Mandibular Distraction Osteogenesis Does Not Consistently Ensure Feeding Independence in Infants With Robin Sequence: a Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined whether airway improvement following mandibular distraction osteogenesis in infants with the Robin sequence was associated with feeding independence. Eight bibliographic sources and supplementary citation pathways were searched until August 2026. The evidence map included 105 reports: 46 direct and 59 indirect. Related publications were linked at the cohort level in the database. Quantitative synthesis was restricted to clinically comparable outcomes reported by at least 3 independent cohorts with explicit denominators. Single proportions were pooled on the logit scale using Paule-Mandel random effects and modified Hartung-Knapp confidence intervals (CIs). In 3 studies comprising 113 infants, 61.1% achieved full oral feeding before discharge (95% CI, 36.8%–80.9%; I 2 ​​​​=10.0%). In 4 independent cohorts comprising 189 infants, the pooled proportion requiring a new postoperative gastrostomy was 21.4% (95% CI, 13.4%–32.5%; I 2 =0%). The point estimate for gastrostomy was higher in syndromic than in isolated Robin sequence, but the difference was not statistically significant (risk ratio, 2.29; 95% CI, 0.90–5.81; P =0.066; 4 studies; 188 infants). Evidence concerning feeding timing and oral sensory-motor stimulation comes from single nonrandomized studies. Certainty was very low for all pooled outcomes. Airway improvement after mandibular distraction osteogenesis did not consistently translate into feeding independence by discharge. These exploratory findings support assessing airway and feeding recovery separately and provide a rationale for prospective validation of the proposed Airway-to-Feeding Independence framework.