Predicting Outcomes after Mandibular Distraction Osteogenesis in Patients with Isolated Pierre-Robin Sequence

Abstract

INTRODUCTION: Pierre-Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and obstructive sleep apnea (OSA). Mandibular distraction osteogenesis (MDO) is a common treatment modality to improve OSA. We aimed to evaluate the sleep study outcomes based on mandibular distraction distance on patients born with OSA secondary to micrognathia. METHODS: A retrospective chart review was conducted for patients with isolated PRS who underwent MDO at Children’s Hospital Los Angeles between January 2006 and September 2021. Relationships between demographics, preoperative sleep variables, and postoperative OSA outcomes were analyzed. Results were stratified according to OSA severity and distraction distance (30 mm vs less than 30 mm). RESULTS: A total of 71 patients met inclusion criteria. Fifty-six patients were distracted to 30 mm, whereas the remaining 15 patients experienced shorter distraction; reasons for shorter distraction included infection, parent preference, and loss to follow-up. Compared with patients distracted to less than 30 mm, those distracted to 30 mm had a significantly greater improvement in AHI when controlling for preoperative sleep study variables (p = 0.047). After MDO, significant improvement was observed in lowest oxygen saturation, AHI, highest carbon dioxide level, and highest oxygen requirement. CONCLUSION: Patients with PRS who have more severe OSA experienced greater improvements in sleep study scores after MDO with more than 89% of patients with severe OSA achieving mild or complete resolution of disease. Our results provide tangible evidence for how distracting patients to 30 mm vs less than 30 mm can improve disease parameters, which can assist clinicians and families in anticipating outcomes after MDO for patients with isolated PRS.