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Orthodontic Airway Plating vs Mandibular Distraction Osteogenesis for Pierre Robin Sequence Airway Obstruction: A Systematic Review of the Literature
Christopher Lavin, MS 1; Evan J. Fahy, MD 1; Darren B. Abbas, MD 1; Arash Momeni, MD 1; Rohit K. Khosla, MD 2; H. Peter Lorenz, MD 1; Michelle Griffin, MBChB, PhD 1; HyeRan Choo, DDS, DMD, MS 2; Karl C. Bruckman, MD, DDS 2; Derrick C. Wan, MD 1 1Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA

Background: Orthodontic Airway Plating (OAP) has recently gained traction for the treatment of Pierre Robin airway obstruction. Mandibular distraction osteogenesis (MDO) is the current gold standard for severe cases, and this study aimed to determine if airway and feeding outcomes are comparable between these two treatment techniques.

Methods: A systematic literature search across PubMed, Embase, and Google Scholar identified all studies published in English, which involved MDO or any form of OAP as treatments for PRS. All relevant articles were reviewed in detail and reported on, adhering to AMSTAR and PRISMA guidelines.

Results: The initial search identified 970 articles, of which 42 MDO studies and 9 OAP studies met criteria for review. A total of 1159 individuals were treated with MDO and 322 individuals were treated with OAP. Primary outcomes of tracheostomy avoidance and decannulation rate, as well as oral feeding tolerance, were similar for MDO and OAP (Figure 1). However, lack of uniformity in reported outcomes prevented direct comparison in other secondary outcomes. Furthermore, inconsistent reporting on pretreatment severity of airway obstruction also limited determination of comparability between modalities.

Conclusion: OAP may be considered for airway obstruction in PRS, as some airway-related and feeding- related outcomes appear similar with MDO, per existing evidence in the literature. However, since PRS severity may have differed between studies, OAP cannot be uniformly considered a replacement for MDO. Further research is required to more comprehensively assess these treatment modalities inclusive of metrics that allow for direct comparison. As it stands, MDO is still the treatment of choice for severe cases as OAP has not been studied in these scenarios, potentially making the similar appearing outcomes a misleading finding.

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