Respiratory Distress following Cleft Palate Repair in Children with Robin Sequence

Abstract

Objective The aim of this study is to assess prevalence, severity, and duration of respiratory distress following palatoplasty in children with Robin sequence and to evaluate perioperative management. Design Retrospective chart review study. Data were collected for patients who were born between 2009 and 2012 and underwent palatoplasty in the Sophia Children's Hospital-Erasmus Medical Center. Results Of the 75 patients with cleft palate, 30 with Robin sequence and a control group of 45 cleft without Robin sequence underwent palatoplasty. Prior to closure, 26 of 30 patients with Robin sequence had been treated by prone positioning, and four needed additional treatment. The mean age at closure was 12.4 months for patients with Robin sequence and 10.9 months for patients without Robin sequence (P = .05). On the basis of the results of preoperative polysomnography with palatal plate, closure was postponed in two patients with Robin sequence. In the Robin sequence group, eight of the 30 patients developed postoperative respiratory distress within 48 hours and one patient, after 7 days; whereas none within the non-Robin sequence group developed respiratory distress. In all nine cases of Robin sequence the obstructive problems resolved within a few days, with four children requiring a temporary nasopharyngeal tube (NPT). There were no significant differences between preoperative polysomnography results of the nine patients with Robin sequence who developed postoperative respiratory distress compared with those patients with Robin sequence who did not. Conclusion Despite delayed closure compared with children without Robin sequence, 30% of the children with Robin sequence developed respiratory distress following palatoplasty, which resolved within a few days. This study emphasizes the need for close perioperative monitoring of patients with Robin sequence who undergo palatoplasty.

Furlow Palatoplasty: Should We Also Focus on the Size of the Nasopharynx?

“…Sleep apnea in the postoperative period remains a source of concern (Smith et al, 2013;Silvestre et al, 2014;Cielo et al, 2016;van Lieshout et al, 2016). Bergeron and his colleagues (2019) have shown with polysomnographic data that obstructive sleep apnea did not develop following primary Furlow surgery in most patients with CP.…”

Predicting Adverse Perioperative Events in Patients Undergoing Primary Cleft Palate Repair

“…Adverse perioperative events (APEs) have a reported incidence between 5% and 40% after palatoplasty and may lead to significant morbidity, parental distress, and a substantial increase in health care costs (Owusu et al, 2013). Identifying patients at risk for adverse airway events may allow providers to avoid these complications (Jindal et al, 2013; Mahboubi et al, 2015; van Lieshout et al, 2016). Yet, while myriad studies discuss operative techniques, long-term complications, and speech outcomes, there is a paucity of data in the plastic surgery literature regarding risks of APEs and their sequelae (Katzel et al, 2009).…”

Predictors of Respiratory Dysfunction at Diagnosis of Robin Sequence

“…Studies on patients with isolated cleft palate clearly show that palatoplasty is associated with worsened respiratory obstruction, 32 and this might be even worse in RS patients. 33,34 For this reason, some authors claim that the presence of the cleft may benefit RS patients as an oronasal air passage. 4 However, other authors state that the tongue might become impacted in the cleft in these patients, perpetuating posterior obstruction.…”

“…The literature on the effects of cleft palate in respiratory function in patients with RS is conflicting. Studies on patients with isolated cleft palate clearly show that palatoplasty is associated with worsened respiratory obstruction, 32 and this might be even worse in RS patients 33,34 . For this reason, some authors claim that the presence of the cleft may benefit RS patients as an oronasal air passage 4 .…”