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- Title
Multimodal Treatment of Robin Sequence Utilizing Mandibular Distraction Osteogenesis and Continuous Positive Airway Pressure.
- Authors
Kosyk, Mychajlo S.; Carlson, Anna R.; Zapatero, Zachary D.; Kalmar, Christopher L.; Liaquat, Sidra; Bartlett, Scott P.; Taylor, Jesse A.; Cielo, Christopher M.; Swanson, Jordan W.
- Abstract
Objective : Mandibular distraction osteogenesis (MDO) and continuous positive airway pressure (CPAP) may each have a role in effectively treating tongue-based airway obstruction (TBAO) in Robin sequence (RS). This study describes longitudinal outcomes after treatment of TBAO with CPAP and/or MDO. Design : Retrospective cohort study. Setting : Tertiary Pediatric Hospital. Patients : A total of 129 patients with RS treated with CPAP and/or MDO from 2009 to 2019 were reviewed. Subjects receiving baseline and at least one follow-up polysomnogram were included. 55 who underwent MDO ± CPAP and 9 who received CPAP-only treatment were included. Main Outcome Measures : Patient characteristics, feeding, and polysomnographic data were compared and generalized linear mixed modeling performed. Results : Baseline obstructive apnea–hypopnea index (OAHI) was greater in the MDO-treated group (median x˜ = 33.7 [interquartile range: 26.5-54.5] than the CPAP-treated group (x˜ = 20.3[13.3-36.7], P ≤.033). There was significant reduction in OAHI following treatment with CPAP and MDO modalities, P ≤.001. SpO2 nadir after MDO was lower in syndromic (x˜ = 85.0[81.0-87.9] compared to nonsyndromic patients (x˜ = 88.4[86.8-90.5], P ≤.005.) CPAP was utilized following MDO in 2/24 (8.3%) of nonsyndromic and 16/31 (51.6%) of syndromic subjects (P ≤.001,) for a median duration of 414 days. Three patients (5%) underwent tracheostomy, all had MDO. Nasogastric tube feeding at hospital discharge was more common following MDO (44, 80%) than CPAP-only (4, 44.4%, P ≤.036), but did not differ at 6-month follow-up (P ≥.376). Conclusions : CPAP appears to effectively reduce obstructive apnea in patients with RS and moderate TBAO and be a useful adjunct in syndromic patients following MDO with improved but persistent obstruction.
- Subjects
BONE lengthening (Orthopedics); TRACHEOTOMY; CONTINUOUS positive airway pressure; RETROSPECTIVE studies; ACQUISITION of data; TERTIARY care; POLYSOMNOGRAPHY; RESPIRATORY obstructions; MEDICAL records; SLEEP apnea syndromes; DESCRIPTIVE statistics; RESEARCH funding; FACIAL nerve; LONGITUDINAL method
- Publication
Cleft Palate Craniofacial Journal, 2023, Vol 60, Issue 8, p993
- ISSN
1055-6656
- Publication type
Article
- DOI
10.1177/10556656221088173