Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health.
NYU Comprehensive Epilepsy Center - Sleep Center, NYU Langone Health.
J Craniofac Surg. 2021 Oct 1;32(7):2326-2329. doi: 10.1097/SCS.0000000000007670.
Neonates with severe Pierre Robin sequence (PRS) can be treated by mandibular distraction osteogenesis (MDO), tongue-lip adhesion, or tracheostomy; however, there is an active debate regarding the indications of MDO in this patient population. Published algorithms identify tracheomalacia, bronchomalacia, laryngomalacia, hypotonic syndromes, and central sleep apnea as contraindications for MDO and indications for tracheostomy, but these comorbidities may exist along a spectrum of severity. The authors propose that appropriately selected neonates with PRS who concurrently express 1 or more of these traditional contraindications may be successfully treated with MDO.
The authors performed a 5-year retrospective chart review of all neonates who underwent MDO for treatment of severe PRS. All patients expressed a comorbidity previously identified as an indication for tracheostomy. Pre- and postoperative characteristics were recorded. Apnea/hypopnea index (AHI) before and after MDO were compared using 2-tailed repeated measures t-test.
The authors identified 12 patients with severe PRS and conditions associated with contraindications to MDO: 9 (75.0%) patients had laryngomalacia, 6 (50.0%) patients had tracheomalacia, 2 (16.6%) patients had bronchomalacia, 1 (8.3%) patient had central sleep apnea, and 3 (25.0%) patients had hypotonia. Five (41.7%) patients underwent concurrent gastrostomy tube placement due to feeding insufficiency. Average birthweight was 3.0 kg. Average pre-op AHI was 34.8. Average post-op AHI was 7.3. All patients successfully underwent MDO with avoidance of tracheostomy.
By employing an interdisciplinary evaluation of patient candidacy, MDO can safely and effectively treat upper airway obstruction and avoid tracheostomy in higher-risk neonatal patients with traditional indications for tracheostomy.
严重 Pierre Robin 序列（PRS）的新生儿可以通过下颌骨牵引成骨术（MDO）、舌唇粘连或气管切开术进行治疗；然而，对于此类患者人群，MDO 的适应证仍存在争议。已发表的算法将气管软化、支气管软化、喉软化、张力减退综合征和中枢性睡眠呼吸暂停确定为 MDO 的禁忌证和气管切开术的适应证，但这些合并症可能存在于严重程度的连续谱中。作者提出，对于同时表达 1 种或多种传统禁忌证的适当选择的 PRS 新生儿，MDO 可能是一种有效的治疗方法。
作者对所有因严重 PRS 接受 MDO 治疗的新生儿进行了 5 年的回顾性图表审查。所有患者均表达了先前被确定为气管切开术适应证的合并症。记录了术前和术后的特征。使用双尾重复测量 t 检验比较 MDO 前后的呼吸暂停/低通气指数（AHI）。
作者确定了 12 例严重 PRS 合并与 MDO 禁忌证相关的患者：9 例（75.0%）患者存在喉软化，6 例（50.0%）患者存在气管软化，2 例（16.6%）患者存在支气管软化，1 例（8.3%）患者存在中枢性睡眠呼吸暂停，3 例（25.0%）患者存在张力减退。5 例（41.7%）患者因喂养不足而行胃造口管放置术。平均出生体重为 3.0kg。平均术前 AHI 为 34.8。平均术后 AHI 为 7.3。所有患者均成功接受 MDO，避免了气管切开术。
通过对患者候选资格进行多学科评估，MDO 可以安全有效地治疗上呼吸道阻塞，并避免对具有传统气管切开术适应证的高危新生儿患者进行气管切开术。
