Mandibular Distraction Osteogenesis vs. Tracheostomy in the Management of Pierre Robin Sequence: A Systematic Review and Meta-Analysis.

Abstract

Objective: This study compares mandibular distraction osteogenesis (MDO) and tracheostomy in managing severe airway obstruction in patients with the Pierre Robin sequence (PRS).

Design: A systematic review and meta-analysis following PRISMA guidelines was performed. Literature searches were conducted across PubMed, ScienceDirect, Cochrane Library, Scopus, E.B.S.C.O., and Web of Science, including grey literature, covering studies until May 30, 2024. Study quality was assessed using the Newcastle-Ottawa Scale.

Patients: patients with Pierre Robin Sequence.

Interventions: Mandibular distraction osteogenesis (MDO) and tracheostomy.

Main outcome measures: Primary outcomes included airway management (tracheostomy avoidance for MDO, decannulation for tracheostomy) and feeding outcomes (G-tube placement). Secondary outcomes were hospital length of stay and associated costs.

Results: Thirteen studies were included. MDO and the MDO-first approach demonstrated significantly better airway outcomes (OR = 10.72, 95% CI = 1.97-58.44, p = 0.006; OR = 4.51, 95% CI = 2.61-7.79, p < 0.00001). MDO also reduced the need for G-tube placement (OR = 0.09, 95% CI = 0.04-0.18, p < 0.00001) and lowered hospital costs (MD = -47.90 thousand USD, 95% CI = -59.93 to -35.87, p < 0.0001). A shorter hospital stay was observed but was not statistically significant.

Conclusions: MDO offers better airway outcomes, lower G-tube placement rates, and reduced costs, making it a preferred option. Larger studies within the same syndromic status are needed to minimize confounding factors and validate these findings.