Franco Johnny, Coppage Jeffrey, Carstens Michael H
Division of Plastic Surgery, Department of Surgery, Saint Louis University, St Louis, Missouri, USA.
J Craniofac Surg. 2010 Jul;21(4):1158-61. doi: 10.1097/SCS.0b013e3181e47d58.
Mandibular distraction is recognized as a treatment of respiratory distress in neonates with microretrognathia as seen in the Pierre Robin syndrome. However, mandibular distraction is a complex and lengthy treatment involving 2 to 4 weeks of distraction and another 4 to 12 weeks for bone consolidation. This study was performed to establish the safety and effectiveness of rapid protocol distraction osteogenesis with recombinant human bone morphogenetic protein 2 (rhBMP-2) in neonates with the Pierre Robin syndrome.
A retrospective review of all patients treated in our department between February 2003 and February 2008 was performed. Three patients with the Pierre Robin syndrome who underwent distraction osteogenesis with rhBMP-2 were identified. Inpatient and outpatient charts were reviewed for time to completion of distraction, age at distraction, need for tracheostomy, and complications of the mandibular distraction.
Three patients (6 hemimandibles) with Pierre Robin syndrome underwent rapid protocol distraction with rhBMP-2. Mean age at initial distraction was 17.3 days. Mean time from device placement to removal was 89.3 days. The complication rate was 16%, with 1 case of nonunion that required subsequent operative intervention. No patient required tracheostomy.
Rapid protocol distraction with rhBMP-2 allows distraction of the hypoplastic mandible to class III occlusion during the initial operation and avoids the latency and distraction phases of standard mandibular distraction. This case series demonstrates the safety and effectiveness of rapid distraction in neonates with Pierre Robin syndrome. Larger studies and long-term follow-up are necessary; however, this study suggests that rapid protocol distraction with rhBMP-2 is effective in neonates with Pierre Robin syndrome.
下颌骨牵张成骨术被认为是治疗患有小下颌后缩（如Pierre Robin综合征所见）的新生儿呼吸窘迫的一种方法。然而，下颌骨牵张成骨术是一种复杂且耗时的治疗方法，包括2至4周的牵张期以及另外4至12周的骨愈合期。本研究旨在确定在患有Pierre Robin综合征的新生儿中使用重组人骨形态发生蛋白2（rhBMP-2）进行快速方案牵张成骨术的安全性和有效性。
对2003年2月至2008年2月在我科接受治疗的所有患者进行回顾性研究。确定了3例接受rhBMP-2牵张成骨术治疗的Pierre Robin综合征患者。回顾住院和门诊病历，以了解牵张完成时间、牵张时的年龄、气管切开术需求以及下颌骨牵张的并发症。
3例（6侧半下颌骨）患有Pierre Robin综合征的患者接受了rhBMP-2快速方案牵张。初次牵张时的平均年龄为17.3天。从装置放置到取出的平均时间为89.3天。并发症发生率为16%，有1例骨不连需要后续手术干预。没有患者需要气管切开术。
使用rhBMP-2的快速方案牵张可在初次手术期间将发育不全的下颌骨牵张至III类咬合，并避免了标准下颌骨牵张的延迟期和牵张期。该病例系列证明了在患有Pierre Robin综合征的新生儿中进行快速牵张的安全性和有效性。需要进行更大规模的研究和长期随访；然而，本研究表明，使用rhBMP-2的快速方案牵张对患有Pierre Robin综合征的新生儿有效。
