Study:

• To compare the efficacy of mandibular distraction osteogenesis (MDO) versus tracheostomy-less airway (TLA) procedures in infants with PRS.
• To evaluate recent data on airway and feeding outcomes for PRS infants undergoing MDO or TLA.

Main Methods:

• A systematic literature review of studies published since 2018 was conducted.
• Included studies focused on MDO and/or TLA efficacy in infants with PRS, with primary outcomes including polysomnography metrics and oral feeding achievement.
• Exclusion criteria involved studies with fewer than 10 participants, non-primary procedures, or follow-up shorter than one year.

Main Results:

• MDO significantly improved apnea-hypopnea index (AHI) and oxygen saturation nadir, unlike TLA.
• 100% of infants in MDO studies achieved oral feeds within one month, compared to 42.5% at nine months in a TLA study.
• MDO demonstrated lower reoperation and gastrostomy rates, with comparable tracheostomy avoidance and growth outcomes to TLA.

Conclusions:

• Mandibular distraction osteogenesis (MDO) provides superior resolution of upper airway obstruction in PRS infants compared to tracheostomy-less airway (TLA).
• MDO results in more stable airway resolution, evidenced by lower reoperation rates.
• MDO is also superior for achieving full oral feeds and avoiding gastrostomy in PRS patients.