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Adverse Outcomes After Mandibular Distraction Osteogenesis in Robin Sequence.

Lucas R Perez Rivera1, Rebecca C Lisk, Rami S Kantar

  • 1Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.

The Journal of Craniofacial Surgery
|June 2, 2026
PubMed
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Adverse outcomes after mandibular distraction osteogenesis (MDO) for Robin sequence are linked to comorbidities. Central nervous system anomalies predict mortality, while airway and cardiopulmonary issues predict tracheostomy and ICU admission.

Area of Science:

  • Craniofacial Surgery
  • Pediatric Otolaryngology
  • Neonatal Care

Background:

  • Mandibular distraction osteogenesis (MDO) is crucial for treating airway obstruction in Robin sequence.
  • Previous outcome analyses were limited by small, single-institution data.
  • A large, multicenter database is needed to identify MDO outcome predictors.

Purpose of the Study:

  • To identify predictors of morbidity and mortality in patients with Robin sequence undergoing MDO.
  • To analyze associations between patient factors and postoperative outcomes.
  • To inform surgical decision-making by understanding risk factors.

Main Methods:

  • Retrospective cohort study using the Epic Cosmos multicenter database (2015-2024).
  • Included 685 patients with Robin sequence undergoing MDO.
Keywords:
Airway obstructionPierre Robin syndromedistractionglossoptosismicrognathismosteogenesis

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  • Multivariable logistic regression analyzed perinatal factors, airway anomalies, genetic syndromes, and congenital anomalies (cardiopulmonary, GI, CNS) against outcomes like mortality, tracheostomy, ICU admission, readmission, ED visits, and length of stay (LOS).

    • Main Results:

    • Central nervous system (CNS) anomalies significantly predicted 1-year mortality and 30-day emergency department visits.
    • Cardiopulmonary anomalies and bronchomalacia predicted tracheostomy.
    • Tracheal stenosis was associated with ICU admission.
    • No factors predicted 30-day readmission.
    • Younger age at surgery correlated with shorter ICU and overall hospital LOS; prematurity, prenatal drug exposure, GER, and CNS anomalies correlated with longer overall LOS.

    Conclusions:

    • Comorbidities, particularly CNS, airway, and cardiopulmonary anomalies, significantly impact MDO outcomes in Robin sequence.
    • Identifying these comorbidities can help surgeons anticipate and manage potential adverse events.
    • This study provides crucial insights for optimizing care in this vulnerable patient population.