www.PRSJournal.com 1433 P ierre Robin sequence, defined by the triad of micrognathia, glossoptosis, and airway obstruction, 1 results from failure of anterior and inferior mandibular growth. The mandible is the primary skeletal support for the position of the tongue, and this failure of growth causes superior and posterior displacement of the tongue. Air- way obstruction is the end result and cleft palate commonly occurs as the palatal shelves are pre- vented by the tongue from descending and fus- ing to form the secondary palate. These patients may exhibit a constellation of findings, includ- ing persistent inspiratory stridor, severe sternal retraction, and poor feeding. They may also have laboratory findings of hypoxia, hypercarbia, and acidosis. Although mortality occurring as a result Disclosure: The authors have no financial interest to declare in relation to the content of this article. Copyright © 2014 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000000225 Roberto L. Flores, M.D. Sunil S. Tholpady, M.D., Ph.D. Shawkat Sati, M.D. Grant Fairbanks, M.D. Juan Socas, M.D. Matthew Choi, M.D. Robert J. Havlik, M.D. Indianapolis, Ind.; Amman, Jordan; Salt Lake City, Utah; Milwaukee, Wis.; and Hamilton, Ontario, Canada Background: The authors present an outcomes analysis of mandibular distraction osteogenesis versus tongue-lip adhesion in the surgical treatment of Pierre Robin sequence. Methods: A retrospective, 15-year, single-surgeon review was undertaken of all nonsyndromic neonates with Pierre Robin sequence treated with mandibular distraction osteogenesis (2004 to 2009; n = 24) or tongue-lip adhesion (1994 to 2004; n = 15). Outcomes included time of extubation, length of intensive care unit stay, incidence of tracheostomy, and surgical complications. Polysomnog- raphy data were collected 1 month and 1 year postoperatively. Sleep study data included changes in oxygen saturation and apnea-hypopnea index. Results: There were no postprocedure tracheostomies in the mandibular distraction osteogenesis group and four tracheostomies in the tongue-lip adhesion group. The preoperative oxygen saturations were significantly lower in the mandibular distraction osteogenesis group compared with tongue-lip adhesion (76.5 percent versus 82 percent; p < 0.05). Preopera- tive apnea-hypopnea index was significantly higher in the mandibular dis- traction osteogenesis group compared with the tongue-lip adhesion group (47 versus 37.6; p < 0.05). Despite these preoperative differences, patients undergoing mandibular distraction osteogenesis demonstrated significantly higher oxygen saturation levels at 1 month (98.3 percent versus 87.5 per- cent; p < 0.05) and 1 year postoperatively (98.5 percent versus 89.2 percent; p < 0.05) and lower apnea-hypopnea index at 1 month (10.9 versus 21.6; p < 0.05) and 1 year postoperatively (2.5 versus 22.1; p < 0.05) compared with tongue-lip adhesion. Surgical complications were comparable between the two groups. Conclusions: In nonsyndromic patients with Pierre Robin sequence, mandibu- lar distraction osteogenesis demonstrates superior outcome measures regard- ing oxygen saturation, apnea-hypopnea index, and incidence of tracheostomy compared with tongue-lip adhesion. (Plast. Reconstr. Surg. 133: 1433, 2014.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. From the Division of Plastic Surgery, Riley Hospital for Chil- dren, Indiana University Medical Center; private practice; the Division of Plastic Surgery, McMaster University; and the Department of Plastic Surgery, Medical College of Wis- consin. Received for publication August 1, 2013; accepted Novem- ber 6, 2013. The Surgical Correction of Pierre Robin Sequence: Mandibular Distraction Osteogenesis versus Tongue-Lip Adhesion PEDIATRIC/CRANIOFACIAL