Impact of Cleft Palate on Tongue-Based Upper Airway Obstruction in Pierre Robin Sequence: Implications for Mandibular Distraction Osteogenesis and Timing of Cleft Palate Repair

Introduction: The objectives of this study are to analyze the impact of cleft palate (CP) on upper airway obstruction using polysomnography in patients with Pierre Robin Sequence (PRS) undergoing mandibular distraction osteogenesis (MDO) and subsequent CP repair. Methods: A single-surgeon, retrospective chart review was performed of all patients with nonsyndromic PRS treated with MDO. Severity of upper airway obstruction was evaluated pre- and post-distraction via polysomnography. Details of MDO and CP repair were collected and any complications recorded. Results: Twenty-one nonsyndromic PRS patients with CP and 6 patients without CP met inclusion criteria. There was no significant difference in predistraction apnea-hypopnea index between the 2 groups (53.4 +/- 42.1 versus 34.4 +/- 18.9; P = 0.3). Patients with CP had significantly higher predistraction SpO(2) saturation (94.5 +/- 1.6% versus 91.0% +/- 4.8%; P = 0.01), SpO(2) nadir (74.5% +/- 9.1% versus 63.6% +/- 11.6%; P = 0.03) and lower percentage time spent below 90% SpO(2) (6.0% +/- 7.2% versus 23.6% +/- 29.9%; P = 0.04). The rate of oronasal fistulas formation was 38%. The time between MDO and CP repair was shorter for patients with complications (250.8 +/- 3.3 versus 370.8 +/- 191.9 days; P = 0.08). Five patients experienced relapse of respiratory difficulties after CP repair. Conclusions: The presence of CP in nonsyndromic PRS patients decreases the severity of obstructive sleep apnea by oxygen parameters on PSG. Palatal fistulas and relapse of respiratory distress are common complications of CP repair following MDO. Delaying CP repair may help to decrease complication rates.