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Mandibular Ramus Versus Body Distraction Osteogenesis In The Treatment Of Pierre Robin Sequence: Does Osteotomy Location Matter? A Systematic Review And Meta-analysis.
Tega Ebeye, MD, MSc1, Ayeh Hussain, BSc
2, Precious Adekoya, BMSc
3, John H. Phillips, MD, FRCSC
2, Christopher R. Forrest, MD, MSc, FRCSC
2, Johanna N. Riesel, MD, MHPE
2.
1University of Toronto, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto, ON, Canada, 2The Hospital for Sick Children, Toronto, ON, Canada, 3Queen's University, Kingston, ON, Canada.
Purpose: Mandibular distraction osteogenesis (MDO) is a common surgical intervention for severe upper airway obstruction (UAO) in Pierre Robin Sequence (PRS); however, consensus regarding the location and outcomes of MDO by osteotomy sites is lacking. This study aims to compare outcomes of the two common approaches to MDO - mandibular body (MB) and mandibular ramus (MR) osteotomies - in PRS.
Methods: A systematic review and meta-analysis of studies reporting techniques and outcomes of MDO in PRS over the last 50 years was conducted. Forest plots by osteotomy type were constructed using pooled proportions for the primary outcome of failure to resolve UAO.
Results: Sixty articles yielded 1,148 patients with MDO at an average of 10 months old and follow-up of 34.6 months. Proportion of failure of UAO reversal was 0.0035 [0.0000; 0.0309] for MB and 0.0293 [0.0052; 0.0656] for MR, with no statistically significant difference between osteotomy sites (p= 0.9212). Subgroup analyses by age at MDO, distractor type, distraction rates and length also revealed no statistically significant differences. Thirty-eight studies reported at least one complication (54.84% of MB studies; 72.41% MR), however, these findings should be interpreted with caution as differences in thresholds for reporting complications might exist.
Conclusions: Both MB and MR osteotomies are highly effective forms of MDO in treating UAO in PRS infants; however, they carry risk of complication. Further research is needed to assess the impact of osteotomy site on long-term outcomes and whether the difference in complication rates would persist in a controlled comparison.
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