title: The surgical correction of Pierre Robin sequence: mandibular distraction osteogenesis versus tongue-lip adhesion.
abstract: BACKGROUND
  The authors present an outcomes analysis of mandibular distraction osteogenesis versus tongue-lip adhesion in the surgical treatment of Pierre Robin sequence.
  
  
  METHODS
  A retrospective, 15-year, single-surgeon review was undertaken of all nonsyndromic neonates with Pierre Robin sequence treated with mandibular distraction osteogenesis (2004 to 2009; n = 24) or tongue-lip adhesion (1994 to 2004; n = 15). Outcomes included time of extubation, length of intensive care unit stay, incidence of tracheostomy, and surgical complications. Polysomnography data were collected 1 month and 1 year postoperatively. Sleep study data included changes in oxygen saturation and apnea-hypopnea index.
  
  
  RESULTS
  There were no postprocedure tracheostomies in the mandibular distraction osteogenesis group and four tracheostomies in the tongue-lip adhesion group. The preoperative oxygen saturations were significantly lower in the mandibular distraction osteogenesis group compared with tongue-lip adhesion (76.5 percent versus 82 percent; p < 0.05). Preoperative apnea-hypopnea index was significantly higher in the mandibular distraction osteogenesis group compared with the tongue-lip adhesion group (47 versus 37.6; p < 0.05). Despite these preoperative differences, patients undergoing mandibular distraction osteogenesis demonstrated significantly higher oxygen saturation levels at 1 month (98.3 percent versus 87.5 percent; p < 0.05) and 1 year postoperatively (98.5 percent versus 89.2 percent; p < 0.05) and lower apnea-hypopnea index at 1 month (10.9 versus 21.6; p < 0.05) and 1 year postoperatively (2.5 versus 22.1; p < 0.05) compared with tongue-lip adhesion. Surgical complications were comparable between the two groups.
  
  
  CONCLUSIONS
  In nonsyndromic patients with Pierre Robin sequence, mandibular distraction osteogenesis demonstrates superior outcome measures regarding oxygen saturation, apnea-hypopnea index, and incidence of tracheostomy compared with tongue-lip adhesion.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Indianapolis, Ind.; Amman, Jordan; Salt Lake City, Utah; Milwaukee, Wis.; and Hamilton, Ontario, Canada From the Division of Plastic Surgery, Riley Hospital for Children, Indiana University Medical Center; private practice; the Division of Plastic Surgery, McMaster University; and the Department of Plastic Surgery, Medical College of Wisconsin.
authors.forename: Roberto L
authors.initials: RL
authors.lastname: Flores
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Tholpady
authors.forename: Shawkat
authors.initials: S
authors.lastname: Sati
authors.forename: Grant
authors.initials: G
authors.lastname: Fairbanks
authors.forename: Juan
authors.initials: J
authors.lastname: Socas
authors.forename: Matthew
authors.initials: M
authors.lastname: Choi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Havlik
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008046:Lip / Q000601:surgery*; D008334:Mandible / Q000601:surgery*; D019857:Osteogenesis, Distraction; D010855:Pierre Robin Syndrome / Q000150:complications / Q000601:surgery*; D017286:Polysomnography; D012189:Retrospective Studies; D013536:Suture Techniques; D014059:Tongue / Q000601:surgery*; D014139:Tracheostomy; D016896:Treatment Outcome