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Magge HN, Schild SD, Mantilla-Rivas E, Landry EC, Afsar NM, Behzadpour HK, Manrique M, Rana MS, Oh AK, Reilly BK. Trends in Natural Decannulation in Patients with Robin Sequence: A Twenty-five Year Retrospective Review. Ann Otol Rhinol Laryngol 2024; 133:69-77. [PMID: 37497838 DOI: 10.1177/00034894231187290] [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: 07/28/2023]
Abstract
OBJECTIVE Robin sequence (RS) consists of micrognathia and glossoptosis that result in upper airway obstruction (UAO). In RS patients who undergo tracheostomy, long-term goals include natural decannulation (ND) without further surgical airway intervention. The objective of this study was to identify long-term trends in the rate and length of time to ND. METHODS Retrospective chart review on 144 patients with RS treated from 1995 to 2020 at a pediatric tertiary care center. Patients were grouped by year of tracheostomy. Demographic data, UAO management, postoperative care, complications, and time to decannulation were recorded. RESULTS Thirty-six patients met the inclusion criteria. Tracheostomy was performed at a median age of 45.5 days. 19 (53%) patients experienced ND at a median time of 66.1 months. ND rate was higher in non-syndromic patients (93% non-syndromic vs 27% syndromic; P < .0001) and during the first study period (1995-2006: 78%, 2007-2020: 28%; P = .003). Cox proportional-hazard regression demonstrated that white race [aHR 0.15 (0.03-0.8); P = .023] and higher birthweight [aHR 0.9 (0.8-0.98); P = .018] were associated with a higher likelihood of ND while a syndromic diagnosis had a negative association with ND [aHR 12.5 (3.3-50.0); P < .001]. CONCLUSIONS Our study documented that ND in patients with RS who underwent tracheostomy was significantly associated with ethnicity, birthweight, and syndromic status. The negative impact on successful ND was most observed in patients with syndromic associations. Additionally, ND rates are lower in the 2007 to 2020 subgroup. We suspect this is because alternative management techniques such as tongue lip adhesion and mandibular distraction osteogenesis became primary surgical treatment in severe RS upper airway obstruction at our institution starting in 2007.
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Affiliation(s)
- Hari N Magge
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sam D Schild
- Division of Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Evie C Landry
- Division of Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Nina M Afsar
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Division of Surgery, Children's National Hospital, Washington, DC, USA
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Brian K Reilly
- Division of Otolaryngology, Children's National Hospital, Washington, DC, USA
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2
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Bakeman AE, Shaffer AD, Tobey ABJ, Jabbour N, Ford MD, Goldstein JA, Simons JP. Prevalence and Management of Laryngomalacia in Patients With Pierre Robin Sequence. Cleft Palate Craniofac J 2023; 60:1395-1403. [PMID: 35668613 DOI: 10.1177/10556656221107298] [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: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the prevalence and presentation of laryngomalacia and efficacy of supraglottoplasty (SGP) in a cohort of patients with Pierre Robin Sequence (PRS). DESIGN Retrospective cohort study. SETTING Tertiary-care children's hospital. PATIENTS, PARTICIPANTS Consecutive patients with PRS born between January 2010 and June 2018. MAIN OUTCOME MEASURES Chart review included demographics, comorbid airway obstruction including laryngomalacia, timing of surgical interventions, clinical symptoms, sleep study data, and modified barium swallow study data. 126 patients with PRS were included; 54% had an associated syndrome, 64% had an overt cleft palate, and 22% had a submucous cleft palate. 64/126 were noted to have laryngomalacia (51%). Patients with concurrent PRS and laryngomalacia were significantly more likely to have submucous cleft palate (P = .005) and present with aspiration with cough (P = .01) compared to patients with PRS without laryngomalacia. Patients with concurrent laryngomalacia and PRS showed a significant decrease in apnea-hypopnea index (AHI) and obstructive AHI (OAHI) after mandibular distraction, with a median AHI and OAHI improvement of 22.3 (P = .001) and 19.8 (P = .002), respectively. Patients who underwent only SGP did not show significant improvement in these parameters (P = .112 for AHI, P = .064 for OAHI). The prevalence of laryngomalacia in our PRS cohort was 51%. Patients with PRS and laryngomalacia are more likely to present with overt aspiration compared to patients with PRS without laryngomalacia. These data support that laryngomalacia does not appear to be a contraindication to pursuing MDO.
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Affiliation(s)
- Anna E Bakeman
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Allison B J Tobey
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Noel Jabbour
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matthew D Ford
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jeffrey P Simons
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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3
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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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4
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Severity of Airway Obstruction May Not Correlate With Weight Gain or Failure to Thrive in Infants With Robin Sequence: A Pilot Study. J Craniofac Surg 2021; 32:2180-2183. [PMID: 33770040 DOI: 10.1097/scs.0000000000007633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Patients with Robin sequence (RS) can present with varying degrees of upper airway obstruction, difficulty maintaining adequate weight gain, and failure to thrive (FTT). Although inductive reasoning would suggest that these issues should be interrelated, the relationships between these factors have not been formally studied. This investigation explores the correlation between polysomnographic (PSG) findings, weight gain, and FTT in patients with RS. DESIGN A prospective database for baseline PSG parameters and serial weight measurements in infants with RS who were admitted for airway obstruction was reviewed. The association between PSG variables and calorie intake with FTT was assessed using univariate and multivariable logistic regression. Categorical analysis of the PSG variables against FTT was explored with a Poisson regression, and linear regression was performed to evaluate the correlation between PSG parameters and percentage of weight gain. RESULTS Univariate and multivariate logistic regression in RS patients with (n = 13) and without (n = 20) FTT showed no significant association between apnea-hypopnea index (adjusted odds ratio [aOR]: 0.99, P-value = 0.403), O2 nadir (aOR: 0.98, P-value = 0.577), time of O2 saturation below 90% (aOR: 1.03, P-value = 0.574), maximum end tidal carbon dioxide (aOR: 1.0, P-value = 0.977), and average calorie intake (OR:1.02; P-value = 0.984). Furthermore, no significant associations were identified between these variables and weight gain. CONCLUSIONS This pilot study questions the widely held and intuitively logical belief that poor weight gain and/or FTT should correlate with the severity of upper airway obstruction in patients with RS. Large prospective investigations should be initiated to better explore the authors' findings. Our results also underscore the importance of individualized treatment for these challenging patients.
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5
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Santoro M, Coi A, Barišić I, Pierini A, Addor MC, Baldacci S, Ballardini E, Boban L, Braz P, Cavero-Carbonell C, de Walle HEK, Draper ES, Gatt M, Haeusler M, Klungsøyr K, Kurinczuk JJ, Materna-Kiryluk A, Lanzoni M, Lelong N, Luyt K, Mokoroa O, Mullaney C, Nelen V, O'Mahony MT, Perthus I, Randrianaivo H, Rankin J, Rissmann A, Rouget F, Schaub B, Tucker D, Wellesley D, Zymak-Zakutnia N, Garne E. Epidemiology of Pierre-Robin sequence in Europe: A population-based EUROCAT study. Paediatr Perinat Epidemiol 2021; 35:530-539. [PMID: 34132407 DOI: 10.1111/ppe.12776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pierre Robin sequence (PRS) is a rare congenital anomaly. Respiratory disorders and feeding difficulties represent the main burden. OBJECTIVE The aim of this study was to investigate the epidemiology of PRS using a cohort of cases from EUROCAT, the European network of population-based registries of congenital anomalies. METHODS We analysed cases of PRS born in the period 1998-2017 collected by 29 population-based congenital anomaly registries in 17 different countries. We calculated prevalence estimates, prenatal detection rate, survival up to 1 week, and proportions of associated anomalies. The effect of maternal age was tested using a Poisson regression model. RESULTS Out of 11 669 155 surveyed births, a total of 1294 cases of PRS were identified. The estimate of the overall prevalence was 12.0 per 100 000 births (95% CI 9.9, 14.5). There was a total of 882 (68.2%) isolated cases, and the prevalence was 7.8 per 100 000 births (95% CI 6.7, 9.2). A total of 250 cases (19.3%) were associated with other structural congenital anomalies, 77 cases (6.0%) were associated with chromosomal anomalies and 77 (6.0%) with genetic syndromes. The prenatal detection rate in isolated cases was 12.0% (95% CI 9.8, 14.5) and increased to 16.0% (95% CI 12.7, 19.7) in the sub-period 2008-2017. The prevalence rate ratio of non-chromosomal cases with maternal age ≥35 was higher than in cases with maternal age <25 for total (PRR 1.26, 95% CI 1.05, 1.51) and isolated cases (PRR 1.33, 95% CI 1.00, 1.64). Survival of chromosomal cases (94.2%) and multiple anomaly cases (95.3%) were lower than survival of isolated cases (99.4%). CONCLUSIONS This epidemiological study using a large series of cases of PRS provides insights into the epidemiological profile of PRS in Europe. We observed an association with higher maternal age, but further investigations are needed to test potential risk factors for PRS.
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Affiliation(s)
- Michele Santoro
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ingeborg Barišić
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Anna Pierini
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marie-Claude Addor
- Department of Woman-Mother-Child University Medical Center CHUV Lausanne, Switzerland
| | - Silvia Baldacci
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Elisa Ballardini
- Neonatal Intensive Care Unit, Paediatric Section, IMER Registry (Emilia Romagna Registry of Birth Defects), Dep. of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ljubica Boban
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Paula Braz
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Hermien E K de Walle
- University Medical Center Groningen, Department of Genetics, University of Groningen, Groningen, the Netherlands
| | - Elizabeth S Draper
- Department Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, G'Mangia, Malta
| | | | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Materna-Kiryluk
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Monica Lanzoni
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Nathalie Lelong
- Epidemiology and Statistics Research Center - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Paris, France
| | - Karen Luyt
- South West Congenital Anomaly Register, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olatz Mokoroa
- Public Health Division of Gipuzkoa, Biodonostia Research Institute, Donostia-San Sebastian, Spain
| | - Carmel Mullaney
- Department of Public Health, HSE South East, Lacken, Kilkenny, Ireland
| | - Vera Nelen
- Provincial Institute of Hygiene, Antwerp, Belgium
| | - Mary T O'Mahony
- Department of Public Health, HSE South (Cork & Kerry), Ireland
| | - Isabelle Perthus
- Auvergne registry of congenital anomalies (CEMC-Auvergne), Department of clinical genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Hanitra Randrianaivo
- Register of Congenital Malformations Isle of Reunion Island, CHU St Pierre, la Reunion, France
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University/National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), Public Health England, Newcastle upon Tyne, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Malformations, CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Bruno Schaub
- French West Indies Registry, Registre des Malformations des Antilles (REMALAN), Maison de la Femme de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, France
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS), Public Health Wales, Swansea, UK
| | - Diana Wellesley
- Wessex Clinical Genetics Service, University Hospitals Southampton, Southampton, UK
| | | | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
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6
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Palaska PK, Antonarakis GS, Suri S. A Retrospective Longitudinal Treatment Review of Multidisciplinary Interventions in Nonsyndromic Robin Sequence With Cleft Palate. Cleft Palate Craniofac J 2021; 59:882-890. [PMID: 34212762 PMCID: PMC9260470 DOI: 10.1177/10556656211026477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To document and analyze the overall longitudinal institutional treatment
experience of children with nonsyndromic Robin sequence (RS) from infancy to
early adulthood. Design: Retrospective longitudinal treatment review. Setting: A tertiary-care, referral, teaching hospital. Patients: Children with nonsyndromic RS and cleft palate (N = 117) born between
December, 1985, and January, 2012. Interventions: Data regarding airway management, nutritional management, audiological
interventions, orthodontic treatment, and surgical interventions were
documented and analyzed in different growth/developmental stages.
Comparative data from other international centers were collected from the
literature. Results: Airway management during infancy involved prone positioning (92%),
nasopharyngeal airway (6%), tracheostomy (2%), and mandibular distraction
osteogenesis (1%). Feeding with nasogastric, gastrostomy, and/or
gastrojejunostomy tubes was used in 44%, Haberman feeders in 53%, and Mead
Johnson feeders in 3%. Gastroesophageal reflux disease was documented in 6%
of the sample. During childhood and early adolescent years, pharyngeal flap
surgery was carried out in 22% of the children, while 11% had secondary
palatal surgery. Audiological management included the use of tympanostomy
tubes in 62%, with several children needing multiple tube replacements. At
least 18% were diagnosed with obstructive sleep apnea. Adenoidectomy or
adenotonsillectomy was undertaken in 4%. Analysis of data pertaining to
middle childhood and adolescent years showed that orthodontic treatment was
conducted for most children for crowding, tooth agenesis, and skeletal
and/or dental dysplasia. Orthognathic surgery frequency (<18%) was
low. Conclusions: Institutional treatment experience of children with nonsyndromic RS involves
multidisciplinary care at different ages and stages of their
development.
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Affiliation(s)
- Pinelopi K Palaska
- Private Practice, Dubai, UAE.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory S Antonarakis
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Orthodontics, University of Geneva, Switzerland
| | - Sunjay Suri
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Dentistry, University of Toronto, Ontario, Canada
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7
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Meshram GG, Kaur N, Hura KS. Pierre Robin Sequence: Diagnostic Difficulties Faced while Differentiating Isolated and Syndromic Forms. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 63:86-90. [PMID: 32771075 DOI: 10.14712/18059694.2020.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pierre Robin sequence (PRS) is characterized by the triad of retrognathia, glossoptosis, and airway obstruction. PRS may occur in isolation or in conjunction with other syndromes. Distinguishing isolated and syndromic forms of PRS helps clinicians decide the management plan. We describe two cases of PRS of Indian ethnicity and describe some of the difficulties that we faced while distinguishing isolated PRS from syndromic PRS. Both cases had a similar clinical presentation. However, one of the cases had a positive family history of congenital deafness and cleft palate, whereas the other case had apparent upper limb anomalies. These facts heightened the suspicion of an associated syndrome. However, based on the available facts and after thorough investigations, a tentative diagnosis of isolated PRS was made for both the patients. Both the cases were managed conservatively and were advised a long-term follow-up. When the associated anomalies are few, minor or concealed at birth, longitudinal follow-up of all PRS cases combined with thorough diagnostics including chromosomal analysis could help differentiate syndromic PRS from isolated PRS. Regardless, all cases of PRS require a multidisciplinary approach.
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Affiliation(s)
- Girish Gulab Meshram
- Department of Pharmacology, Atal Bihari Vajpayee Institute of Medical Sciences and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
| | - Neeraj Kaur
- Department of Radiology, The University of Texas Health Science Centre, San Antonio, Texas, USA
| | - Kanwaljeet Singh Hura
- Department of Paediatrics, Richmond University Medical Centre, Staten Island, New York, USA
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8
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Mandibular Distraction in Robin Sequence With Multi-Level Airway Disease: Always Contraindicated? J Craniofac Surg 2020; 31:1883-1887. [DOI: 10.1097/scs.0000000000006620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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9
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Jodeh DS, Nguyen ATH, Rottgers SA. Le Fort 1 and Bimaxillary Osteotomies Increase the Length of Stay but not Postoperative Morbidity Compared to Mandibular Osteotomies and Single Jaw Procedures. J Craniofac Surg 2020; 31:1734-1738. [PMID: 32371693 DOI: 10.1097/scs.0000000000006514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study is to examine the association between type of facial osteotomies performed during orthognathic surgery and postoperative outcomes including complications, length of stay, and readmission. METHODS A retrospective review of orthognathic surgery cases from the Pediatric Health Information System (PHIS) database from 2004 to 2014 was undertaken. Osteotomy procedures were classified as Le Fort 1 (LF 1), Mandibular osteotomy, Genioplasty or their combinations. Primary outcome variable was major complications. Secondary outcomes included postoperative LOS > 1 day and 90-day readmission. Random-intercept logistic regression models were utilized to assess the association between the type of osteotomy performed and the outcomes. Bonferroni approach was used to account for multiple comparisons. RESULTS The sample included 5413 patients, with a mean age of 17.1 ± 1.68 years and 60.65% were female. The most common procedures were LF1 (39.4%), followed by bimaxillary surgery (23%). Major complications occurred in 8.57% of patients, postoperative LOS > 1 day in 52.4% and 90-day all-cause readmission in 11.16%. In adjusted analyses comparing LF1 compared to mandibular osteotomies, there were no significant differences for major complications (OR = 0.78), 90-day readmission rate (OR = 0.98). However, LF1 was associated with an increased odds for LOS compared to mandibular osteotomies (OR = 1.42). Addition of osteotomies is associated with a significant increase in LOS (P < 0.001). CONCLUSIONS Patients undergoing orthognathic surgery demonstrated increased length of stay for LF1 or bimaxillary osteotomies. Osteotomy type did not impact the odds of readmission or complications. The trends revealed should be helpful for patient counseling.
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Affiliation(s)
- Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital
| | - Anh Thy H Nguyen
- Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital
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10
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Nguyen JQN, Calabrese CE, Heaphy KJ, Koudstaal MJ, Estroff JA, Resnick CM. Can Robin Sequence Be Predicted From Prenatal Ultrasonography? J Oral Maxillofac Surg 2019; 78:612-618. [PMID: 31758942 DOI: 10.1016/j.joms.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/24/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Prenatal diagnosis of Robin sequence (RS) could promote safe delivery and improve perinatal care. The purpose of this study was to evaluate the correlation between prenatal ultrasonography (US) and magnetic resonance imaging (MRI) studies for assessing micrognathia to determine if US alone can be used to reliably screen for RS. MATERIALS AND METHODS This was a retrospective case-control study of fetuses evaluated in the Advanced Fetal Care Center at Boston Children's Hospital from 2002 to 2017. To be included, 1) prenatal MRI and US must have been performed during the same visit, 2) the infant must have been live-born, and 3) the diagnosis must have been confirmed postnatally. Patients with images of inadequate quality for analysis were excluded. Patients were divided into 4 groups based on postnatal diagnosis: 1) RS (micrognathia, glossoptosis, and airway obstruction) (RS group), 2) micrognathia without RS (micrognathia group), 3) cleft lip and palate (CLP) without micrognathia (CLP group), and 4) gestational age-matched controls with normal craniofacial morphology (control group). The inferior facial angle (IFA) was measured using both imaging modalities and compared. Receiver operating characteristic curves were applied to identify a threshold for the diagnosis of RS from US. The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio were calculated. RESULTS A total of 94 patients were included (mean gestational age at imaging, 24.9 ± 5.2 weeks), with 25 in the RS group (26.6%), 29 in the micrognathia group (30.9%), 23 in the CLP group (24.5%), and 17 in the control group (18.1%). The IFA was significantly smaller in the RS group than in all other groups on both US and MRI (P < .001). A moderate correlation was found between IFA measurements on US and MRI (intraclass correlation coefficient, 0.729). An IFA threshold on US of 45.5° maximized sensitivity (84%) and specificity (81%) for the diagnosis of RS. CONCLUSIONS We suggest incorporating the IFA into routine prenatal US and referring patients for confirmatory MRI when the US IFA is lower than 45.5°.
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Affiliation(s)
| | - Carly E Calabrese
- Clinical Research Specialist, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Kathryn J Heaphy
- Pediatric Radiology Fellow, Department of Radiology, Boston Children's Hospital, Boston, MA
| | - Maarten J Koudstaal
- Assistant Professor of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; and Research Associate, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA
| | - Judy A Estroff
- Associate Professor of Radiology, Harvard Medical School, Boston, MA; and Director of Fetal-Neonatal Imaging, Department of Radiology, Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA
| | - Cory M Resnick
- Assistant Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA; and Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
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11
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Abu-Ghname A, Masoumy M, Monson LA. Cervical Stenosis in Non-Syndromic Pierre Robin Sequence. J Craniofac Surg 2019; 30:1866-1868. [PMID: 31283644 DOI: 10.1097/scs.0000000000005727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pierre Robin sequence is a triad of micrognathia, glossoptosis, and airway obstruction that has reported associations with numerous birth defects and anomalies including craniocervical pathologies. Given the number of airway assessments and neck manipulations these neonates experience, undetected cervical instability can result in detrimental consequences. The authors present a case of a neonate with non-syndromic Pierre Robin sequence planned for mandibular distraction osteogenesis that developed abnormal motor activity following intubation. The patient was eventually diagnosed with cervical spine stenosis and craniocervical instability after radiologic investigation. This paper demonstrates the significance of preoperative cervical spine evaluation and the importance of maintaining high level of suspicion when performing neck manipulations in those high-risk infants.
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Affiliation(s)
- Amjed Abu-Ghname
- Division of Plastic Surgery at Texas Children's Hospital/ Michael E. DeBakey, Department of Surgery, Baylor College of Medicine, Houston, TX
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Kim JJ, Choi DS, Jang I, Cha BK, Park IW. Pierre Robin sequence with severe scoliosis in an adult: A case report of clinical and radiological features. Imaging Sci Dent 2019; 49:323-329. [PMID: 31915619 PMCID: PMC6941832 DOI: 10.5624/isd.2019.49.4.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022] Open
Abstract
Pierre Robin sequence (PRS) is characterized by the triad of micrognathia, glossoptosis, and airway obstruction. PRS does not have a single pathogenesis, but rather is associated with multiple syndromes. This report presents the case of a 35-year-old woman with PRS and scoliosis. Among the syndromes related to PRS, cerebro-costo-mandibular syndrome (CCMS), which is characterized by posterior rib gap defects and vertebral anomalies, was suspected in this patient. However, no posterior rib gap defect was detected on radiological examinations. Although over 80 cases of CCMS have been reported to date, few cases of PRS with scoliosis alone have been reported. Therefore, this report demonstrated the clinical, radiological, and cephalometric characteristics of an adult patient with PRS and scoliosis, but without rib anomalies.
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Affiliation(s)
- Jae-Jun Kim
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Dong-Soon Choi
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Insan Jang
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Bong-Kuen Cha
- Department of Orthodontics, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - In-Woo Park
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
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Current Trends in Surgical Airway Management of Neonates with Robin Sequence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1973. [PMID: 30881787 PMCID: PMC6414126 DOI: 10.1097/gox.0000000000001973] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/15/2018] [Indexed: 12/23/2022]
Abstract
Background Robin sequence is defined by the clinical triad of micrognathia, glossoptosis, and upper airway obstruction, and is frequently associated with cleft palate and failure to thrive. Though the efficacy of certain surgical interventions to relieve airway obstruction has been well established, algorithms dictating decision making and perioperative protocols are poorly defined. Methods A 22-question survey was sent via e-mail to members of the American Cleft Palate-Craniofacial Association and International Society of Craniofacial Surgeons. Questions were related to surgeon experience in treating neonates with Robin sequence, and specific perioperative protocols. Results One hundred fifty-one responses were collected. Most respondents were surgeons practicing in North America(82.8%), in a university hospital setting (81.5%) and had completed a fellowship in pediatric plastic surgery or craniofacial surgery (76.2%). Preoperative protocols varied widely by years in training and location of practice. Although 78.8% of respondents always performed direct laryngoscopy, only 49.7% of respondents routinely obtained preoperative polysomnography. Mandibular distraction osteogenesis was the most common primary surgical airway intervention reported by 74.2%, with only 12.6% primarily utilizing tongue-lip adhesion. Slightly less than half of respondents ever performed tongue-lip adhesion. Operative selection was influenced by surgeon experience, with 80% of those in practice 0-5 years primarily utilizing mandibular distraction, compared with 56% of respondents in practice >15 years. Conclusions This study documents wide variations in preoperative, operative, and postoperative protocols for the surgical airway management of neonates with severe Robin sequence. These results underscore the need to acquire more objective data, to compare different protocols and outcome measures.
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Pierre Robin sequence: A comprehensive narrative review of the literature over time. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:419-428. [DOI: 10.1016/j.jormas.2018.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022]
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The Effect of Mandibular Distraction Osteogenesis on Weight Velocity in Infants With Severe Pierre Robin Syndrome. J Craniofac Surg 2018; 29:1851-1854. [DOI: 10.1097/scs.0000000000004650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Di Pasquo E, Amiel J, Roth P, Malan V, Lind K, Chalouhi C, Soupre V, Gordon CT, Lyonnet S, Salomon LJ, Abadie V. Efficiency of prenatal diagnosis in Pierre Robin sequence. Prenat Diagn 2017; 37:1169-1175. [DOI: 10.1002/pd.5162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Elvira Di Pasquo
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Centre; Necker Hospital; Paris France
| | - Jeanne Amiel
- Laboratory of Embryology and Genetics of Congenital Malformations; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Philippe Roth
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Centre; Necker Hospital; Paris France
| | - Valérie Malan
- Cytogenetics Laboratory; Necker Hospital; Paris France
| | - Katia Lind
- General Pediatrics Department and Rare Disease Reference Centre “Syndrome de Pierre Robin et Troubles de Succion Déglutition Congénitaux”; Necker Hospital; Paris France
| | - Christel Chalouhi
- General Pediatrics Department and Rare Disease Reference Centre “Syndrome de Pierre Robin et Troubles de Succion Déglutition Congénitaux”; Necker Hospital; Paris France
| | | | - Christopher T. Gordon
- Laboratory of Embryology and Genetics of Congenital Malformations; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Stanislas Lyonnet
- Laboratory of Embryology and Genetics of Congenital Malformations; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Laurent J. Salomon
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Centre; Necker Hospital; Paris France
- Paris Descartes-Sorbonne Paris Cité University; Paris France
| | - Véronique Abadie
- Paris Descartes-Sorbonne Paris Cité University; Paris France
- General Pediatrics Department and Rare Disease Reference Centre “Syndrome de Pierre Robin et Troubles de Succion Déglutition Congénitaux”; Necker Hospital; Paris France
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