Outcomes in Early Mandibular Distraction Osteogenesis: Single versus Repeat Distraction
Julia A. Cook, MD1, Sarah E. Sasor, MD2, Sunil S. Tholpady, MD, PhD1, Patrick Gerety, MD1.
1Indiana University, Division of Plastic & Reconstructive Surgery, Indianapolis, IN, USA, 2University of Michigan, Section of Plastic Surgery, Ann Arbor, MI, USA.
PURPOSE: Mandibular distraction osteogenesis (MDO) has demonstrated efficacy for tongue-based airway obstruction in infant Pierre Robin Sequence (PRS), but the rate of repeat distraction has not been described. The purpose of this study is to identify risk factors for PRS patients who require repeat distraction after MDO in early infancy.
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 single versus repeat distraction cohorts.
RESULTS: 103 patients were identified - 95 had a single distraction procedure; 8 required repeat distraction. Repeat distraction was performed at an average 4.0±4.4 years from removal of initial distractors; indications included 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, distraction length, or length of follow up (4.4±3.7 years) between single and repeat distraction groups. Average AHI was 39.9±26.9 pre-operatively and 10.1±10.4 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).
CONCLUSIONS: In this study, 7.8% of infants required repeat distraction; identified risk factors included genetic anomaly or syndromic diagnosis, pre-operative laryngomalacia, or recurrent airway obstruction.
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