Massive Mandibular Advancement With Bilateral Sagittal Split Osteotomy and Rib Bone Grafts for Pierre Robin Sequence

Pierre Robin sequence (PRS) is characterized by micrognathia, glossoptosis, and airway obstruction, and it often requires early airway management. Mandibular distraction osteogenesis is commonly performed during infancy, but residual micrognathia, occlusal problems, and aesthetic concerns may persist into adulthood. However, reoperation on previously distracted mandibles can be challenging due to scarring, thin mandibular bone, and altered anatomy. We report the case of a 19-year-old man with PRS who had undergone 2 mandibular distraction osteogenesis procedures during infancy, yet continued to have severe micrognathia, obstructive sleep apnea, and dissatisfaction with his facial profile. A surgery-first, 2-jaw orthognathic approach was adopted, aiming for both functional and aesthetic improvements. The treatment included a Le Fort I osteotomy with posterior impaction and clockwise rotation of the maxilla, and a 20-mm mandibular advancement using bilateral sagittal split osteotomy with rib bone grafts to bridge gaps and reinforce stability. The procedure immediately improved the patient's airway function, facial aesthetics, and occlusion, with postoperative orthodontics successfully achieving proper overjet and overbite, resulting in a stable functional occlusion. At 1-year follow-up, the patient was seen to have stable and satisfactory occlusion, significant aesthetic enhancement, and resolution of obstructive sleep apnea symptoms, with a reduced apnea-hypopnea index. This case suggests that surgery-first, 2-jaw surgery with rib bone grafting is a feasible option for adult patients with PRS with prior distraction osteogenesis. After careful planning and execution, it resulted in both functional and aesthetic benefits in this case.