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 |
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PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
16027704 | Denny/2005 | 11 neonatal patients (5 Male; 6 Female) with severe Pierre Robin sequence | Case Series | Key results | At 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 |
(Oral Surgery) (Orthodontics) |
Keywords |
Distraction osteogenesis, Pierre Robin, Airway correction
|
ID# |
2154 |
Date of submission |
10/07/2011 |
E-mail |
frostn@uthscsa.edu |
Author |
Natalie A. Frost |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor |
Richard Finlayson, DDS |
Faculty mentor e-mail |
finlaysonr@uthscsa.edu |
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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?) |
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.
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
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. | |