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Cleft & Craniofacial Surgery

(7) The Timing of Mandibular Distraction Osteogenesis to Optimize Functional Outcomes

Thursday, September 18, 2025
2:30 PM - 4:00 PM EDT
Disclosure(s):
Yeon Joo Hong, DDS: No financial relationships to disclose
Valeria Mejia, BS: No financial relationships to disclose
Asli Pekcan, BS: No financial relationships to disclose
Raina K. Patel, BS: No financial relationships to disclose
Melanie Bakovic, BS: No financial relationships to disclose
Abstract: Mandibular distraction osteogenesis (MDO) is a key treatment for Robin Sequence (RS), though the ideal timing to optimize outcomes remains unclear. This study examines the impact of timing of MDO intervention on respiratory, nutritional, and speech outcomes.

A retrospective review was conducted of patients with RS who underwent MDO at a tertiary children’s hospital from 2004 to 2023. A sensitivity analysis determined the age at which MDO optimized outcomes including obstructive sleep apnea (OSA), gastrostomy tube placement, nutritional supplementation duration, secondary speech surgery (SCS), and palatal fistula formation. Statistical analyses involved Pearson’s chi-square and Student’s T-tests.

Of 115 patients, 58 underwent MDO before 4 weeks of age and 57 underwent MDO after. The early group showed greater improvements in severe OSA and end-tidal carbon dioxide levels post-MDO [Figure 1]. The early group had lower rates of initial feeding by gastrostomy tube placement (1.7% vs 29.8%, P < .001) and similar supplementation durations of 1.3 months. Cleft repair outcomes were better in the early group, with fewer palatal fistulas and lower rates of VPI surgery (4.0% vs 17.9%, P < .05).

MDO within 4 weeks significantly improved respiratory, nutritional, and speech outcomes, supporting early intervention as optimal for RS patients.

References:
1. Ow ATC, Cheung LK. Meta-analysis of mandibular distraction osteogenesis: clinical applications and functional outcomes. Plast Reconstr Surg. 2008 Mar;121(3):54e-69e.
2. Mao Z, Battaglino R, Zhou J, Cui Y, Shrivastava M, Tian G, Sahebdel F, Ye L. The Effect of Timing of Mandibular Distraction Osteogenesis on Weight Velocity in Infants Affected by Severe Robin Sequence. Children (Basel). 2022 Feb 28;9(3):319.
Figure 1. Timing of MDO Comparisons and Management Algorithm after MDO