(6) Predicting Outcomes Following Mandibular Distraction Osteogenesis in Patients With Isolated Pierre-Robin Sequence

Thursday, September 15, 2022

1:30 PM – 3:00 PM CDT

Table 1. Linear Regression

Presenting Author(s)

Eloise Stanton, BA

Medical Student
Keck School of Medicine of USC
LOS ANGELES, California, United States

Co-Author(s)

Katelyn Kondra, MD

Resident
Keck Medicine of USC
Los Angeles, California, United States
Christian Jimenez, BS

Medical Student
Keck School of Medicine of USC
Los Angeles, California, United States
NM

Naikhoba Munabi, MD, MPH

Resident
Keck Medicine of USC
Los Angeles, California, United States
Allen Huang, MD, DDS

Resident
Children's Hospital Los Angeles
LOS ANGELES, California, United States
KC

Kevin Chen, MD

Fellow
Children's Hospital Los Angeles
Los Angeles, California, United States
WM

William Magee, III, MD, DDS

Attending Physician
Children's Hospital Los Angeles
Los Angeles, California, United States
MU

Mark M. Urata, MD, DDS

Attending Physician
Children's Hospital Los Angeles
Los Angeles, California, United States
JH

Jeffrey Hammoudeh, MD, DDS

Attending Physician
Children's Hospital Los Angeles
Los Angeles, California, United States

Disclosure(s):

Eloise Stanton, BA: No financial relationships to disclose

Katelyn Kondra, MD: No financial relationships to disclose

Christian Jimenez, BS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Naikhoba Munabi, MD, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Allen Huang, MD, DDS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Kevin Chen, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

William Magee, MD, DDS, III: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Mark M. Urata, MD, DDS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Jeffrey Hammoudeh, MD, DDS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Abstract: Pierre Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and obstructive sleep apnea (OSA). MDO has become a well-documented and effective surgical modality to treat OSA and avoid tracheostomy.1,2 The overall benefits of MDO for patients with PRS are well described in the literature. The effect of distraction distance has not been investigated. The authors sought to elucidate the patient and distraction factors that affect postoperative outcomes for these patients.
A retrospective chart review was conducted for patients with isolated PRS who underwent MDO at Children's Hospital Los Angeles between January 2006-September 2021. Patients with diagnoses other than isolated PRS were excluded. Inclusion criteria specified patients requiring mandibular distraction given elevated AHI with planned distraction to 30mm, as is the current standard at our institution. Relationships between demographics, preoperative sleep variables, and postoperative OSA outcomes were analyzed. Results were stratified according to OSA severity and distraction distance (30mm vs. < 30mm). Data were analyzed with SPSS software Version 28.0 (SPSS Inc., Chicago, IL). Descriptive statistics and tests of statistical significance were performed, including Student’s t-test, chi-square, multiple linear regression, and correlation analysis. A statistically significant result was indicated by a value of p < 0.05.
A total of 71 patients met inclusion criteria. Fifty-six patients were distracted to 30mm, while the remaining 15 patients experienced shorter distraction; reasons for shorter distraction included infection, parent preference, and loss to follow-up. Compared with patients distracted to less than 30mm, those distracted to 30mm had a significantly greater improvement in AHI when controlling for preoperative sleep study variables (p=0.047) (Table 1). Following MDO, significant improvement was observed in lowest oxygen saturation (preoperative: 78.7%, postoperative: 85.5%, p < 0.001), AHI (preoperative: 31.1, postoperative: 8.4, p < 0.001), highest carbon dioxide level (preoperative: 52.1, postoperative: 46.0, p=0.002), and highest oxygen requirement (preoperative: 0.74, postoperative: 0.21, p=0.001).
Patients with PRS who have more severe OSA experienced greater improvements in sleep study scores after MDO with over 89% of patients with severe OSA achieving mild or complete resolution of disease. Our results provide tangible evidence for how maximally distracting patients to 30mm can improve disease parameters, which can assist clinicians and families in anticipating outcomes after MDO for patients with isolated PRS.
1. Deguchi T Sr, Katashiba S, Inami T, Foong KWC, Huak CY. Morphologic quantification of the maxilla and the mandible with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2010;137(2):218-222.
2. Gürsoy S, Hukki J, Hurmerinta K. Five year follow-up of mandibular distraction osteogenesis on the dentofacial structures of syndromic children. Orthodontics & Craniofacial Research. 2008;11(1):57-64. doi:10.1111/j.1601-6343.2008.00415.x