Clinical Outcomes and Complications Following Mandibular Distraction Osteogenesis in Pierre Robin Sequence

BACKGROUND: Pierre Robin sequence (PRS) is a congenital craniofacial anomaly characterized by micrognathia, glossoptosis and airway obstruction. Mandibular distraction osteogenesis (MDO) is increasingly performed to relieve severe airway obstruction in infants with PRS. However, concerns remain regarding the efficacy and incidence of facial nerve dysfunction and other postoperative complications following MDO. METHODS: A retrospective review of a prospectively collected database was performed to identify patients with PRS who underwent MDO at the Children's Hospital of Fudan University between June 2018 and December 2024 and completed at least 6 months of follow-up. Data collected included patient demographics and complications. Univariate logistic regression analysis was performed to investigate predictors of postoperative complications. RESULTS: Among the 70 patients who underwent MDO, 55 (78.57%) met the inclusion criteria. The study cohort comprised 36 males (65.45%) and 19 females (34.55%), with a mean surgical age of 58.41±53.99 days. Mean mandibular distraction length was 11.14±2.08 mm. Weight Z-scores showed a trend toward improvement (preoperative -1.64±1.39 versus postoperative -1.12±1.43; P=0.063). Procedure-related complications occurred in 6 patients (10.9%): facial nerve dysfunction in 5 (9.09%), with 3 (5.45%) showing incomplete recovery at 6 months; surgical site infection in 1 (1.81%). Pulmonary infection occurred in 15 patients (27.27%). No significant predictors of facial nerve dysfunction or pulmonary infection were identified. CONCLUSIONS: MDO is an effective and safe intervention for infants with severe airway obstruction, achieving high rates of symptom relief with a low incidence of major surgery-related complications. Refining surgical techniques to reduce marginal mandibular nerve injury and optimizing perioperative respiratory care are important areas for future improvement.