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Mace EL, Krishnapura SG, Golinko M, Phillips JD, Belcher RH. Pre-Operative Characteristics Helping to Avoid Gastrostomy Tube After Mandibular Distraction in Neonates With Pierre-Robin Sequence: A Institutional Case-Series and Review of the Literature. Ann Otol Rhinol Laryngol 2024; 133:679-685. [PMID: 38712740 PMCID: PMC11179316 DOI: 10.1177/00034894241249547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE to investigate the ability of mandibular distraction osteogenesis (MDO) to avoid gastrostomy tube (G-tube). DATA SOURCES PubMed, EBSCOhost, Cochrane, and Embase. REVIEW METHODS We retrospectively reviewed the number of MDO cases performed at our institution for patients with Robin Sequence (RS) over the past 10 years. In our institutional review, patients were excluded if they had a G-tube already placed at the time of surgery. We also performed a systematic review of the literature. Articles were excluded if they did not detail feeding outcomes after MDO, or if MDO was performed on patients that did not have RS. RESULTS In our systematic review, 12 articles were included that comprised a total of 209 neonates with RS that underwent MDO. A total of 174 (83.3%) patients avoided a G-tube once MDO was performed. A total of 14 patients met the inclusion criteria at our institution. Of the 14 RS patients, 9 (64%) avoided having a G-tube placed and all (14/14) avoided tracheostomy. The average birth weight of patients avoiding a G-tube was 3.11 kg compared to 2.25 kg (P = .045) in the group requiring a G-tube. In the group avoiding a G-tube, the average weight at time of operation was 3.46 kg compared to 2.83 kg (P = .037) in the group requiring a G-tube. CONCLUSION MDO may be considered as a surgical option to prevent G-tube placement for neonates with non-syndromic RS who have difficulty with PO feeding but whose airway obstruction is not severe enough to require respiratory support. Based on our institutional experience, a minimum weight of 3.00 kg correlated with higher success rates of PO intake and avoiding a G-tube.
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Affiliation(s)
- Emily L Mace
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michael Golinko
- Vanderbilt Department of Plastic Surgery, Nashville, TN, USA
| | - James D Phillips
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Cleft and Craniofacial Program, Nashville, TN, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Cleft and Craniofacial Program, Nashville, TN, USA
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2
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Abdilahi A, Ramin S, Meyer C, Chinnadurai S, Morrell N, Tibesar R, Roby B. The Effect of Palatoplasty on Growth. Laryngoscope 2024. [PMID: 38924106 DOI: 10.1002/lary.31593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/22/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To assess the effect of palatoplasty on growth velocity in undernourished and nourished orally fed children with cleft palate. METHODS A retrospective chart review was conducted using a data query with cleft-associated ICD-10 and ICD-9 codes to identify children who underwent cleft palate repair between 2006 and 2022 at a tertiary pediatric hospital. Data gathered included demographics, admission variables, weight gain, and weight percentile as per the WHO growth chart data. Inclusion was limited to patients with complete growth data and without parenteral feeding support. Nutritional status was defined as undernourished (≤3rd percentile) and nourished (>3rd percentile). Between and within-group comparisons were made using nonparametric tests. RESULTS A total of 192 patients met the study criteria. Among undernourished patients, the median pre- and postsurgical weekly weight gain was 0.09 kg and 0.05 kg (p = <0.0001), and the median growth percentiles were 0.67% and 1.1%, respectively (p = 0.03). Among nourished patients, the median pre- and postsurgical weekly weight gain was 0.12 kg and 0.07 kg (p = <0.0001), and the median growth percentiles were 25.4% and 29.5%, respectively (p = <0.0001). The postsurgical reduction in weight gain per week was similar across nutritional status (p = 0.43), however, the nourished group demonstrated a larger increase in median growth percentile (3.3% vs. 0.23%; p = 0.03). CONCLUSION This study demonstrates that palatoplasty does not independently improve growth velocity in children who were able to maintain an oral preoperative diet. In the case of undernourished children, there was no clinically significant improvement in postoperative growth percentiles. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Abdiasis Abdilahi
- University of Minnesota Medical School-Twin Cities, Minneapolis, Minnesota, U.S.A
| | - Seth Ramin
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, U.S.A
| | - Cassandra Meyer
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
| | - Sivakumar Chinnadurai
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology, Bahir Dar University College of Health Sciences, Bahir Dar, Ethiopia
| | - Noelle Morrell
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
| | - Robert Tibesar
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
| | - Brianne Roby
- Children's Minnesota Pediatric Otolaryngology & Facial Plastic Surgery, Minneapolis, Minnesota, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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3
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Choo H, Davis AS, Bain LC, Ahn H. Weight Gain of Infants with Robin Sequence Treated Nonsurgically Using the Stanford Orthodontic Airway Plate (SOAP): 1-Year Follow-Up. Cleft Palate Craniofac J 2024:10556656241233239. [PMID: 38373407 DOI: 10.1177/10556656241233239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To identify weight gain trends of infants with Robin sequence (RS) treated by the Stanford Orthodontic Airway Plate treatment (SOAP). DESIGN Retrospective longitudinal cohort study. SETTING Single tertiary referral hospital. PATIENTS Eleven infants with RS treated with SOAP. INTERVENTIONS Nonsurgical SOAP. MAIN OUTCOME MEASURES Body weight, Weight-for-age (WFA) Z-scores, and WFA percentiles at birth (T0), SOAP delivery (T1), SOAP graduation (T2), and 12-months old (T3). RESULTS Between T0 and T1, the weight increased but the WFA percentile decreased from 36.5% to 15.1%, and the Z-score worsened from -0.43 to -1.44. From T1 to T2, the percentile improved to 22.55% and the Z-score to -0.94. From T2 to T3, the percentile and the Z-scores further improved to 36.59% and -0.48, respectively. CONCLUSIONS SOAP provided infants experiencing severe respiratory distress and oral feeding difficulty with an opportunity to gain weight commensurate with the WHO healthy norms without surgical intervention.
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Affiliation(s)
- HyeRan Choo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Neonatal and Pediatric Craniofacial Airway Orthodontics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Alexis S Davis
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Lisa C Bain
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - HyoWon Ahn
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Neonatal and Pediatric Craniofacial Airway Orthodontics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, Korea
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4
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McGhee H, Gehle D, Shope C, Wen CC, Marston AP, Discolo C, Pecha PP. Feeding Performance and Outcomes in Infants With Robin Sequence Undergoing Mandibular Distraction Osteogenesis. Cleft Palate Craniofac J 2024; 61:295-301. [PMID: 36128745 PMCID: PMC10074639 DOI: 10.1177/10556656221127542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To describe perioperative feeding performance in infants with Robin sequence (RS) who underwent mandibular distraction osteogenesis (MDO). A retrospective study of infants that underwent MDO from May 2010 to December 2019. Tertiary pediatric hospital. A total of 40 patients underwent MDO and 20 met inclusion criteria. Of the included infants, 6 had an associated syndrome and 80% were male. Time to full oral feeds, rate of G-tube placement, and change in weight percentile following MDO. Average oral intake prior to MDO was 22.1% of individual goal feeds. Among the 15 (75%) children that did not require G-tube placement, mean time to full oral feeds after MDO was 11 days ± 5.7 days, with 80% of infants reaching full oral feeds within 2 weeks after extubation. The proportion of G-tube placement in patients with a syndrome was higher than in isolated RS (-0.6; 95% CI: -1.0, -0.2). Mean percentages of weight-for-age percentile decreased during the first 3 months after the procedure. This was followed by a mean upturn in weight starting after the third month after MDO with a recovery to preoperative mean weight-for-age percentiles by 6 months after surgery. This study suggests that infants with RS may achieve full oral feeds despite poor feeding performance before MDO. Infants with syndromic RS are more likely to require G-tube. These findings may be used to inform G-tube discussion and offer a timeline to work toward goal oral feeds for infants with RS after MDO.
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Affiliation(s)
- Heather McGhee
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Gehle
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Chelsea Shope
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Chun-Che Wen
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Alexander P Marston
- Department of Otolaryngology – Head and Neck Surgery, Tufts University School of Medicine, Boston, MA, USA
| | - Christopher Discolo
- Department of Otolaryngology – Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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5
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Yi A, Brand WT, Black JS. Feeding Outcomes After Mandibular Distraction for Airway Obstruction in Infants. J Craniofac Surg 2023; 34:1640-1643. [PMID: 37431904 DOI: 10.1097/scs.0000000000009551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/22/2023] [Indexed: 07/12/2023] Open
Abstract
Robin sequence is a congenital issue resulting in airway obstruction, difficulty feeding, and failure to thrive. Mandibular Distraction Osteogenesis is used to improve airway obstruction in these patients, but little data exists characterizing feeding outcomes following surgery. This study aims to evaluate feeding outcomes and weight gain following mandibular distraction for airway correction in infants. A single-center retrospective chart review was conducted, and patients under 12 months old who underwent mandibular distraction between December 2015 and July 2021 were included in the study. The presence of cleft palate, distance of distraction, and polysomnography results were recorded. The primary outcomes were the length of distraction, need for nasogastric tube or G-tube at discharge, time lapsed to achieve full oral feeds, and weight gain (kilogram). Ten patients met the criteria. Of those 10 patients, 4 were syndromic, 7 had a cleft palate, and 4 had a congenital cardiac diagnosis. The average length of stay postsurgery was 28 days. Eight patients achieved full oral feeds in an average of 65.6 days. Five patients required nasogastric tube or G-tube at discharge, with 3 of these patients later transitioning to full oral feeds. All patients gained weight 3 months postsurgery with an average of 0.521 kg/mo. Patients who achieved full oral feeds gained an average of 0.549 kg/mo. Patients with supplementation gained an average of 0.454 kg/mo. All patients demonstrated improvement in airway obstruction with an average postoperative apnea hypopnea index of 1.64. Further investigation is necessary to identify challenges seen in feeding after mandibular distraction osteogenesis and improve care.
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Affiliation(s)
- Amber Yi
- University of Virginia School of Medicine, Charlottesville, VA
| | - William T Brand
- Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, VA
| | - Jonathan S Black
- Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville, VA
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6
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Poets CF, Wiechers C, Koos B, Muzaffar AR, Gozal D. Pierre Robin and breathing: What to do and when? Pediatr Pulmonol 2022; 57:1887-1896. [PMID: 33580741 DOI: 10.1002/ppul.25317] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/09/2023]
Abstract
Robin sequence is characterized by mandibular retrognathia, airway obstruction, and glossoptosis; 80%-90% also have a cleft palate. Various treatment approaches exist, and although controlled studies are rare, objective assessment of treatment outcomes that address the leading clinical issues, namely obstructive sleep apnea and failure to thrive, are essential. Sleep-disordered breathing may be detected using cardiorespiratory polygraphy or polysomnography. Pulse oximetry alone may miss infants with frequent obstructive apneas, yet no intermittent hypoxia. Among conservative treatment options, the Tubingen Palatal Plate with a velar extension shifting the tongue base forward is the only approach that corrects the underlying anatomy and that has undergone appropriate evaluation. Of the surgical treatment options, which are not necessarily the first line of therapy, mandibular distraction osteogenesis (MDO) is effective and has been most extensively adopted. Notwithstanding, it is puzzling that MDO is frequently used in some countries, yet hardly ever in others, despite similar tracheostomy rates. Thus, prospective multicenter studies with side-by-side comparisons aimed at identifying an optimal treatment paradigm for this potentially life-threatening condition are urgently needed.
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Affiliation(s)
- Christian F Poets
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Bernd Koos
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Arshad R Muzaffar
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, Missouri, USA
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7
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Mao Z, Battaglino R, Zhou J, Cui Y, Shrivastava M, Tian G, Sahebdel F, Ye L. The Effect of Timing of Mandibular Distraction Osteogenesis on Weight Velocity in Infants Affected by Severe Robin Sequence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030319. [PMID: 35327691 PMCID: PMC8947281 DOI: 10.3390/children9030319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022]
Abstract
Background: Impaired weight gain is prevalent in Robin Sequence (RS) newborns. Although mandibular distraction osteogenesis (MDO) has been proven to improve oral feeding, its impact on postoperative weight gain remains unclear. The purpose of this study is to explore whether MDO can help RS babies reach a normal weight, as well as the effect of MDO timing on weight velocity. Methods: One hundred infants with severe RS and one hundred with normal controls met the inclusion criteria for the study. Included patients underwent MDO. Weights at different timing points were recorded and analyzed and compared to normal controls. Results: After the distractor removal weights of patients undergoing MDO at <1 month and 1−2 months were close to the normal control (6.81 ± 0.93 kg versus 7.18 ± 0.61 kg, p = 0.012, and 6.82 ± 0.98 kg versus 7.37 ± 0.75 kg, p = 0.033, respectively), the weights of patients undergoing MDO at 2−3 months and 3−4 months still lagged behind (7.56 ± 1.29 kg versus 8.20 ± 0.61 kg, p = 0.000206 and 7.36 ± 1.05 kg versus 8.25 ± 0.77 kg, p = 0.004, respectively). The weights of all RS infants undergoing MDO showed no significant difference compared to the controls when they aged to 1 year (9.34 ± 0.99 kg versus 9.55 ± 0.45 kg, p = 0.254 for MDO at <1 month; 9.12 ± 0.91 kg versus 9.33 ± 0.46 kg, p = 0.100 for MDO at 1 to 2 months; 9.38 ± 0.29 kg versus 9.83 ± 0.53 kg, p = 0.098 for MDO at 2 to 3 months; and 9.38 ± 0.29 kg versus 9.83 ± 0.53 kg, p = 0.098 for MDO at 3 to 4 months). Conclusion: The MDO procedure helped patients with severe RS to reach a normal weight; and MDO intervention was recommended at an early stage for early weight gain.
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Affiliation(s)
- Zhe Mao
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Ricardo Battaglino
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA; (R.B.); (F.S.)
| | - Jiawei Zhou
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Yingqiu Cui
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Mayank Shrivastava
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Gabriel Tian
- Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510623, China; (Z.M.); (J.Z.); (Y.C.); (G.T.)
| | - Faezeh Sahebdel
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA; (R.B.); (F.S.)
| | - Liang Ye
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA; (R.B.); (F.S.)
- Correspondence:
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8
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Choo H, Galera RI, Balakrishnan K, Lin HFC, Ahn H, Lorenz P, Khosla RK, Profit J, Poets CF, Lee JS. Disruptive Therapy Using a Nonsurgical Orthodontic Airway Plate for the Management of Neonatal Robin Sequence: 1-Year Follow-up. Cleft Palate Craniofac J 2022; 60:758-767. [PMID: 35167404 DOI: 10.1177/10556656221076980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We recently published the 3-month follow-up of 2 neonates with Robin sequence whose mandibular hypoplasia and restricted airway were successfully treated with an orthodontic airway plate (OAP) without surgical intervention. Both infants were successfully weaned off the OAP after several months of continuous use. We present the course of OAP treatment in these patients with a focus on breathing, feeding, and facial growth during their first year of life. Both infants demonstrated stable mandibular projection, resolution of obstructive sleep apnea, and normal development.
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Affiliation(s)
- HyeRan Choo
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rhona I. Galera
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Karthik Balakrishnan
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hung-Fu C. Lin
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - HyoWon Ahn
- KyungHee University Dental Hospital, Seoul, Korea
| | - Peter Lorenz
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rohit K. Khosla
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jochen Profit
- Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Janice S. Lee
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
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9
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Wiechers C, Iffländer R, Gerdes R, Ciuffolotti M, Arand J, Weise C, Peters K, Grandke B, Reinert S, Koos B, Poets CF. Retrospective study on growth in infants with isolated Robin sequence treated with the Tuebingen Palate Plate. Orphanet J Rare Dis 2021; 16:338. [PMID: 34344420 PMCID: PMC8335857 DOI: 10.1186/s13023-021-01959-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Robin sequence (RS) are at risk of growth failure, mainly due to their increased work of breathing and feeding difficulties. Various conservative and surgical treatment approaches exist, but their impact on weight gain has not yet been adequately addressed. A functional treatment concept, used in our center for > 20 years, includes a pre-epiglottic baton plate (Tuebingen palatal plate) and intensive feeding training. OBJECTIVE To investigate the effect of the Tuebingen treatment protocol on growth and weight trajectories during infancy. METHODS This retrospective study analyzed longitudinal data from infants with isolated RS admitted to Tuebingen University Children's Hospital, Germany between 1998 and 2019. Through our electronic patient database, we evaluated anthropometric parameters until reaching 1-year follow-up. Results are shown as median (IQR). RESULTS In 307 infants analyzed, median Z-score for weight decreased from - 0.28 at birth to - 1.12 upon admission to our center at a median age of 22 days. Z-score then remained largely unchanged until discharge (Z-score difference, - 0.08), while the proportion of infants receiving tube feedings decreased from 55.1 to 13.7%. Z-score subsequently increased from - 1.17 at discharge to - 0.44 at the 1-year follow-up (p < 0.001). CONCLUSION Based on a comparatively large cohort, this functional treatment was associated with better weight gain and improved feeding. As RS infants often show postnatal growth failure, weight monitoring may be a valuable parameter for monitoring treatment effectiveness. Clinical Trial Registration Not necessary due to the retrospective design.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Regina Iffländer
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Rieke Gerdes
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Melissa Ciuffolotti
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Jörg Arand
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Christina Weise
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Katharina Peters
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bärbel Grandke
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Siegmar Reinert
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Craniofacial Surgery, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany. .,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.
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10
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Soto E, Ananthasekar S, Kurapati S, Robin NH, Smola C, Maddox MH, Boyd CJ, Myers RP. Mandibular Distraction Osteogenesis as a Primary Intervention in Infants With Pierre Robin Sequence. Ann Plast Surg 2021; 86:S545-S549. [PMID: 33833161 PMCID: PMC8601586 DOI: 10.1097/sap.0000000000002702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pierre Robin sequence (PRS) is a triad of congenital facial abnormalities that can present as a syndrome (syndromic PRS [sPRS]) or an isolated entity (isolated PRS [iPRS]). Patients with PRS can develop airway and feeding problems that may result in failure to thrive. Mandibular distraction osteogenesis (MDO) is a method for improving the functional issues associated with breathing and feeding. There is a Paucity of literature evaluating the outcomes of MDO between sPRS and iPRS patients. METHODS An institutional review board-approved retrospective review of PRS patients managed by a single surgeon and treated with MDO between January 2015 and December 2019 at a tertiary referral hospital was performed. The patients were stratified into iPRS or sPRS based on gene testing. Airway outcome measures included avoidance of tracheostomy, relief of sleep apnea, and oxygen saturation improvement. Primary feeding measures included achievement of full oral feeds and growth/weight gain. Statistical analysis included t tests and χ2 tests where appropriate using SPSS. RESULTS Over the study period, of the 29 infants with PRS, 55% identified as iPRS and 45% as sPRS. There were no significant differences in the patient characteristics, apnea-hypoxia index (22.27 ± 12.27) and laryngeal view (3 ± 0.79) pre-MDO. After MDO, 83% of the subjects achieved a positive feeding outcome and 86% achieved a positive airway outcome with no statistical significance between sPRS and iPRS (P = 0.4369). There was a statistically significant change post-MDO in apnea-hypoxia index (5.24 ± 4.50, P = 0.02) and laryngeal view (1.59 ± 1.00, P = 0.01). CONCLUSIONS Our recent experience would lead us to believe that sPRS patients have greater morbidities and challenging clinical developments that, when properly evaluated, can be managed by MDO. There is a potential role for MDO in reducing the need for traditional surgical interventions for respiratory and feeding problems in both iPRS and sPRS patients.
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Affiliation(s)
- Edgar Soto
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Srikanth Kurapati
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Nathaniel H. Robin
- Department of Genetics, University of Alabama at Birmingham School of Medicine
| | - Cassi Smola
- Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mary Halsey Maddox
- Division of Pediatric Pulmonary & Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Carter J. Boyd
- Division of Plastic Surgery, New York University, New York, NY
| | - René P. Myers
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL
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