Surgical management and outcomes of Pierre Robin Sequence: a comparison of mandibular distraction osteogenesis and tongue-lip adhesion

There is a paucity of primary literature directly comparing tongue-lip adhesion (TLA) versus mandibular distraction osteogenesis (MDO) in surgical treatment of patients with Pierre Robin Sequence (PRS). This study comprehensively reviews the literature to evaluate and compare the effectiveness of MDO and TLA in improving airway and feeding outcomes. A search was performed using the MEDLINE (PubMed interface) and Embase databases for publications between 1960 through June 2017. English-language, original studies involving MDO or TLA in treatment of PRS subjects were included. Extracted data included prevention of tracheostomy (primary airway outcome) and ability to feed exclusively by mouth (primary feeding outcome). Sixty-seven studies total were included in the review. Ninety-five percent (657/693) of subjects treated with MDO avoided tracheostomy. Eighty-nine percent (289/323) of subjects treated with TLA avoided tracheostomy. Eighty-seven percent (323/370) of subjects treated with MDO achieved full oral feeds at latest follow-up. Seventy percent (110/157) of subjects treated with TLA achieved full oral feeds at latest follow up. The rate of second intervention for recurrent obstruction ranged from 4 to 6% in MDO studies, compared to range of 22 to 45% in TLA studies. Variability of patient selection, surgical techniques, outcomes measurement methods, and follow up length across studies precluded meta-analysis of the data. Both MDO and TLA are effective alternatives to tracheostomy for patients who fail conservative management, improve feeding and promote weight gain. MDO may be superior to TLA in long-term resolution of airway obstruction and avoidance of gastrostomy, but is associated with notable complications. Disclosure: None of the authors listed have any conflicts of interest to report. Authorship: All listed authors 1) contributed to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafted the article or revised it critically; 3) gave final approval of the version to be published; 4) agreed to be accountable for all aspects of the work. Conflicts of Interest: The authors report no relevant financial disclosures related to this current work. IRB: This study does not contain primary data involving human subjects at the Children's Hospital of Philadelphia and so did not undergo Institutional Review Board review. Corresponding Author: Dr. Scott P. Bartlett, Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, The University of Pennsylvania, Colket Translational Research Building, 9th Floor, Philadelphia, PA 19104; E-mail: bartletts@email.chop.edu ©2018American Society of Plastic Surgeons

https://ift.tt/2sBpkBB