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Management of Airway Obstruction in Infants With Pierre Robin Sequence

Runyan, Christopher, M., MD, PhD*; Uribe-Rivera, Armando, DDS; Tork, Shahryar, MD; Shikary, Tasneem, A., MD§; Ehsan, Zarmina, MD; Weaver, K., Nicole, MD; Hossain, Md, Monir, PhD, MSc**; Gordon, Christopher, B., MD††; Pan, Brian, S., MD‡‡

Plastic and Reconstructive Surgery – Global Open: May 10, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001688
Latest Articles: PDF Only

Background: Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined.

Methods: A retrospective chart review was performed on 171 neonates with PRS. Infants were grouped based upon intervention modality: nonsurgical (conservative) or surgical [mandibular distraction osteogenesis (MDO) or tracheostomy]. Demographic data, physical examination findings, and study results were compared between groups to determine risk factors for surgical intervention, and to predict long-term success or failure of those interventions.

Results: The most significant, objective risk factor among those receiving surgery was a poor preintervention sleep study [obstructive index (OI): 42.4 versus 12.9 for the conservative treatment group; P < 0.001]. Only 11% of those treated conservatively had an OI >20, whereas 67.5% of those treated surgically met this severity measure. Of those receiving surgery, tracheostomy was associated with neurologic impairment (P = 0.030) and low birth weight (P = 0.046) compared with the MDO group. Together with syndromic status, these risk factors were useful for predicting failure of MDO to avoid subsequent tracheostomy (test sensitivity and specificity were 64.2% and 100.0%, respectively). No long-term differences in speech or micrognathia were detected between the 3 groups; however, those treated conservatively or with MDO had improved long-term feeding and airway obstruction outcomes compared with the tracheostomy group.

Conclusions: Surgical intervention for PRS-related tongue-based airway obstruction should be strongly considered with an OI >20. Tracheostomy should be reserved for complex patients with concomitant syndromic diagnosis, neurologic impairment, and low birth weight.

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From the *Department of Plastic Surgery, Wake Forest University, Winston-Salem, N.C.

Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, N.Y.

Department of Plastic Surgery, Ohio State University, Columbus, Ohio

§Otolaryngology, Trihealth, Cincinnati, Ohio

Department of Pulmonary and Sleep Medicine, Children’s Mercy Hospital and University of Missouri-Kansas City, Kansas City, Mo.

Division of Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

**Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

††Department of Plastic Surgery, Dayton Children’s Hospital, Dayton, Ohio

‡Division of Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Published online 10 May 2018.

Received for publication November 28, 2017; accepted January 5, 2018.

Presented at the 57th Annual Meeting of the Ohio Valley Society of Plastic Surgeons, June 5–7, 2014, Greenbrier Resort, WV; American Society of Plastic Surgery, October 10–14, 2014, Chicago, IL; and 72nd Annual Meeting of the American Cleft Palate–Craniofacial Association, April 22–25, 2015, Rancho Mirage, CA.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

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Christopher M. Runyan, MD, PhD, Department of Plastic Surgery, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, E-mail: crunyan@wakehealth.edu

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.