Comparative Analysis of Surgical Outcomes of Mandibular Distraction Osteogenesis in Isolated Pierre Robin Sequence and Syndromic Micrognathia

Abstract

Background:

Bilateral mandibular distraction osteogenesis (MDO) has been used successfully to treat children with upper airway obstruction secondary to micrognathia associated with isolated Pierre Robin sequence (iPRS). Clinical benefit of distraction has not been as evident in syndromic children with micrognathia. The purpose of this study is to evaluate surgical outcomes of bilateral MDO in individuals with iPRS compared to those with micrognathia and an associated syndromic diagnosis.

Methods:

Retrospective cohort study designed and implemented at 2 academic medical centers. Inclusion criteria included diagnosis of micrognathia and Pierre Robin Sequence and/or a genetic syndrome as determined by genetic testing and underwent bilateral MDO between 1/1/2007 and 1/31/2024. The primary predictor variable was the primary craniofacial associated diagnosis: iPRS or micrognathia with syndromic association. Primary outcome variable is surgical success defined by de-cannulation after MDO and improvement in apnea-hypopnea index (AHI). Secondary outcome variables include complications: dental, growth, surgical.

Results:

Bilateral MDO achieved decannulation in (5/5; 100%) of iPRS patients compared to (4/10; 40%) of micrognathic patients with syndromic association (P < .01). Similar reduction in AHI after bilateral MDO was found between the iPRS (−17.7 ± 5.6) and syndromic (−11.2 ± 14.8) cohorts (P = .29). The most common specific complications of the final cohort were missing teeth (56.5%%), malformed teeth (47.8%%), and altered eruption (47.8%).

Conclusions:

Bilateral MDO is more successful at achieving decannulation in iPRS patients compared to micrognathic patients with syndromic association. Mean reduction in AHI after bilateral MDO is similar in iPRS patients compared to syndromic patients. There is no difference in complication rates between iPRS and micrognathic syndromic patients after bilateral MDO, but overall dental complication rates are high (78.3%).