GP2b - Evaluating Complication Rates of Mandibular Distraction Osteogenesis in Syndromic and Robin Sequence Patients: A 20-Year Review

Abstract:

Background: Mandibular distraction osteogenesis (MDO) offers an alternative to tracheostomy for airway management in pediatric patients with micrognathia.^1,2 Limited studies exist evaluating the safety of this procedure across patients with craniofacial syndromes and Robin Sequence (RS). This study aims to assess complication rates of MDO in patients stratified by history of craniofacial syndrome and RS.

Methods: A retrospective cohort study at a tertiary institution from 2004 to 2023 was conducted. Patients who underwent MDO were included, excluding those with less than 6 months of follow-up. The cohorts were divided into patients with syndromic RS, isolated RS, syndromic congenital micrognathia (CM), and nonsyndromic CM. Primary outcomes included postoperative complications, such as 30-day infection rates, major complications, and minor complications. Major complications were defined as any event requiring rehospitalization and/or reoperation with general anesthesia, or sequelae lasting longer than 6 months. Statistical analysis was performed using Fisher’s exact, Pearson’s chi-squared, and Mann Whitney U tests.

Results: A total of 133 patients met the inclusion criteria, with a median age of 1.1 months (corrected for gestational age) at the time of surgery and a median follow-up of 6.1 years. Cardiac anomalies were significantly more prevalent in patients with syndromic RS (54.5%) and syndromic CM (50.0%) compared to nonsyndromic CM (30.0%) and isolated RS (26.4%) (P = .045). Hypotonia was most common in patients with syndromic CM (85.7%), followed by those with syndromic RS (40.9%), nonsyndromic CM (30.0%), and isolated RS (26.4%) (P < .001). There were no significant differences across cohorts in respiratory or gastrointestinal comorbidities, total distraction, or distraction rate. Postoperative outcomes showed no significant differences in major complications, minor complications, or readmission rates across the cohorts. However, infection rates within 30 days were significantly higher in patients with syndromic CM (50%) compared to those with syndromic RS (22.7%), isolated RS (18.4%), and nonsyndromic CM (10%) (P = .047). Tracheal colonization was also significantly higher in patients with syndromic CM (21.4%) compared to those with isolated RS (4.6%) and absent in those with syndromic RS and nonsyndromic CM (P = .027). No significant differences were observed in postoperative tracheostomy or oxygen requirements across the cohorts.

Conclusion: This study found comparable major and minor complication rates across all patient groups undergoing MDO, regardless of syndromic status or RS. However, patients with syndromic CM exhibited higher 30-day infection rates, particularly from tracheal colonization. MDO remains a safe and effective procedure for airway management in both syndromic and nonsyndromic patients, with and without RS.

References:
1. Breik O, Tivey D, Umapathysivam K, Anderson P. Mandibular distraction osteogenesis for the management of upper airway obstruction in children with micrognathia: a systematic review. Int J Oral Maxillofac Surg. 2016;45(6):769-782. doi:10.1016/j.ijom.2016.01.009
2. Nazarian Mobin SS, Francis CS, Karatsonyi AL, Hammoudeh JA, Urata MM. Mandibular Distraction Instead of Tracheostomy in Pierre Robin Sequence Patients: Is It Worth It? Plastic and Reconstructive Surgery. 2012;130(5):766e-767e. doi:10.1097/PRS.0b013e318267da28