Swallowing Disorders in Pierre Robin Sequence: Its Correction by Distraction

Abstract

Pierre Robin sequence is characterized by micro-gnathia, glossoptosis, feeding difficulties, and upper respiratory obstruction, which are frequently complicated by bronchial aspiration and pulmonary infection. Gastroesophageal reflux is also common in these patients. To assess the results of mandibular distraction, a study was performed in 18 patients to detect swallowing disorders associated with apnea episodes and gastroesophageal reflux. Polysomnography, barium pharyngoscopy, determination of blood gases, and esophageal pH measurements were undertaken before and 4 months after distraction osteogenesis. Bilateral corticotomies, followed by distraction with external devices, were performed, achieving 7 to 19 mm of elongation (mean = 12 mm). Gastroesophageal reflux was found in 83% of cases associated with apnea episodes, but it disappeared after distraction osteogenesis. Mean preoperative oxygen saturation was 72%, and it was 93% afterward. The preoperative apnea index was 18.3, and the preoperative 8.5 hypopnea index was 8.5; both disappeared. Pharyngeal transit time became less than 1 second after treatment. Abnormal tongue movements and barium stasis in the pharyngeal recess and in the trachea were eliminated in all the patients.

Evaluation of airway volume changes in patients treated with distraction osteogenesis: a pilot study

“…It has been observed that DO reduces the need for tracheotomy especially in pediatric patients and allows for early decannulation in patients who previously underwent tracheotomy 14,15 . In addition, oral feeding is significantly improved after DO 16,17 . Surgical intervention using DO in early childhood is a common approach.…”

Functional outcomes of mandibular distraction for the relief of severe airway obstruction and feeding difficulties in neonates with Pierre Robin sequence

“…Some neonates are not able to be fed orally and necessitates the placement of nasogastric tube 11 . Several theories have been proposed related to this restriction such as glossoptosis preventing the forward positioning of tongue during swallowing and additional lack of sucking and swallowing coordination secondary to airway obstruction in severe patients 26 . Mandibular distraction had also found to be beneficial in means of feeding problems 1,11 .…”

Mandibular Distraction Osteogenesis in Low-Weight Neonates with Robin Sequence

“…Mandibular Distraction Osteogenesis (MDO) has been demonstrated to be a safe 3,[11][12][13][14][15][16][17] and effective 3,6,8,12,13,[15][16][17] intervention to relieve airway obstruction in infants with severe RS.…”

“…After popularization by McCarthy, 1 MDO was successfully applied to children with RS to relieve affected patients from tracheostomy. [2][3][4] After these initial reports,…”