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Scientific Oral Presentation

Pediatric Otolaryngology

Impact of Palate Repair and Subsequent Adenotonsillectomy on OSA in Children with Robin-sequence After MDO

Sunday, October 18, 2026
11:24 AM - 11:30 AM PT
Location: 409AB
Disclosure(s):
Evette A. Ronner, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sukgi S. Choi, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Obstructive sleep apnea (OSA) is common among infants with Robin Sequence (RS). Mandibular distraction osteogenesis (MDO) may be performed in the first weeks of life, followed by palate repair around 12 months old. Some studies report increased sleep-disordered symptoms after palate repair, but the literature is limited. We aim to evaluate OSA in children with RS who had MDO and subsequent palate repair and adenotonsillectomy.

Methods: Retrospective chart review was performed in RS patients with MDO at one institution between 5/1/14–9/1/25. OSA was evaluated using polysomnography (PSG), specifically obstructive Apnea-Hypopnea Index (oAHI), oxygen nadir, and end-tidal CO2 (EtCO2). Pre- and post-surgery results were compared using paired t-test or Wilcoxon signed rank test.

Results: Ninety patients underwent MDO [mean (SD) age 6.7 (22.3) yr; 46.7% female]. PSG after MDO showed significant decrease in oAHI (25.8 (20.0) vs 2.3 (6.1)) and EtCO2 (50.9 (8.9) vs 43.4 (5.4)) and increase in nadir (78.1% (11.1) vs 91.0% (5.4)) (P < 0.01). Sixty-five (72.2%) had cleft palate and 56 (62.2%) underwent palate repair. Following repair, oAHI significantly increased (1.0 (1.9) vs 7.0 (9.2), P< 0.01) but there was no difference in nadir or EtCO2. Nineteen (21.1%) had a tonsillectomy and/or adenoidectomy, of which 11 had prior palate repair. Adenotonsillectomy did not impact oAHI, nadir, or EtCO2.

Conclusions: Most patients with RS had improvement in OSA following MDO. Subsequent palate repair resulted in a significant increase in oAHI for most patients. In this population, adenotonsillectomy after palate repair was not associated with improved OSA. Clinicians should recognize the risk of worsened OSA following palate repair and potential limited benefit of adenotonsillectomy.