MANDIBULAR DISTRACTION OSTEOGENESIS AS A METHOD IN TREATING COMPLICATIONS ASSOCIATED WITH PIERRE ROBIN SEQUENCE

Sherif Amer Saad Amer A proposal for master degree in oral and maxillofacial surgery Cairo University

Distraction Osteogensis
Ilizarov

discovered two biological principles of Distraction Osteogenesis:

tension stress effect on the genesis of tissues.

1. The

2. The

influence of blood supply and loading on

the shape of bones and joints.

 The

first Ilizarovs principle postulates that Ilizarov gradual traction creates stress that can stimulate and maintain regeneration of living tissues. The newly formed bone remodels to conform to the bones natural bone structure.

 The

second principle theorizes that the shape and mass of bones and joints are dependent upon an interaction between mechanical loading and blood supply.

 Techniques


of Distraction:

Callotasis (distraction of a fracture callus):

  

Latency. Distraction. Consolidation.

Physeal distraction which includes:

 Distraction epiphysiolysis.


Chondrodiatasis

Pierre Robin Sequence

Retrognathia

PRS

Glossoptosis

Cleft palate

 Etiology:

 Complications of PRS:
Respiratory Problems:
Upper airway obstruction can cause hypoxia, hypercapnia, cor-pulmonale, aspiration pneumonia ( early days of life).

Feeding Problem:
Failure to thrive, energy expenditure, and exhaustion, cardiac failure, and ultimately death.

Management
Non-surgical Prone positioning. High-flow nasal cannula. Special head caps to extend the neck. Head traction. Feeding devices (NGT) . nasopharyngeal or endotracheal tube Surgical Tongue traction suture. lip-tongue adhesion (glossopexy). Subperiosteal release of tongue musculature. Transmandibular Kwire.

Tracheostomy

New treatment
Distraction osteogenesis by Gradual advancement of the osteotomised mandible addresses the root of the problem.

AIM OF THE STUDY



To evaluate the efficacy of mandibular DO in the correction of complications associated with Pierre Robin Sequence. And to implement certain parameters of study compatible with patients young age.

PATIENTS AND METHODS



Twelve patients regardless of the sex presented with Pierre Robin Sequence will be selected for the study from the Oral and Maxillofacial Surgery Department, Nasser Institute Hospital. Selected patients will be divided into two groups,
 

Group I: Neonates (up to 28 days). Group II: Infants up to two year.

1. 2.

History and Clinical examination. Surgical technique:

3.

Follow-up:
1.

2.

Pulse oximetry readings will be obtained preoperatively and postoperatively. Parameters of distraction:
  

Latency period Distraction rate 12 hours. Distraction period

: 48 hours. : 1 mm. every : 20 days.

3.

4.

Traction tongue suture decreased gradually according to the pulse oximeter reading. It was removed completely after ensuring proper readings (above 94%). A questionnaire will be adapted to evaluate aerodigestive mechanisms.