Mandibular Distraction Osteogenesis for Pierre Robin Sequence in Early Infancy: A Systematic Review

Area of Science:

• Craniofacial Surgery
• Pediatric Airway Management
• Surgical Protocols

Background:

• Pierre Robin Sequence (PRS) involves micrognathia, glossoptosis, and airway obstruction.
• Neonatal management is established, but post-neonatal surgical guidelines are lacking.
• This review focuses on mandibular distraction osteogenesis (MDO) treatment algorithms.

Purpose of the Study:

• To evaluate published treatment algorithms for MDO in PRS.
• To identify common decision-making criteria for MDO.
• To propose a unified MDO algorithm based on literature.

Main Methods:

• PRISMA guidelines were followed for a literature search.
• Studies describing MDO treatment algorithms or protocols were included.
• 23 out of 275 identified studies met the inclusion criteria.

Main Results:

• Non-invasive airway management and polysomnography (PSG) with an Apnea-Hypopnea Index (AHI) > 20 guided decisions.
• Mandibular distraction osteogenesis (MDO) was favored over tongue-lip adhesion (TLA) in 16 studies.
• MDO interventions typically occurred in early infancy (mean age 100 days).

Conclusions:

• Algorithm-based PRS management prioritizes early PSG, conservative trials, and MDO.
• MDO is the preferred surgical option for airway obstruction in PRS.
• Further research is needed to refine MDO success criteria and optimize post-neonatal care.