Early Adverse Events Following Pediatric Mandibular Advancement: Analysis of the ACS NSQIP-Pediatric Database

Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford orthodontic airway plate treatment

STUDY OBJECTIVES

Severe respiratory distress of neonates with Robin sequence is traditionally managed by surgery. Stanford orthodontic airway plate treatment (SOAP) is a nonsurgical option. The study aimed to determine whether SOAP can improve polysomnography parameters of neonates with Robin sequence.

METHODS

Polysomnography of neonates with Robin sequence treated with SOAP at a single hospital were retrospectively analyzed. Patients without polysomnography at all 4 time points (pre, start of, mid, and posttreatment) were excluded. Data were analyzed using a linear mixed effects model.

RESULTS

Sixteen patients were included. All patients had cleft palate. The median age (minimum, maximum) at the start of treatment was 1.1 months (0.3, 5.1) with the treatment duration of 4.5 months (3.5, 6.0). The mean obstructive apnea-hypopnea index (95% confidence interval) decreased from 39.3 events/h (32.9, 45.7) to 12.2 events/h (6.7, 17.7) (P < .001), obstructive apnea index decreased from 14.1 (11.2, 17.0) events/h to 1.0 (-1.5, 3.5) events/h (P < .001), and oxygen nadir increased from 79.9% (77.4, 82.5) to 88.2% (85.5, 90.8) (P < .001) between pre and start of treatment. Respiratory improvements were sustained during and after the treatment. All patients avoided mandibular distraction osteogenesis or tracheostomy following SOAP.

CONCLUSIONS

As being a rare diagnosis, the number of participants was, as expected, low. However, the current study shows that SOAP can improve polysomnography parameters, demonstrating its potential utility before surgical interventions for neonates with Robin sequence and cleft palate experiencing severe respiratory distress.

CITATION

Choo H, Sidell DR, Kim J-W, Ahn H-W, Day HS, Sullivan SS. Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford orthodontic airway plate treatment. J Clin Sleep Med. 2024;20(11):1807-1817.

Craniofacial Distraction Osteogenesis

Distraction osteogenesis (DO) of the craniofacial skeleton has become an effective technique for the treatment of both nonsyndromic and syndromic conditions. The advent of craniofacial DO has allowed for earlier intervention in pediatric patients with less complication risk and morbidity compared to traditional techniques. In this review, we will discuss current application and technique for craniofacial DO by anatomical region and explore future applications in craniofacial surgery.

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

BACKGROUND

Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications.

METHODS

We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications.

RESULTS

The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009).

CONCLUSION

Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations.