G-tube placement in patients with robin sequence undergoing mandibular distraction osteogenesis: A multi-institutional review

• Published in: Journal of cranio-maxillo-facial surgery Vol. 52; no. 12; pp. 1449 - 1452
• Main Authors: Roby, Brianne B., Schnell, Avery, Johnson, Tara L., Scholes, Melissa, Scott, Andrew R.
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.12.2024
• Subjects: Child; Child, Preschool; Cleft palate; Female; Gastrostomy; Gastrostomy - methods; Humans; Infant; Male; Mandible - surgery; Mandibular distraction; Micrognathia; Osteogenesis, Distraction - methods; Pierre Robin Syndrome - surgery; Retrospective Studies; Robin sequence; Gastrostomy; Micrognathia; Cleft palate; Robin sequence; Mandibular distraction
• ISSN: 1010-5182; 1878-4119; 1878-4119
• DOI: 10.1016/j.jcms.2024.08.023

The goal of this study was to investigate the relationship between mandibular distraction osteogenesis (MDO) and rates of postoperative gastrostomy tube (G-tube) placement among patients with isolated and syndromic Robin sequence (RS). This study was a multi-institutional retrospective chart review of patients with RS who underwent MDO at one of three different pediatric tertiary medical centers. The primary aim of the study was to compare rates of G-tube placement following MDO among the three institutions. The primary outcome was analyzed using Fischer's exact test. The secondary aim of the study was to assess for other contributing factors to G-tube placement such as demographic differences, length of hospital stay, and age at MDO. Analysis of secondary outcomes was assessed using multiple logistic regression models. A total of 125 patients met the inclusion criteria, which required RS diagnosis, completion of MDO between 2004 and 2019, and adequate medical record availability. Sixty percent (n = 75) of subjects were categorized as isolated RS (iRS) and forty percent (n = 50) as syndromic RS (sRS). After MDO, 20% (n = 25) of all patients had G-tubes placed. Of the iRS group, 14.7% (n = 11) required a G-tube, while 28% (n = 14) of the sRS group required a G-tube. The post-operative G-tube rate was similar between institutions when considering all patients. When considering only those patients with iRS, the post-MDO G-tube rate at one center was significantly higher than the other two. Overall, most patients with RS did not require a G-tube after MDO, regardless of diagnosis. However, the significant differences in rates of G-tube placement among patients with iRS may indicate differing practice philosophies, surgical protocols, thresholds for G-tube placement, or regional influences between institutions. Robin CSequence (RS) is defined as a clinical constellation of micrognathia, glossoptosis, and airway obstruction with variable cleft palate that can be divided into isolated (iRS) and syndromic (sRS) based on comorbidities. Many RS patients experience airway and feeding difficulties. Mandibular Distraction Osteogenesis (MDO) is a surgical technique aimed at eliminating obstruction to improve the airway and feeding. The rate of gastrostomy tube (g-tube) placement after MDO was studied across three institutions. Most patients with RS did not require a G-tube after MDO regardless of iRS or sRS diagnosis. G-tube placement for patients with iRS did differ among institutions.