Runyan Christopher M, Uribe-Rivera Armando, Tork Shahryar, Shikary Tasneem A, Ehsan Zarmina, Weaver K Nicole, Hossain Md Monir, Gordon Christopher B, Pan Brian S
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.
Plast Reconstr Surg Glob Open. 2018 May 10;6(5):e1688. doi: 10.1097/GOX.0000000000001688. eCollection 2018 May.
Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined.
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.
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; < 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 ( = 0.030) and low birth weight ( = 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.
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.
与皮埃尔·罗宾序列征（PRS）相关的气道阻塞通常采用手术治疗；然而，预测手术需求的客观指标定义尚不明确。
对171例PRS新生儿进行回顾性病历审查。根据干预方式将婴儿分组：非手术（保守）或手术[下颌骨牵张成骨术（MDO）或气管切开术]。比较各组之间的人口统计学数据、体格检查结果和研究结果，以确定手术干预的危险因素，并预测这些干预措施的长期成功或失败。
接受手术治疗的患者中，最显著的客观危险因素是干预前睡眠研究结果不佳[阻塞指数（OI）：保守治疗组为42.4，而手术治疗组为12.9；<0.001]。保守治疗的患者中只有11%的OI>20，而手术治疗的患者中有67.5%达到了这一严重程度标准。在接受手术治疗的患者中，与MDO组相比，气管切开术与神经功能损害（=0.030）和低出生体重（=0.046）相关。与综合征状态一起，这些危险因素有助于预测MDO避免后续气管切开术失败的情况（检测敏感性和特异性分别为64.2%和100.0%）。三组之间在言语或小颌畸形方面未发现长期差异；然而，与气管切开术组相比，保守治疗或MDO治疗的患者在长期喂养和气道阻塞方面有改善。
对于与PRS相关的舌后气道阻塞，当OI>20时应强烈考虑手术干预。气管切开术应保留给伴有综合征诊断、神经功能损害和低出生体重的复杂患者。
