Does Mandibular Distraction Change the Laryngoscopy Grade in Infants With Robin Sequence?

Abstract

To review a series of infants with Robin sequence (RS) who underwent mandibular distraction osteogenesis (MDO) at the authors' institution and document changes in pre- and postoperative laryngoscopy grades. Consecutive patients with RS who underwent MDO from March 2005 to June 2017 were identified. Patients were included if they had a preoperative polysomnogram confirming obstructive sleep apnea, had failed nonoperative airway management, had undergone MDO by the senior author (C.M.R.), and had complete documentation. Patients were excluded if they did not have a laryngoscopy performed (ie, tracheostomy dependent) or if there was insufficient information in their medical record. Variables included demographic data, operative information, and laryngoscopic details at 3 time points: before MDO (T0), at device removal (T1), and at latest follow-up laryngoscopy (T2). Descriptive statistics were computed. Significance was set at a P value less than .05. Twenty-two infants with RS underwent MDO during the study period and 13 of these met criteria for inclusion. Mean age at MDO (T0) was 19.6±38.8weeks. Mean ages at device removal (T1) and latest follow-up laryngoscopy (T2) were 28.2±41.5 and 62.7±49.6weeks, respectively. Three patients had Stickler syndrome; the others had nonsyndromic RS. Mean apnea-hypopnea index was 23.6±16.6 preoperatively and 0.3±0.7 after MDO (P=.011). At T0, a grade IIb laryngoscopic view was most common (46.1%) and only 3 patients (23.1%) had a grade I view. At T1, most patients (69.2%) had a grade I view and only 2 (14.4%) had a grade of IIb or worse (P=.011). At T2, all but 1 patient had a grade I view. In addition to resolving obstructive apnea, MDO is associated with an improvement in the grade of laryngoscopic view. This could increase airway safety at home and improve ease of intubation for future operations.