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Title Mandibular Distraction: A Successful Treatment Technique To Correct Skeletal Growth In Neonates With Severe Pierre Robin Sequence
Clinical Question Does mandibular distraction in severe Pierre Robin neonates aid in the correction of skeletal abnormalities and dental development?
Clinical Bottom Line Distraction osteogenesis is an effective therapy to increase the length of the short mandible and is an alternative to tracheostomy in carefully selected patients with Pierre Robin sequence. Follow-up at 5 years demonstrated normal shape of the mandible with an undisturbed tooth eruption sequence.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16027704 Denny/200511 neonatal patients (5 Male; 6 Female) with severe Pierre Robin sequenceCase Series
Key resultsAt 1 month, 54.5% were oral feeders, at 1 year 100%. Sleep studies (to detect obstructive apnea) were obtained on 7 patients and were normal 1 week to 1 month after operation. Growth was observed above the 50th percentile in all patients with no comorbidities. A 5-year clinical follow-up showed the operated mandible to maintain a normal shape and produce an undisturbed tooth eruption sequence. The distracted mandible is indistinguishable from normal by radiologic evaluation and clinical examination.
Evidence Search "Osteogenesis, Distraction"[Mesh] AND "Pierre Robin Syndrome"[Mesh] AND Clinical Trial[ptyp]
Comments on
The Evidence
This study was a case series with a small (n=11) sample; due to ethical concerns, a control group without treatment is not possible. Patients were followed for 5-years, which provides increased evidence regarding the stability of the skeletal correction. In the hierarchy of evidence, case series are considered relatively weak. This study does, however, provide longitudinal follow-up and assessment that improves the strength of this case series.
Applicability Neonates with Pierre Robin. In this patient population, the tongue posture caused by small mandible was the primary source of obstruction (evidenced by radiologic evaluation & nasopharyngoscopy). Traditional management (prone positioning, tongue-lip adhesion, nasopharyngeal airway intubation), failed in these patients and would otherwise require a neonatal tracheostomy for airway control.
Specialty/Discipline (Oral Surgery) (Orthodontics)
Keywords Distraction osteogenesis, Pierre Robin, Airway correction
ID# 2154
Date of submission: 10/07/2011spacer
E-mail frostn@uthscsa.edu
Author Natalie A. Frost
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Meenakshi Vishwanath (San Antonio, TX) on 09/20/2012
Distraction osteogenesis (DO), is a biological process of bone formation between the surfaces of new bone segments that are gradually separated by incremental traction. This is achieved in five steps (1) Osteotomy-triggers osteoinduction; (2) Latency- allows for clot formation with vasoformative elements in the granulation tissue. These are replaced by soft callus; (3) Distraction- the gradual application of traction leads to bone growth stimulation by increasing fibroblast production and angiogenesis; (4) Consolidation-completion of mineralization; (5) Remodeling of the new bone. The advantage that DO has over conventional surgery is that the slow incremental traction allows for soft tissue adaptation and subsequent elongation. Reference: Craniofacial Distraction Osteogenesis (Mosby, 2001). Mikhail L. Samchukov, Jason B. Cope, Alexander M. Cherkashin.
Comments and Evidence-Based Updates on the CAT
post a comment
by Kourtney Kouth, Chandler Kuhlman (San Antonio, Tx) on 11/30/2017
A Trip database search was conducted on 11/28/17 and a more recently completed primary research article (Papoff, 2013, 23978696) was found. This provided further support for the CAT's conclusion that mandibular distraction osteogenesis (MDO) is a viable and effective treatment option for infants with Pierre Robin sequence. Further, this study compared MDO treatment to an alternative, tongue-lip adhesion (TLA) using 18 infants with the condition as subjects and found that although MDO requires a longer hospital recovery time, the long term clinical success for this option is higher than for TLA. The results help to remedy concerns mentioned in the CAT of a small sample size with no control group and add support to the CAT's recognition of the treatment's stability after a 5 year follow up.

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