Mandibular Distraction Osteogenesis In The Very Small With Robin Sequence: Is It Safe?
Youssef H. Tahiri, MD, CM, MSc, FRCSC, FAAP1, S. Travis Greathouse, MD1, Sunil S. Tholpady, MPH, MD, PhD1, Robert J. Havlik, MD2, Roberto L. Flores, MD3.
1Indiana University, Indianapolis, IN, USA, 2Medical College of Wisconsin, Milwaukee, WI, USA, 3New York University, New York, NY, USA.
Background: The aim of this study is to evaluate the efficacy, safety profile and the complications associated with Mandibular Distraction Osteogenesis (MDO) performed in neonates ≤ 4kg, with Robin sequence (RS).
Methods: A 10-year retrospective review of all neonates (< 6 months) with MDO treated RS was performed. Patients ≤ 4kg (experimental) and > 4kg (control) who underwent MDO were compared. Demographics, medical comorbidities, improvement in apnea/hypopnea index (AHI), need for tracheostomy, repeat distraction, and complications were evaluated.
Results: 94 patients underwent MDO. 67 patients were ≤ 4kg while 27 were > 4kg. The mean follow up was 2.9 years in patients ≤ 4 kg and 3.3 years in the control group. Mean age and weight at time of distraction for the experimental and control groups were 22 days old / 3.19 kg and 2 years 9 months /12 kg; respectively. There was no significant difference in success of MDO to treat airway obstruction in the ≤ 4 kg group vs. the control group (97% vs. 88.9%; p = 0.1407). The most common complication was surgical site infection (11.9%). Overall complication rates did not differ significantly between the two groups (14.9% vs. 22.2%; p = 0.3829). The rates of repeat distraction were similar between the two groups (6.3% and 14.8%; p = 0.2206).
Conclusion: MDO is a safe and effective treatment modality for neonates ≤ 4kg with severe airway obstruction. The efficacy, safety, and complication profiles are not significantly different from larger patients.
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