Long-Term Orthognathic Considerations in the Pierre Robin Sequence Patient.
Adolescent
Cephalometry
/ statistics & numerical data
Cleft Palate
/ complications
Conservative Treatment
/ adverse effects
Female
Follow-Up Studies
Humans
Male
Malocclusion, Angle Class II
/ diagnosis
Mandible
/ anatomy & histology
Orthognathic Surgical Procedures
/ methods
Pierre Robin Syndrome
/ complications
Retrospective Studies
Treatment Outcome
Young Adult
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
entrez:
2
11
2020
pubmed:
3
11
2020
medline:
16
12
2020
Statut:
ppublish
Résumé
One of the arguments against early intervention for micrognathia in Pierre Robin sequence is the concept that the growth of the mandible will eventually "catch up." Long-term growth of the mandible and occlusal relationships of conservatively managed Pierre Robin sequence patients remain unknown. In this study, the authors evaluated the orthognathic surgery requirements for Pierre Robin sequence patients at skeletal maturity. Orthognathic surgical requirements of conservatively managed Pierre Robin sequence and isolated cleft patients (aged ≥13 years) at two institutions were reviewed and analyzed using t test, chi-square test, and Fisher's exact test. Values of p < 0.05 were considered statistically significant. Of the Pierre Robin sequence patients (n = 64; mean age ± SD, 17.9 ± 2.9 years), 65.6 percent were syndromic (primarily Stickler and velocardiofacial syndrome), 96.9 percent had a cleft palate, and 39.1 percent required orthognathic surgery at skeletal maturity. Nonsyndromic and syndromic Pierre Robin sequence patients demonstrated no differences in occlusal relationships or mandibular surgery frequency. The majority of Pierre Robin sequence patients requiring mandibular advancement had a class II occlusion. Comparison of Pierre Robin sequence patients to isolated cleft palate patients (n = 17) revealed a comparable frequency of orthognathic surgery between the two; however, Pierre Robin sequence patients did require mandibular advancement surgery at a greater frequency than cleft palate patients (p = 0.006). The present study found that 39.1 percent of conservatively managed Pierre Robin sequence patients required orthognathic surgery at skeletal maturity, of which the vast majority required mandibular advancement for class II malocclusion. These data suggest that mandibular micrognathia in conservatively managed Pierre Robin sequence patients may not resolve over time and may require surgical intervention. Risk, II.
Sections du résumé
BACKGROUND
One of the arguments against early intervention for micrognathia in Pierre Robin sequence is the concept that the growth of the mandible will eventually "catch up." Long-term growth of the mandible and occlusal relationships of conservatively managed Pierre Robin sequence patients remain unknown. In this study, the authors evaluated the orthognathic surgery requirements for Pierre Robin sequence patients at skeletal maturity.
METHODS
Orthognathic surgical requirements of conservatively managed Pierre Robin sequence and isolated cleft patients (aged ≥13 years) at two institutions were reviewed and analyzed using t test, chi-square test, and Fisher's exact test. Values of p < 0.05 were considered statistically significant.
RESULTS
Of the Pierre Robin sequence patients (n = 64; mean age ± SD, 17.9 ± 2.9 years), 65.6 percent were syndromic (primarily Stickler and velocardiofacial syndrome), 96.9 percent had a cleft palate, and 39.1 percent required orthognathic surgery at skeletal maturity. Nonsyndromic and syndromic Pierre Robin sequence patients demonstrated no differences in occlusal relationships or mandibular surgery frequency. The majority of Pierre Robin sequence patients requiring mandibular advancement had a class II occlusion. Comparison of Pierre Robin sequence patients to isolated cleft palate patients (n = 17) revealed a comparable frequency of orthognathic surgery between the two; however, Pierre Robin sequence patients did require mandibular advancement surgery at a greater frequency than cleft palate patients (p = 0.006).
CONCLUSIONS
The present study found that 39.1 percent of conservatively managed Pierre Robin sequence patients required orthognathic surgery at skeletal maturity, of which the vast majority required mandibular advancement for class II malocclusion. These data suggest that mandibular micrognathia in conservatively managed Pierre Robin sequence patients may not resolve over time and may require surgical intervention.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, II.
Identifiants
pubmed: 33136957
doi: 10.1097/PRS.0000000000007246
pii: 00006534-202011000-00035
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
599e-606eCommentaires et corrections
Type : CommentIn
Références
Lee JC, Bradley JP. Surgical considerations in Pierre Robin sequence. Clin Plast Surg. 2014;41:211–217.
Purnell CA, Janes LE, Klosowiak JL, Gosain AK. Mandibular catch-up growth in Pierre Robin sequence: A systematic review. Cleft Palate Craniofac J. 2019;56:168–176.
Matsuda A, Suda N, Motohashi N, Tsuji M, Ohyama K. Skeletal characteristics and treatment outcome of five patients with Robin sequence. Angle Orthod. 2006;76:898–908.
Daskalogiannakis J, Ross RB, Tompson BD. The mandibular catch-up growth controversy in Pierre Robin sequence. Am J Orthod Dentofacial Orthop. 2001;120:280–285.
Suri S, Ross RB, Tompson BD. Craniofacial morphology and adolescent facial growth in Pierre Robin sequence. Am J Orthod Dentofacial Orthop. 2010;137:763–774.
Do JBA, Bellerive A, Julien AS, Leclerc JE. Cleft palates and occlusal outcomes in Pierre Robin sequence. Otolaryngol Head Neck Surg. 2019;160:246–254.
Rogers GF, Rogers G, Lim AA, Mulliken JB, Padwa BL. Effect of a syndromic diagnosis on mandibular size and sagittal position in Robin sequence. J Oral Maxillofac Surg. 2009;67:2323–2331.
Laitinen SH, Heliövaara A, Ranta RE. Craniofacial morphology in young adults with the Pierre Robin sequence and isolated cleft palate. Acta Odontol Scand. 1997;55:223–228.
Shi B, Losee JE. The impact of cleft lip and palate repair on maxillofacial growth. Int J Oral Sci. 2015;7:14–17.
Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 1987;24:5–77.
Good PM, Mulliken JB, Padwa BL. Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate. Cleft Palate Craniofac J. 2007;44:396–401.
Oberoi S, Chigurupati R, Vargervik K. Morphologic and management characteristics of individuals with unilateral cleft lip and palate who required maxillary advancement. Cleft Palate Craniofac J. 2008;45:42–49.
Chen ZQ, Wu J, Chen RJ. Sagittal maxillary growth pattern in unilateral cleft lip and palate patients with unrepaired cleft palate. J Craniofac Surg. 2012;23:491–493.
Lee JC, Slack GC, Walker R, et al. Maxillary hypoplasia in the cleft patient: Contribution of orthodontic dental space closure to orthognathic surgery. Plast Reconstr Surg. 2014;133:355–361.
Lai LH, Hui BK, Nguyen PD, et al. Lateral incisor agenesis predicts maxillary hypoplasia and Le Fort I advancement surgery in cleft patients. Plast Reconstr Surg. 2015;135:142e–148e.
Long RE Jr, McNamara JA JrFacial growth following pharyngeal flap surgery: Skeletal assessment on serial lateral cephalometric radiographs. Am J Orthod. 1985;87:187–196.
Yoshikane F, Lai LH, Hui BK, et al. Orthognathic consequences of sphincter pharyngoplasty in cleft patients: A 2-institutional study. Plast Reconstr Surg Glob Open. 2016;4:e676.
Voshol IE, van Adrichem LN, van der Wal KG, Koudstaal MJ. Influence of pharyngeal flap surgery on maxillary outgrowth in cleft patients. Int J Oral Maxillofac Surg. 2013;42:192–197.