title: Swallowing disorders in Pierre Robin sequence: its correction by distraction.
abstract: Pierre Robin sequence is characterized by micro-gnathia, glossoptosis, feeding difficulties, and upper respiratory obstruction, which are frequently complicated by bronchial aspiration and pulmonary infection. Gastroesophageal reflux is also common in these patients. To assess the results of mandibular distraction, a study was performed in 18 patients to detect swallowing disorders associated with apnea episodes and gastroesophageal reflux. Polysomnography, barium pharyngoscopy, determination of blood gases, and esophageal pH measurements were undertaken before and 4 months after distraction osteogenesis. Bilateral corticotomies, followed by distraction with external devices, were performed, achieving 7 to 19 mm of elongation (mean = 12 mm). Gastroesophageal reflux was found in 83% of cases associated with apnea episodes, but it disappeared after distraction osteogenesis. Mean preoperative oxygen saturation was 72%, and it was 93% afterward. The preoperative apnea index was 18.3, and the preoperative 8.5 hypopnea index was 8.5; both disappeared. Pharyngeal transit time became less than 1 second after treatment. Abnormal tongue movements and barium stasis in the pharyngeal recess and in the trachea were eliminated in all the patients.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea González, and Postgraduate Division, Medical School, Universidad Nacional Autónoma de México, Mexico City, Mexico. fortizm@prodigy.net.mx
authors.forename: Fernando Ortíz
authors.initials: FO
authors.lastname: Monasterio
authors.forename: Fernando
authors.initials: F
authors.lastname: Molina
authors.forename: Fidel
authors.initials: F
authors.lastname: Berlanga
authors.forename: María Elena
authors.initials: ME
authors.lastname: López
authors.forename: Héctor
authors.initials: H
authors.lastname: Ahumada
authors.forename: Raúl H
authors.initials: RH
authors.lastname: Takenaga
authors.forename: Antonio
authors.initials: A
authors.lastname: Ysunza
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation* / Q000379:methods; D008844:Micrognathism / Q000209:etiology / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods*; D010855:Pierre Robin Syndrome / Q000150:complications* / Q000601:surgery; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome