Robin Sequence: 5-Year Speech Outcomes—A Case-Control Study

Abstract

Background: Pierre Robin sequence (Robin sequence) is defined as the triad of micrognathia, glossoptosis, and airway obstruction. It is frequently associated with palatal clefting. In recent years, increased interest in speech outcomes of cleft patients diagnosed with Robin sequence has been shown. Methods: Speech outcomes of cleft patients with Robin sequence were assessed at age 5 in comparison with a cleft palate–only cohort. Speech parameters were evaluated according to the Cleft Audit Protocol for Speech-Augmented and analyzed using the National Audit Standards for Speech (United Kingdom). All patients were treated in the same institution during the same period (2005 to 2012). Subjects who needed nasopharyngeal airway support and those whose airway was managed by positioning only were eligible. Results: Fifty-one cleft patients diagnosed with Robin sequence were included in this study. Outcomes were compared to those of 128 nonsyndromic cleft palate–only patients. Patients with Robin sequence were shown to present with a significantly higher rate of cleft speech characteristics in comparison to the reference cohort (p = 0.001). Furthermore, it was shown that Robin sequence is associated with a significantly higher rate of secondary speech surgery for velopharyngeal dysfunction before the age of 5 (p = 0.016). Robin sequence patients with a nasopharyngeal airway presented with a higher rate of cleft speech characteristics compared to Robin sequence patients managed with positioning only. Conclusion: Cleft patients with Robin sequence are more likely to need further surgery to correct velopharyngeal dysfunction before the age of 5 and are more prone to present with cleft speech characteristics at the age of 5. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

New perspectives in the treatment of patients with Robin Sequence

“…. Other studies demonstrated cleft palate width to be an independent predictor for VPI in cleft lip and/or palate patients (Lam et In our previous cited studies the VPI rates found ranged from 0-58% in patients with RS Schwaiger et al, 2021). We observed higher rates of VPI in our RS-group (73%) and in our ICP-group (63%) compared to the literature.…”

Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion

“…That stated, there is data to suggest that palatal closure by 15 months of age prior to learning palate-related sounds is associated with improved speech and hearing (Rohrich et al, 1996;Shaffer et al, 2020;Kalmar et al, 2020). This data is also important in the backdrop of increasing reports of speech difficulties in the RS group (Stransky et al, 2013;Schwaiger et al, 2021). Age at palatoplasty in those studies was 9-13 months, and in neither study were cohorts treated with MDO.…”

Speech Outcomes following Mandibular Distraction Osteogenesis for Robin Sequence: Midchildhood Results

“…More recently, Schwaiger et al 17 compared 51 patients with Robin sequence, including syndromic, to 128 patients with nonsyndromic CP only. Using the Cleft Audit Protocol for Speech-Augmented, which accounts for resonance, nasal airflow, and cleft speech characteristics, they reported higher rates of cleft speech characteristics in the Robin sequence group compared to their control.…”