Is Tongue-Lip Adhesion or Mandibular Distraction More Effective in Relieving Obstructive Apnea in Infants With Robin Sequence?

Abstract

Tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) are the most common operations for obstructive apnea (OA) in infants with Robin sequence (RS). The purpose of this study was to compare early outcomes of TLA and MDO on resolution of OA. This is a retrospective cohort study of infants with RS treated with TLA or MDO from 2005 through 2018. To be included, patients had to have polysomnograms pre- and postoperatively unless intubated or tracheostomy dependent. Patients were excluded if the operation occurred after 1year of age. The primary predictor variable was type of operation (TLA or MDO). The primary outcome variable was "successful resolution of OA," defined as 1) postoperative apnea-hypopnea index (AHI) score lower than 5, 2) postoperative OA severity score of 0 to 1 (no to mild OA), and 3) no need for additional airway intervention during the first year of life. Descriptive, bivariate, and regression analyses were performed. Statistical significance was set at a P value less than .05. Forty-three patients were included (TLA, n=19 [44%]; MDO, n=24 [56%]). Eighteen patients (41%) were syndromic. Patients in the TLA group were significantly younger at operation (28.2±23.1days) compared with those in the MDO group (87.1±81.7days; P=.002). The MDO group had more severe preoperative OA (AHI score, 20.5±14.9; OA severity score, 4.7±0.8) than the TLA group (AHI score, 17.6±31.0; OA severity score, 3.6±1.4; P<.041). Postoperative AHI score and OA severity score for the TLA group were 11.7±19.5 (33.5% decrease; P=.496) and 2.3±1.8 (improvement by 1.3±2.4 levels; P=.051), respectively. Postoperative AHI score and OA severity score for the MDO group were 1.1±1.8 (94.6% decrease; P<.001) and 0.2±0.4 (improvement by 4.6±0.8 levels; P<.0001), respectively. Successful resolution of OA occurred in 9 patients (47%) in the TLA group and 22 patients (92%) in the MDO group. Postoperative complications were similar. MDO is more effective than TLA in relieving OA in infants with RS.