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Optimizing Outcomes In Robin Sequence: The Role Of Early Mandibular Distraction Osteogenesis In Airway, Feeding, And Speech Management
Valeria Mejia, BS1, Asli Pekcan, BS
1, Melanie Bakovic, BS
2, Raina Patel, BS
2, Marvee Turk, MD
1, Pasha Shakoori, DDS MD
2, Mark M. Urata, DDS MD
2, Jeffrey A. Hammoudeh, DDS MD
1.
1Keck School of Medicine of USC, Los Angeles, CA, USA,
2Children's Hospital Los Angeles, Los Angeles, CA, USA.
Purpose: Mandibular distraction osteogenesis (MDO) is a key treatment for Robin Sequence (RS), though the ideal timing for optimal outcomes is still debated. This study examines the effect of early MDO intervention on respiratory, nutritional, and speech outcomes.
Methods: A retrospective review was conducted of RS patients who underwent MDO at a children’s hospital from 2004 to 2023. A sensitivity analysis determined the age at which MDO maximized outcomes in breathing, feeding, and speech. Outcomes included obstructive sleep apnea (OSA), gastrostomy tube placement, nutritional supplementation duration, secondary speech surgery, and palatal fistula formation. Statistical analyses involved Pearson’s chi-square and Student’s T-tests.
Results: Of 115 patients, 65 received MDO before six weeks of age, while 50 had it later. The early group showed reduced severe OSA and lower end-tidal carbon dioxide levels [Figure 1]. Nutritional outcomes were improved in the early group, with lower gastrostomy rates (5.5% vs. 33.3%, p<0.001) and shorter supplementation duration (6.7 vs. 16.0 months, p<0.05). Speech outcomes were better in the early group, with fewer palatal fistulas (1.7% vs. 4.3%, p<0.05) and lower rates of secondary speech surgery (1.7% vs. 6.1%, p<0.05).
Conclusion: Early MDO within six weeks significantly improves respiratory, nutritional, and speech outcomes in RS patients, reducing OSA severity, gastrostomy tube reliance, and secondary surgeries. These results support early MDO as optimal for enhancing long-term health in RS patients.
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