Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion
Mychajlo S. Kosyk, Anna R. Carlson, Zachary D. Zapatero, Christopher L. Kalmar, Jordan W. Swanson, Scott P. Bartlett, Jesse A. Taylor
The Children's Hospital of Philadelphia, Philadelphia, PA
Purpose:: This study aims to evaluate the timing and safety of cleft palate (CP) repair in patients with Robin sequence (RS) treated with mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA) for management of upper airway obstruction.
Methods: A retrospective review was performed of all patients at The Children’s Hospital of Philadelphia with RS who underwent either MDO or TLA and CP repair between 2006-2020. Demographics, syndromic/cleft palate status, hospital/operative details, feeding outcomes, and complications were collected.
Results: Sixty-six MDO patients and 14 TLA patients met inclusion. Cohort demographics, cleft type, and comorbidities were well-matched between groups except more syndromic patients underwent MDO (N=27, 41%, p≤.002). In the MDO and TLA cohorts, mean CP repair age was 12.8±1.9 months and 14.6±1.6 months, respectively (p≤.002). Despite the earlier CP repair in the MDO group, there were no peri-operative complications after palatoplasty in either group. All sleep respiratory parameters, as measured on polysomnogram (PSG), improved after MDO/TLA prior to palatoplasty p≤.050. All PSG parameters remained significantly improved after palatoplasty compared to preoperative values, p≤.043. Obstructive apnea hypopnea index and Oxygen saturation nadir further improved after palatoplasty within the MDO group, p≤.050, while no changes in the TLA group, p≤.500.
Conclusion: In this retrospective cohort study, MDO was associated with earlier age at palatoplasty than TLA with a similar perioperative risk profile for palatoplasty. In those patients with pre- and post-palatoplasty PSG data, palatoplasty was not associated with a deterioration in PSG parameters, and in fact in the MDO group, PSG data improved.
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