Resnick Cory M, LeVine Joshua, Calabrese Carly E, Padwa Bonnie L, Hansen Anne, Katwa Umakanth
Assistant Professor, Harvard School of Dental Medicine and Harvard Medical School; Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
Dental Student, Harvard School of Dental Medicine, Boston, MA.
J Oral Maxillofac Surg. 2019 Jan;77(1):136-156. doi: 10.1016/j.joms.2018.05.031. Epub 2018 Jun 4.
There is no widely accepted protocol for management of infants with Robin sequence (RS) who present with airway obstruction and feeding impairment. The purposes of this study were to evaluate diagnostic and treatment preferences of clinicians from the United States and non-US countries and to use these data to propose an algorithm for early management of infants with RS.
A cross-sectional study was implemented using a survey, which was distributed to craniofacial surgeons and non-surgeon physicians involved in management of infants with RS. Predictor variables were nationality, specialty, and surgical volume. Outcome variables included survey responses regarding preferences for evaluation and early treatment of patients with RS. A diagnostic and early treatment algorithm was proposed based on the most common survey responses. Descriptive and analytic statistics were calculated and a P less than .05 was considered significant.
A total of 275 responses were received and 82 were excluded, leaving a final sample of 193 participants: 155 (80%) surgeons and 38 (20%) non-surgeon physicians. Thirty-seven US states were represented by 143 (74%) respondents and 50 (26%) participants were from 19 non-US countries. There were 96 (50%) low-volume and 97 (50%) high-volume respondents. There was general agreement in methods for evaluation and early treatment among respondents; the only significant differences were 1) US surgeons operate earlier to address airway obstruction than those from other countries (P = .001), 2) high-volume providers tend to operate earlier (P = .017) and to choose mandibular distraction more frequently (P = .003) than low-volume respondents, and 3) mandibular distraction is the preferred operation in the United States, but several operations for airway improvement are used equally in non-US countries (P < .001).
Despite variation in the evaluation and treatment of infants with RS, this international and multispecialty survey showed trends that could represent best practices. An algorithm based on these findings is proposed.
对于患有罗宾序列征（RS）且出现气道阻塞和喂养障碍的婴儿，目前尚无广泛接受的管理方案。本研究的目的是评估美国和非美国国家临床医生的诊断和治疗偏好，并利用这些数据提出一种针对RS婴儿早期管理的算法。
采用一项调查进行横断面研究，该调查分发给参与RS婴儿管理的颅面外科医生和非外科医生。预测变量为国别、专业和手术量。结果变量包括关于RS患者评估和早期治疗偏好的调查回复。基于最常见的调查回复提出了一种诊断和早期治疗算法。计算了描述性和分析性统计数据，P值小于0.05被认为具有统计学意义。
共收到275份回复，排除82份，最终样本为193名参与者：155名（80%）外科医生和38名（20%）非外科医生。143名（74%）受访者来自美国37个州，50名（26%）参与者来自19个非美国国家。有96名（50%）低手术量和97名（50%）高手术量受访者。受访者在评估和早期治疗方法上总体一致；唯一显著的差异是：1）美国外科医生比其他国家的外科医生更早进行手术以解决气道阻塞问题（P = 0.001）；2）高手术量的医疗服务提供者比低手术量的受访者倾向于更早进行手术（P = 0.017）且更频繁地选择下颌骨牵张术（P = 0.003）；3）下颌骨牵张术在美国是首选手术，但在非美国国家，几种改善气道的手术使用频率相同（P < 0.001）。
尽管RS婴儿的评估和治疗存在差异，但这项国际多专业调查显示出了可能代表最佳实践的趋势。基于这些发现提出了一种算法。
