S7B-04 SESSION 7B: HFM ROBIN - PART II RATE AND RISK FACTORS FOR REPEATED MANDIBULAR DISTRACTION OSTEOGENESIS IN INFANT PATIENTS WITH TONGUE BASED AIRWAY OBSTRUCTION

Abstract

Introduction: Mandibular distraction osteogenesis (MDO) has demonstrated efficacy for tongue-based airway obstruction in infant Pierre Robin Sequence (PRS). The purpose of this study is to identify risk factors for patients who require repeat distraction after MDO in early infancy for PRS. Methods: Consecutive patients who underwent MDO from 2004 to 2018 at a single institution were retrospectively reviewed. Patient characteristics including age at initial MDO, comorbidities, polysomnographic parameters, and distraction data were collected. Patients whose initial surgery was before 2 months of age were identified and divided into cohorts: single versus repeat distraction. Results: 103 patients were identified during the study period - 95 had a single distraction procedure and 8 required repeat distraction. Indications for repeat distraction were recurrent airway obstruction (6), failure to extubate (1), and persistent micrognathia (1). There was no difference in age or weight at initial distraction, duration of distraction, or distraction length between single and repeat distraction groups. Overall, average AHI was 39.9 pre-operatively and 10.1 post-operatively; neither varied between groups. Genetic anomalies and syndromic diagnoses were more common in the repeat distraction group (75.0% vs. 40.0% single distraction, p=0.06). More patients had laryngomalacia in the repeat distraction group (75.0% vs. 33.7% single distraction, p=0.02). Conclusion: MDO has been accepted as efficacious in PRS but the rate of repeat distraction has not been described. In this study 7.8% of infants required redistraction and the identified risk factors were genetic anomaly or syndromic diagnosis, pre-operative laryngomalacia, or recurrent airway obstruction.