Mao Zhe, Tian Gabriel, Shrivastava Mayank, Zhou Jiawei, Ye Liang
Department of Oral and Maxillofacial Surgery, Guangzhou Women and Children's Medical Center, Guangzhou 510000, China.
Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA.
Children (Basel). 2023 Sep 23;10(10):1591. doi: 10.3390/children10101591.
Mandibular Distraction Osteogenesis (MDO) is now the preferred procedure to alleviate airway obstruction in infants with severe Robin Sequence (RS). However, there have been very few studies investigating complications related to MDO surgery performed on patients affected by isolated RS. In this study, age at distraction, weight at distraction, preoperative intubation, repeat MDO and complications associated with MDO were included as variables. Minor, moderate and major problems were evaluated and recorded as surgical site infections (SSI), injuries to the facial nerve, self-extinction hypertrophic scars, temporomandibular joint ankylosis, device failures, early ossification and fibrous non-union. One hundred and fifty one patients with isolated RS were included. At distraction, the mean age was 72 days (12-540 days) and the mean weight was 4.05 kg (2.4-12.2 kg). Only one patient needed tracheostomy after MDO, and none required further distraction. Ultimately, the complication rate was 15.23%, and there was a total of 7.95% minor, 9.27% moderate and 0% major complications. Minor incidents included surgical site infection (SSI) managed with antibiotics taken orally ( = 8), neuropraxia in the VII cranial nerve (CN) ( = 1), and hypertrophic scarring ( = 3). Incidents reported as moderate were SSIs managed with intravenous antibiotics ( = 9), incision and drainage ( = 3) and self-extubation ( = 2). There was no case of TMJ ankylosis. There were no cases of early or premature ossification, fibrous non-union and device fracture. In conclusion, MDO is an effective and appropriate management technique for infants with isolated RS and severe airway obstruction. Infections at the surgery site accounted for the vast majority of the complications. Further investigations may be needed to determine the long-term consequences of MDO.
下颌骨牵张成骨术（MDO）现已成为缓解重度罗宾序列征（RS）婴儿气道阻塞的首选手术方法。然而，很少有研究调查针对孤立性RS患者进行MDO手术相关的并发症。在本研究中，将牵张时的年龄、牵张时的体重、术前插管、再次进行MDO以及与MDO相关的并发症作为变量。对轻微、中度和严重问题进行评估并记录为手术部位感染（SSI）、面神经损伤、自消性增生性瘢痕、颞下颌关节强直、器械故障、早期骨化和纤维性骨不连。纳入了151例孤立性RS患者。牵张时，平均年龄为72天（12 - 540天），平均体重为4.05千克（2.4 - 12.2千克）。MDO术后仅1例患者需要气管切开，且无人需要进一步牵张。最终，并发症发生率为15.23%，其中轻微并发症占7.95%，中度并发症占9.27%，严重并发症占0%。轻微事件包括口服抗生素治疗的手术部位感染（SSI）（ = 8）、第七颅神经（CN）神经失用（ = 1）和增生性瘢痕形成（ = 3）。报告为中度的事件有静脉用抗生素治疗的SSI（ = 9）、切开引流（ = 3）和自行拔管（ = 2）。没有颞下颌关节强直的病例。没有早期或过早骨化、纤维性骨不连和器械骨折的病例。总之，MDO是治疗孤立性RS且气道严重阻塞婴儿的一种有效且合适的治疗技术。手术部位感染占并发症的绝大多数。可能需要进一步研究以确定MDO的长期后果。
