Comparative Effectiveness of Preepiglottic Baton Plates and Mandibular Distraction in Infants with Robin Sequence

Abstract

Background: Mandibular distraction osteogenesis (MDO) and preepiglottic baton plates (PEBP) are both effective for early management of upper-airway obstruction (UAO) in infants with Robin sequence (RS), but have not been directly compared. The purpose of this study was to compare early airway, feeding, and growth outcomes between these treatments. Methods: This is a bicentric retrospective cohort study from 2015 through 2021 including infants with RS treated with MDO or PEBP before 6 months of age with pretreatment and posttreatment sleep studies and follow-up at least through age 1 year. The primary outcome was immediate postintervention UAO, measured as obstructive apnea-hypopnea index or obstructive apnea index, as available. Latest follow-up sleep studies, feeding, and growth characteristics were also assessed. Results: A total of 114 participants were included (MDO, n = 31; PEBP, n = 83). Pretreatment UAO was similar between groups (P = 0.61). PEBP was initiated at a younger age (median (interquartile range) 31 (14, 53) versus 41 (28, 84) days of life; P < 0.05). Significant reduction in obstructive apnea-hypopnea index or obstructive apnea index was achieved in both groups, greater with MDO (98%) compared with PEBP (94%) (P < 0.05). PEBP demonstrated better early feeding and growth outcomes compared with MDO, with fewer surgical feeding tubes needed (P < 0.001), and more rapid early growth (P = 0.038). When stratified by preintervention UAO, infants starting with moderate UAO experienced similar airway outcomes with both treatments (P = 0.11), whereas those with severe UAO had greater resolution with MDO (P < 0.001). Conclusion: Both treatments effectively relieved moderate UAO in infants with RS, but MDO was more effective for infants with severe respiratory compromise. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.