Abstract：
BACKGROUND: The hypoplastic mandible in the congenital condition Pierre Robin sequence (PRS) displaces the base of the tongue posteriorly, which results in upper airway obstruction (UAO) that can potentially be corrected with mandibular distraction osteogenesis (MDO). Jaw thrust (JT) is routinely performed during evaluation of the airway; similar to MDO, it projects the mandible and tongue anteriorly to open the airway. The authors demonstrate that JT can be used as a criterion to predict successful MDO outcomes in infants with PRS.
METHODS: The study was a single-center, retrospective chart review of infants diagnosed with PRS between 2016 and 2023. Data regarding their demographics, comorbid diagnoses, JT success, airway anomalies, laryngeal grade of view, apnea-hypopnea index, and perioperative course were statistically analyzed.
RESULTS: Of the 16 patients included in the study, 11 had successful relief of their airway obstruction with JT and proceeded with MDO. The unsuccessful JT group had significantly greater proportions of females, birth prematurity, gastrostomies, tracheostomies, and longer hospital stays. In the successful JT group, both the mean laryngeal grade of view ( P =0.029) and mean apnea-hypopnea index ( P =0.025) improved significantly post-MDO. Post-MDO tracheostomy was also avoided in all but 1 patient who was not previously tracheostomized.
CONCLUSIONS: There is no widely accepted algorithm to guide craniofacial surgeons on the optimal intervention for relieving UAO in infants with PRS. In our institutional experience, patients whose preoperative JT relieved UAO also successfully relieved UAO with MDO. In patients with PRS, JT may be a useful criterion for selecting appropriate candidates for MDO.
METHODS: The study was a single-center, retrospective chart review of infants diagnosed with PRS between 2016 and 2023. Data regarding their demographics, comorbid diagnoses, JT success, airway anomalies, laryngeal grade of view, apnea-hypopnea index, and perioperative course were statistically analyzed.
RESULTS: Of the 16 patients included in the study, 11 had successful relief of their airway obstruction with JT and proceeded with MDO. The unsuccessful JT group had significantly greater proportions of females, birth prematurity, gastrostomies, tracheostomies, and longer hospital stays. In the successful JT group, both the mean laryngeal grade of view ( P =0.029) and mean apnea-hypopnea index ( P =0.025) improved significantly post-MDO. Post-MDO tracheostomy was also avoided in all but 1 patient who was not previously tracheostomized.
CONCLUSIONS: There is no widely accepted algorithm to guide craniofacial surgeons on the optimal intervention for relieving UAO in infants with PRS. In our institutional experience, patients whose preoperative JT relieved UAO also successfully relieved UAO with MDO. In patients with PRS, JT may be a useful criterion for selecting appropriate candidates for MDO.
摘要：
背景：先天性皮埃尔·罗宾序列（PRS）中的发育不良下颌骨向后移位了舌根，导致上呼吸道阻塞（UAO），可以通过下颌牵张成骨（MDO）进行纠正。下颌推力(JT)通常在气道评估期间进行;类似于MDO,它向前突出下颌骨和舌头以打开气道。作者证明，JT可以用作预测PRS婴儿成功MDO结局的标准。
方法：这项研究是单中心，2016年至2023年诊断为PRS的婴儿的回顾性图表回顾.关于他们的人口统计数据，共病诊断，JT成功,气道异常,喉等级的观点，呼吸暂停低通气指数,并对围手术期进行统计学分析。
结果：纳入研究的16例患者中，11使用JT成功缓解了气道阻塞，并进行了MDO。不成功的JT组的女性比例明显更高，出生早产,胃造口术,气管切开术,住院时间更长。在成功的JT组中，MDO后平均喉部视野分级(P=0.029)和平均呼吸暂停低通气指数(P=0.025)均显著改善.除了1例先前未进行气管造口术的患者外，所有患者都避免了MDO后气管造口术。
结论：目前还没有被广泛接受的算法来指导颅面外科医生对减轻PRS婴儿UAO的最佳干预措施。根据我们的制度经验，术前JT缓解UAO的患者也成功缓解了MDO的UAO。在PRS患者中，JT可能是选择MDO的适当候选的有用标准。
方法：这项研究是单中心，2016年至2023年诊断为PRS的婴儿的回顾性图表回顾.关于他们的人口统计数据，共病诊断，JT成功,气道异常,喉等级的观点，呼吸暂停低通气指数,并对围手术期进行统计学分析。
结果：纳入研究的16例患者中，11使用JT成功缓解了气道阻塞，并进行了MDO。不成功的JT组的女性比例明显更高，出生早产,胃造口术,气管切开术,住院时间更长。在成功的JT组中，MDO后平均喉部视野分级(P=0.029)和平均呼吸暂停低通气指数(P=0.025)均显著改善.除了1例先前未进行气管造口术的患者外，所有患者都避免了MDO后气管造口术。
结论：目前还没有被广泛接受的算法来指导颅面外科医生对减轻PRS婴儿UAO的最佳干预措施。根据我们的制度经验，术前JT缓解UAO的患者也成功缓解了MDO的UAO。在PRS患者中，JT可能是选择MDO的适当候选的有用标准。
