A Simple Mandibular Distraction Protocol to Avoid Tracheostomy in Patients With Pierre Robin Sequence.
Cleft Palate Craniofac J
; 54(2): 210-215, 2017 03.
Article
en En
| MEDLINE
| ID: mdl-26068388
ABSTRACT
OBJECTIVE:
Recent treatment goals for Pierre Robin sequence (PRS) focus on avoiding tracheostomy through modalities such as mandibular distraction osteogenesis (MDO). We primarily evaluated the efficacy of our straightforward MDO treatment protocol for resolution of PRS-associated airway obstruction while secondarily analyzing patient characteristics associated with success or failure of MDO.DESIGN:
A retrospective chart review before and after treatment.SETTING:
Tertiary institutional center and private practice setting. PATIENTS All patients were diagnosed with PRS and treated with MDO, according to the MDO treatment protocol, by a single surgeon with the same operative technique from 1999 to 2013. A sample size of n = 38 met the inclusion criteria. Data assessed included tracheostomy status (pre-MDO, post-MDO, or none), microlaryngoscopy and bronchoscopy (MLB) findings, multipositional airway study results, clinical resolution of airway obstruction following MDO, and patient characteristics. MAIN OUTCOMEMEASURE:
Resolution of airway obstruction with avoidance of a tracheostomy.RESULTS:
Prior to referral for MDO, five patients required urgent tracheostomy. Of patients without a pre-MDO tracheostomy (n = 33), two patients required tracheostomy post-MDO, while 94% avoided tracheostomy with clinical resolution of airway obstruction (n = 31). On secondary analysis, anatomic abnormalities diagnosed by MLB were associated with a higher rate of tracheostomy (P = .037), confirming the utility of preoperative evaluation with MLB; otherwise, no patient characteristics demonstrated significance in patient selection. Follow-up ranged from 6 months to 10 years (mean = 6.45 years, median = 7.61 years).CONCLUSIONS:
Our treatment protocol demonstrates MDO is highly effective for resolving severe airway obstruction related to PRS. Based on secondary analysis, our simplified protocol does not require amendment.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Síndrome de Pierre Robin
/
Osteogénesis por Distracción
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Obstrucción de las Vías Aéreas
/
Mandíbula
Tipo de estudio:
Etiology_studies
/
Guideline
/
Observational_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
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Male
/
Newborn
Idioma:
En
Revista:
Cleft Palate Craniofac J
Asunto de la revista:
ODONTOLOGIA
Año:
2017
Tipo del documento:
Article