title: Gastrostomy Placement Rates in Infants with Pierre Robin Sequence: A Comparison of Tongue-Lip Adhesion and Mandibular Distraction Osteogenesis.
abstract: BACKGROUND
  This study was conducted to compare the gastrostomy rates in infants with Pierre Robin sequence treated with tongue-lip adhesion or mandibular distraction osteogenesis.
  
  
  METHODS
  This was a retrospective study of symptomatic plastic and reconstructive surgery patients treated over an 8-year period. The primary predictor variable was surgical intervention (tongue-lip adhesion or distraction osteogenesis). Secondary predictor variables were categorized as demographic and clinical factors. The primary outcome was the need for gastrostomy tube placement. Secondary outcomes were complication rates, costs, and length of stay.
  
  
  RESULTS
  Thirty-one tongue-lip adhesion and 30 distraction osteogenesis patients were included in the study. The groups were statistically comparable with regard to demographic and clinical factors (p > 0.18). Gastrostomy rates were higher in patients who underwent tongue-lip adhesion (48 percent) versus those who underwent distraction osteogenesis (16.7 percent; p = 0.008). In an adjusted model, subjects undergoing tongue-lip adhesion were more likely to require gastrostomy tube for nutritional support (OR, 6.5; 95 percent CI, 1.7 to 25.2; p = 0.007). There were two major complications in the tongue-lip adhesion group and none in the distraction osteogenesis group. There were three minor complications in the tongue-lip adhesion group and five in the distraction osteogenesis group. Total operating room costs were higher for distraction osteogenesis (p = 0.05), and total hospital costs and length of stay were higher for tongue-lip adhesion (p < 0.05).
  
  
  CONCLUSIONS
  Among infants with symptomatic Pierre Robin sequence, treatment by distraction osteogenesis is associated with a lower risk for gastrostomy placement for nutritional support. Hospital costs are higher for tongue-lip adhesion.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: Srinivas M
authors.initials: SM
authors.lastname: Susarla
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Swanson
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: Denver
authors.initials: D
authors.lastname: Lough
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: S Alex
authors.initials: SA
authors.lastname: Rottgers
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Redett
authors.affiliation: Baltimore, Md.|From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
authors.forename: Anand R
authors.initials: AR
authors.lastname: Kumar
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007223:Infant; D008046:Lip / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000191:economics; D010855:Pierre Robin Syndrome / Q000191:economics / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000191:economics; D012189:Retrospective Studies; D014059:Tongue / Q000601:surgery*; D016896:Treatment Outcome