Airway Management in Pierre Robin Sequence: Patterns of Practice

Abstract

Objectives : To report survey results from American Cleft Palate-Craniofacial Association members on the practice patterns of airway obstruction management in patients with Pierre Robin sequence. Design : A 10-question online survey was sent and the data were reviewed. Setting : Online survey of members of the American Cleft Palate-Craniofacial Association. Patients : Surveys assessed management patterns of patients with Pierre Robin sequence whom a surgeon member of the American Cleft Palate-Craniofacial Association treated for airway obstruction. Interventions : The survey comprised data on management strategies for airway obstruction in Pierre Robin sequence, including tracheostomy, tongue-lip adhesion, mandibular distraction, and treatments that falls in the "other" category. Results : A total of 87 American Cleft Palate-Craniofacial Association members completed the survey. Respondents' results were analyzed as a whole and by individual subspecialty: plastic surgery (n = 33), oromaxillofacial surgery (n = 21), and otolaryngology (n = 29). Although most of the surgeons were trained to manage airway obstruction in Pierre Robin sequence patients using tracheostomy (47%, n = 39) and tongue-lip adhesion (31%, n = 26), 48% reported a current preference for mandibular distraction (n = 40). Of surgeons who preferred to manage Pierre Robin sequence with tongue-lip adhesion (n = 23), 65% were trained to do so (n = 15). Surgeons preferring mandibular distraction (n = 40) and tracheostomy (n = 14) more often reported they were trained to manage Pierre Robin sequence with tracheostomy. Conclusions : Currently there are various practice patterns for the management of airway obstruction in Pierre Robin sequence. Training habits and subspecialty category may influence a surgeon's preference in patients who fail conservative therapy. Treatment guidelines are lacking and may require significant collaboration among centers and subspecialties to develop a more standardized approach to a challenging clinical entity.

Epidemiology of Robin sequence with cleft palate in the East of Scotland between 2004 and 2013

“…We regard CPAP There is heterogeneity of approach to management of UAO in RS, with no evidence-based clinical practice guidelines to direct management. 23 This lack of uniformity in approach was highlighted by a recent survey of practices across 101 European centers, which showed that NPA, CPAP, and palatal plates were strongly favored in the UK, France, and Germany, respectively. 7 Only 7% of our cohort required surgical airway management which concurs with the findings of recent large studies.…”

Craniofacial syndromes and sleep-related breathing disorders

“…A recent online survey of American Cleft Palate–Craniofacial Association members on the practice patterns of management of upper airway obstruction in patients with PRS revealed a wide variation in personal practice (93). Mandibular distraction was the most common primary procedure, followed by tongue-lip adhesion, and then tracheostomy.…”

Health‐related quality of life in children with Robin sequence

“…There are various treatments available (positioning, nasopharyngeal airway, tongue‐lip‐adhesion, mandibular distraction, and tracheotomy [Evans et al, ]. The choice between treatment schedules depends on the severity of the problems, but decision making is often based on the physician's preference, training habits, and subspecialty category [Collins et al, ; Basart et al, ]. At present, it remains uncertain which treatment is best.…”