Paes Emma C, Bittermann Gerhard K P, Bittermann Dirk, Muradin Marvick M, van Hogezand Rose, Etty Erika, Mink van der Molen Aebele B, Kon Moshe, Breugem Corstiaan C
Utrecht, The Netherlands From the Departments of Paediatric Plastic Surgery and Oral and Maxillofacial Surgery and Special Dental Care, Wilhelmina Children's Hospital; and University Medical Centre.
Plast Reconstr Surg. 2016 Feb;137(2):375e-385e. doi: 10.1097/01.prs.0000475769.06773.86.
Mandibular distraction osteogenesis with a unidirectional resorbable device is an effective treatment option for severe upper airway obstruction in infants with Robin sequence. Long-term effects, especially with regard to tooth development and mandibular outgrowth, are not known.
Robin sequence infants with a follow-up of greater than or equal to 5 years were included. Baseline characteristics were extracted from medical records. Panoramic and lateral cephalometric radiographs were analyzed and patients were recalled for physical examination.
Ten infants underwent mandibular distraction osteogenesis at a mean age of 3.7 months (median, 19 months; range, 11 days to 27 months). Mean length of follow-up was 6.8 years (range, 5.0 to 7.9 years). Ten Robin sequence infants without mandibular distraction osteogenesis (mean length of follow-up, 7.4 years; range, 6.7 to 8.9 years) were the controls. Shape anomalies, positional changes, and root malformations of molars were seen significantly more often than in the control group (p = 0.007, p = 0.009, and p = 0.043, respectively). Mandibular length was shorter (p = 0.030), but mandibular ramus height was comparable (p = 0.838) with that of the non-mandibular distraction osteogenesis group. Compared with healthy controls, all Robin sequence infants had a significantly shorter mandible.
Mandibular distraction osteogenesis with a resorbable system reveals overall good short- and long-term results, but the effects on developing molars and mandibular outgrowth likely necessitate secondary procedures. This factor should be considered when deciding on treatment options and counseling of parents.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
使用单向可吸收装置进行下颌骨牵张成骨术是治疗罗宾序列征婴儿严重上气道梗阻的有效方法。其长期影响，尤其是对牙齿发育和下颌骨生长的影响尚不清楚。
纳入随访时间大于或等于5年的罗宾序列征婴儿。从病历中提取基线特征。分析全景和侧位头影测量X线片，并召回患者进行体格检查。
10例婴儿接受了下颌骨牵张成骨术，平均年龄为3.7个月（中位数为19个月；范围为11天至27个月）。平均随访时间为6.8年（范围为5.0至7.9年）。10例未接受下颌骨牵张成骨术的罗宾序列征婴儿（平均随访时间为7.4年；范围为6.7至8.9年）作为对照组。磨牙的形态异常、位置改变和牙根畸形在研究组中比对照组更常见（分别为p = 0.007、p = 0.009和p = 0.043）。下颌骨长度较短（p = 0.030），但下颌升支高度与未接受下颌骨牵张成骨术的组相当（p = 0.838）。与健康对照组相比，所有罗宾序列征婴儿的下颌骨均明显较短。
使用可吸收系统进行下颌骨牵张成骨术显示出总体良好的短期和长期效果，但对正在发育的磨牙和下颌骨生长的影响可能需要二次手术。在决定治疗方案和向家长咨询时应考虑这一因素。
临床问题/证据水平：治疗性，III级
