606 - Feeding Outcomes in Robin Sequence Patients Undergoing Mandibular Distraction Osteogenesis- a Multi-Institutional Review

Poster Number: 606
Publication Number: 606.404

Tara L. Johnson, Children's Hospitals and Clinics of Minnesota, Excelsior, MN, United States; Melissa Scholes, University of Colorado School of Medicine, Denver, CO, United States; Andrew R. Scott, Tufts Childrens Hospital, Boston, MA, United States; Scott Hirsch, University of Colorado School of Medicine, Aurora, CO, United States; Clara M. Kerwin, University of Colorado School of Medicine, Denver, CO, United States; Brianne B. Roby, Children’s Minnesota/University of Minnesota, St. Paul, MN, United States

Background: Robin sequence (RS) is a clinical constellation of micrognathia, glossoptosis, and airway obstruction with variable cleft palate. RS is associated with airway and feeding difficulties. Mandibular Distraction Osteogenesis (MDO) is a surgical procedure that brings the lower mandible forward to correct tongue placement and airway obstruction. The goal of MDO is to alleviate the need for tracheostomies and gastronomy tubes (G-tubes). Past studies suggest patients with isolated Robin sequence (iRS) have better outcomes than those with syndromic Robin sequence(sRS). The major indication for MDO is airway obstruction, but evidence suggests MDO corrects feeding difficulties as well.

Objective: Determine the effectiveness of MDO in relieving the need of G-tubes for feeding in infants with micrognathia as a part of iRS or sRS.

Design/Methods: A multi-institution retrospective chart review was performed on all patients with RS who underwent MDO at 3 tertiary pediatric hospitals. Inclusion criteria was diagnosis of iRS or sRS. The need for G-tube was recorded. Co-morbidities, gestational age, birth weight, and length of hospital stay post-MDO were considered as possible confounding variables.

Results: 125 patients were identified who underwent MDO from 2004-2019. 75 (60%) were iRS patients and 50 (40%) were sRS patients. After MDO, 14.7% of iRS patients required a G-tube, while 28% of sRS patients required a G-tube. The rates of post-operative G-tubes varied by institution, however not statistically significant, ranging from 0%-22.5% among iRS patients (p=0.1527) and 20%-33.34% among patients with sRS (p=0.7780). 17 of the 125 patients required a G-tube prior to MDO. Conclusion(s): This study shows that the majority of RS patients did not need a G-tube after MDO regardless of iRS or sRS status. This holds true for all 3 institutions included in the study. These results indicate that MDO can be an effective treatment for correcting feeding difficulties and avoiding G-tube need in RS patients.