Near-Normalized Maxillomandibular Relationship and Upper Airway in Infants with Robin Sequence Treated with Stanford Orthodontic Airway Plate: Computed Tomography Study

Abstract

Objective: To assess craniofacial and upper airway growth in infants with Robin sequence (RS) during the 1st year of life when their severe upper airway obstruction was treated non-surgically with the Stanford orthodontic airway plate treatment program (SOAP). Design: Retrospective longitudinal cohort study comparing SOAP-treated infants with RS (treatment group) with age-matched healthy controls (HC) using computed tomography (CT). Setting: Single tertiary referral hospital. Patients: Twelve SOAP-treated infants with RS. Interventions SOAP. Main Outcome Measures: Craniofacial skeletal cephalometric parameters and three-dimensional airway metrics. Results: No infants required mandibular distraction or tracheostomy surgery after SOAP. The pre-treatment CT was acquired at the mean age (+/- SD) of 1.3 months (+/- 0.7). The treatment lasted for 4.8 months (+/- 0.9). Post-treatment CT was acquired at 12.9 months (+/- 2.3) of age. The pre-treatment obstructive apnea hypopnea index decreased from 29.21 events/hour (+/- 14.80) to 4.11 events/hour (+/- 2.21) at post-treatment. The total mandibular length increased from 40.58 mm (+/- 2.98) to 62.15 mm (+/- 2.77) at post-treatment (p < 0.001) resulting in the growth velocity of 51.02% (+/- 11.20) or 20.52 mm (+/- 3.95) per year. The maxillary and mandibular lengths of the treatment group at post-treatment were shorter than those of HC although the maxillomandibular relationship was not different (p = 0.618). The upper airway volume and minimal cross-sectional area were also not different (p = 0.083, p = 0.254, respectively). Conclusions: The maxillomandibular relationship and upper airway of the SOAP-treated infants with RS were near-normalized at post-treatment, comparable to age-matched healthy infants.