Is Tongue-Lip Adhesion or Mandibular Distraction More Effective in Relieving Obstructive Apnea in Infants with Robin Sequence?

Publication date: Available online 18 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Cory M. Resnick, Carly E. Calabrese, Rohit Sahdev, Bonnie L. Padwa

Abstract

Objective

Tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) are the most common operations for obstructive apnea (OA) in infants with Robin sequence (RS). The purpose of this study is to compare early outcomes of TLA and MDO on resolution of OA.

Methods

Retrospective cohort study of infants with RS treated with TLA or MDO from 2005-2018. To be included, patients had to have polysomnograms (PSG) pre- and postoperatively unless intubated or tracheostomy dependent. Patients were excluded if the operation occurred after 1 year-of-age. The primary predictor variable was type of operation (TLA or MDO). The primary outcome variable was "successful resolution of OA", defined as: (1) postoperative apnea-hypopnea index (AHI)<5, (2) postoperative OA severity score 0-1 (no/mild OA), and (3) no need for additional airway intervention during the first year-of-life. Descriptive, bivariate and regression analyses were performed. Statistical significance was set at p<0.05.

Results

43 patients were included: TLA, n=19 (44%); MDO, n=24 (56%). Eighteen subjects (41%) were syndromic. Patients in the TLA group were significantly younger at operation (28.2±23.1 days) compared to the MDO group (87.1±81.7 days, p=0.002). The MDO group had more severe preoperative OA (AHI=20.5±14.9; OA severity score=4.7±0.8) than the TLA group (AHI=17.6±31.0; OA severity score=3.6±1.4, p<0.041). Postoperative AHI and OA severity score for the TLA group were 11.7±19.5 (33.5% reduction, p=0.496) and 2.3±1.8 (improvement by 1.3±2.4 levels, p=0.051), respectively. Postoperative AHI and OA severity score for the MDO group were 1.1±1.8 (94.6% reduction, p<0.001) and 0.2±0.4 (improvement by 4.6±0.8 levels, p<0.0001), respectively. Successful resolution of OA occurred in 9 patients (47%) in the TLA group and 22 (92%) patients in the MDO group. Post-operative complications were similar.

Conclusion

MDO is more effective than TLA in relieving OA in infants with RS.

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