Feeding and reflux in children after mandibular distraction osteogenesis for micrognathia: A systematic review

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• 作者：Omar Breik^a ; ^b ; ^{Omar.breik@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Kandiah Umapathysivam^b ; David Tivey^b ; Peter Anderson^c ; ^d
• 关键词：MDO ; mandibular distraction osteogenesis ; GERD ; Gastro-esophageal reflux ; PRS ; Pierre Robin Sequence ; iPRS ; isolated Pierre Robin Sequence ; sMicro ; syndromic micrognathia ; RR ; retrospective review ; CR ; Case report ; TMJ ; Temporomandibular Joint
• 刊名：International Journal of Pediatric Otorhinolaryngology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：85
• 期：Complete
• 页码：128-135
• 全文大小：793 K

文摘

Mandibular distraction osteogenesis (MDO) is becoming increasingly more commonly used as in neonates and infants with upper airway obstruction secondary to micrognathia. A significant number of these children are dependent on nasoenteric feeding or gastrostomies after birth for adequate nutrition and often suffer from gastro-esophageal reflux (GERD).

Objective

This analysis is a subset of a larger systematic review. The objective of this study is to determine the effects of MDO on feeding and GERD.

Data sources

The databases searched included PubMed, Embase, Scopus, Web of Knowledge and grey literature sources.

Study selection

The inclusion criterion included studies in children with clinical evidence of micrognathia/Pierre Robin Sequence (PRS) who have failed conservative treatments, including both syndromic (sMicro) and non-syndromic (iPRS) patients. 21 studies relevant to feeding and 4 studies relevant to GERD outcomes were included. All studies included were case series and case reports.

Results

MDO leads to a significant improvement in feeding, with 82% of children feeding exclusively orally after surgery. The overall percentage of children with iPRS who were feeding orally was 93.7% compared with only 72.9% in the sMicro group (p < 0.004). A growth decline within the first six weeks after surgery was observed in multiple studies. Overall, out of 70 patients with pre-operative GERD, only four had evidence of GERD after surgery.

Conclusions

Considering the limitations of this systematic review, this study found that successful relief of airway obstruction by MDO leads to improvement of feeding and improvement in symptoms of GERD in children with upper airway obstruction secondary to micrognathia. Clinicians need to be aware of the risk of growth decline in the initial post-operative period.