From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine; and the Cleft Palate Program, Orthopaedic Institute for Children.
Plast Reconstr Surg. 2020 Nov;146(5):599e-606e. doi: 10.1097/PRS.0000000000007246.
One of the arguments against early intervention for micrognathia in Pierre Robin sequence is the concept that the growth of the mandible will eventually "catch up." Long-term growth of the mandible and occlusal relationships of conservatively managed Pierre Robin sequence patients remain unknown. In this study, the authors evaluated the orthognathic surgery requirements for Pierre Robin sequence patients at skeletal maturity.
Orthognathic surgical requirements of conservatively managed Pierre Robin sequence and isolated cleft patients (aged ≥13 years) at two institutions were reviewed and analyzed using t test, chi-square test, and Fisher's exact test. Values of p < 0.05 were considered statistically significant.
Of the Pierre Robin sequence patients (n = 64; mean age ± SD, 17.9 ± 2.9 years), 65.6 percent were syndromic (primarily Stickler and velocardiofacial syndrome), 96.9 percent had a cleft palate, and 39.1 percent required orthognathic surgery at skeletal maturity. Nonsyndromic and syndromic Pierre Robin sequence patients demonstrated no differences in occlusal relationships or mandibular surgery frequency. The majority of Pierre Robin sequence patients requiring mandibular advancement had a class II occlusion. Comparison of Pierre Robin sequence patients to isolated cleft palate patients (n = 17) revealed a comparable frequency of orthognathic surgery between the two; however, Pierre Robin sequence patients did require mandibular advancement surgery at a greater frequency than cleft palate patients (p = 0.006).
The present study found that 39.1 percent of conservatively managed Pierre Robin sequence patients required orthognathic surgery at skeletal maturity, of which the vast majority required mandibular advancement for class II malocclusion. These data suggest that mandibular micrognathia in conservatively managed Pierre Robin sequence patients may not resolve over time and may require surgical intervention.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
反对 Pierre Robin 序列中下颌骨过小进行早期干预的一个论点是下颌骨的生长最终会“赶上”。保守治疗的 Pierre Robin 序列患者的下颌骨长期生长和咬合关系仍不清楚。在这项研究中，作者评估了骨骼成熟时 Pierre Robin 序列患者接受正颌手术的需求。
回顾了两家机构保守治疗的 Pierre Robin 序列和孤立性腭裂患者（年龄≥13 岁）的正颌手术需求，并使用 t 检验、卡方检验和 Fisher 精确检验进行分析。p 值<0.05 被认为具有统计学意义。
在 Pierre Robin 序列患者（n=64；平均年龄±标准差，17.9±2.9 岁）中，65.6%为综合征型（主要为 Stickler 和 velocardiofacial 综合征），96.9%有腭裂，39.1%在骨骼成熟时需要正颌手术。非综合征型和综合征型 Pierre Robin 序列患者的咬合关系或下颌骨手术频率无差异。需要下颌骨前伸的 Pierre Robin 序列患者大多数存在 II 类咬合。将 Pierre Robin 序列患者与孤立性腭裂患者（n=17）进行比较，发现两者的正颌手术频率相当；然而，Pierre Robin 序列患者确实比腭裂患者更频繁地需要下颌骨前伸手术（p=0.006）。
本研究发现，39.1%的保守治疗的 Pierre Robin 序列患者在骨骼成熟时需要正颌手术，其中绝大多数需要下颌骨前伸以矫正 II 类错颌。这些数据表明，保守治疗的 Pierre Robin 序列患者的下颌骨小颌可能不会随时间而缓解，可能需要手术干预。
临床问题/证据水平：风险，II 级。
