Long Term Assessment of Pierre Robin Sequence Patients Treated With A Vertically-Oriented Mandibular Distraction Vector
Michael Lypka, MD, DMD, Heather Hendricks, DDS, Jeffrey Goldstein, MD.
Children's Mercy Hospital, Kansas City, MO, USA.
Purpose – For many surgeons, mandibular distraction is the preferred technique for treatment of Pierre Robin Sequence neonates with significant airway obstruction. Technique varies among surgeons, from external to internal devices, combined with a host of distraction vectors and osteotomy designs. Yet there are few long term follow-up studies of the neonate treated by mandibular distraction, with little information relating outcomes to technique. It is the purpose of this study to analyze long term outcomes of patients who underwent neonatal mandibular distraction for obstructive apnea via a vertically-oriented ramus distraction vector.
Methods – With IRB approval, patients with Pierre Robin Sequence and significant obstructive apnea, treated with neonatal mandibular distraction, were retrospectively reviewed. Follow-up ranged from 6 to 15 years. All were treated with internal distraction devices oriented vertically on the ramus. Radiographic assessment of the distracted mandible was undertaken using 3 dimensional CT scan data, or available plain films, and compared to age matched controls.
Results – Eighteen patients were available for review. All patients exhibited markedly increased vertical ramus height, with blunted sigmoid notches. All patients demonstrated an extremely high angle mandibular morphology, with narrowed bigonial width. Condylar anatomy was altered, with a higher than expected incidence of TMJ ankylosis. Most patients had recurrence of mandibular retrognathia with poor chin projection at long term follow-up.
Conclusions – Vertical distraction of the neonatal mandibular ramus leads to consistent abnormal mandibular morphology with age. Mandibular growth is suboptimal and the effects on the mandibular condyle are concerning.
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