Complications associated with neonatal mandibular distraction osteogenesis in the treatment of robin sequence

Kariuki P. Murage, Melinda A. Costa, Michael T. Friel, Robert J. Havlik, Sunil S. Tholpady, Roberto L. Flores

Research output: Contribution to journalArticle

19 Scopus citations


BACKGROUND: Robin sequence (RS) is defined as a triad of retrognathia, glossoptosis, and airway obstruction. Although several studies have reported on the efficacy of mandibular distraction, the risks associated with this operation remain unclear. An outcomes analysis focusing on complications is reported here. METHODS: A 7-year retrospective review of all patients with RS treated with mandibular distraction was performed. Recorded variables included associated medical comorbidities, improvement in apnea/hypopnea index, need for tracheostomy, repeat distraction, and complications. Complications associated with mandibular distraction were categorized as major, moderate, or minor. They included surgical site infection (SSI), device failure, temporomandibular joint ankylosis, facial nerve injury, hypertrophic scarring, self-extubation premature ossification, and fibrous nonunion. RESULTS: Fifty patients were identified. Four patients (8%) required tracheostomy following distraction, and 3 required repeat distraction. There were 0% major, 12% moderate, and 18% minor complications. Moderate complications were device failure (2%), SSI requiring return to the operating room (2%), and SSI requiring intravenous antibiotics (8%). Minor complications were SSI managed with oral antibiotics (12%), self-extubation (4%), and transient facial nerve palsy (2%). The most common complication was SSI (22%), of which 90.9% were successfully treated by antibiotics alone. There was a 0% rate of temporomandibular joint ankylosis. CONCLUSIONS: Mandibular distraction is a safe and effective treatment option for infants with RS and severe airway obstruction. The most common complication is infection; the majority of cases are successfully treated with antibiotics alone.

Original languageEnglish (US)
Pages (from-to)383-387
Number of pages5
JournalJournal of Craniofacial Surgery
Issue number2
StatePublished - Mar 2014


  • airway obstruction
  • complications
  • distraction osteogenesis
  • jaw lengthening,glossoptosis
  • mandibular distraction osteogenesis
  • mandibular hypoplasia
  • neonatal
  • Pierre Robin sequence
  • Robin anomalad
  • Robin sequence

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery
  • Medicine(all)

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