Subperiosteal Release of the Floor of the Mouth in Airway Management in Pierre Robin Sequence

Breugem, Corstiaan C.; Olesen, Peter R.; Fitzpatrick, Donald G.; Courtemanche, Douglas J.

doi:10.1097/scs.0b013e31816aab0b

Cited by 17 publications

(11 citation statements)

References 29 publications

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“…This decision-making process can be challenging for caregivers. To date, many authors have described their preferred surgical techniques, such as tongue–lip adhesion (TLA) [ 17 , 18 ], tracheotomy [ 19 , 20 ], subperiosteal release of the floor of the mouth [ 21 , 22 ], or mandibular distraction osteogenesis (MDO) [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm

et al. 2015

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ObjectivesInitial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution’s approach and a review of the current literature.Material and methodsA retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996–2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS.ResultsForty-four infants (59 %) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25 %, p = .014). A mandibular distraction was conducted in 24 % (n = 18) of cases, a tracheotomy in 9 % (n = 7), and a tongue–lip adhesion in 8 % (n = 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described.ConclusionsRS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended.Clinical RelevanceWe provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics.

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Section: Introductionmentioning

confidence: 99%

A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm

et al. 2015

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“…Pierre Robin sequence (PRS) generally consists of a triad of symptoms entailing micrognathia, glossoptosis and the resulting post-partum respiratory distress [ 5 ]. Although there currently is no global consensus on the exact definition of PRS, there is a well-known common concomitance of CP [ 4 ].…”

Section: Resultsmentioning

confidence: 99%

Late detection of cleft palate

et al. 2015

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Cleft palate only (CPO) is a common congenital malformation, and most patients are diagnosed within the first weeks after birth. Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. The purpose of this study is to retrospectively investigate (1) at which age CPO is diagnosed and (2) how the presence of syndromes and other factors relate to the age at diagnosis. The mean age of all children at our centre with CPO included between 1997 and 2014 at diagnosis (n = 271) was 1 year and 4 months. In all, 24.8 % (n = 67) was older than 12 months when diagnosed, and 37.3 % (n = 101) of all children had been diagnosed >30 days. These findings remain valid when a cut-off point of 14 days is used (44.3 % late). Moreover, the grade of the cleft was a determining factor for successful diagnosis; submucous clefts were detected much later on average (89.3 % > 30 days; p = .000). Similar results were found using Kaplan-Meier survival analyses.Conclusion: CPO is often diagnosed late. Patients diagnosed ≤30 days after birth more often presented with an associated disorder. Early diagnoses became more frequent as the severity of the cleft increased (grades 1–4). Professionals should perform more thorough intra-oral investigations, including manual palpations and visual inspections of the palate; they should be made more aware of the frequent accompanying symptoms. What is Known: • The presence of cleft palate only (CPO) is known to negatively affect feeding, hearing, speech and (social) development. • Submucous clefts are often underdiagnosed due to their difficulty to detect. As far as we know the literature shows that symptomatic submucous CPs are often diagnosed at an average age of 4.9 years. What is New: • 37.3 % respectively of all children with CPO were diagnosed relatively late (>30 days after birth), 24.8 % was older than 12 months when diagnosed. Mean age of all children with CPO was 1 year and 4 months. • We conclude that midwives and pediatricians should perform more through intra-oral investigations of all new-borns, including both a manual palpation, als well a visual inspection of the palate.

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“…Nonsurgical interventions include positional change, the nasopharyngeal airway, continuous positive airway pressure, and the palatal plate [ 1 , 2 , 16 , 22 ]. However, when facing severe respiratory distress, surgical procedures are applicable, such as mandibular distraction osteogenesis (MDO), tongue-lip adhesion (TLA), subperiosteal release of the floor of the mouth, and tracheotomy [ 4 , 6 , 8 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality in Robin sequence: identification of risk factors

et al. 2018

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Although Robin sequence (RS) is a well-known phenomenon, it is still associated with considerable morbidity and even mortality. The purposes of this study were to gain greater insight into the mortality rate and identify risk factors associated with mortality in RS. We retrospectively reviewed all RS infants followed at the Wilhelmina Children’s Hospital from 1995 to 2016. Outcome measurements were death and causes of death. The authors identified 103 consecutive RS infants with a median follow-up of 8.6 years (range 0.1–21.9 years). Ten of the 103 infants (10%) died at a median age of 0.8 years (range 0.1–5.9 years). Nine of these ten infants (90%) were diagnosed with an associated syndrome. Of these, seven infants died of respiratory insufficiency due to various causes (two related to upper airway obstruction). The other two syndromic RS infants died of arrhythmia due to hypernatremia and of West syndrome with status epilepticus. One isolated RS infant died of brain ischemia after MDO surgery. Cardiac anomalies were observed in 41% and neurological anomalies in 36%. The presence of a neurological anomaly was associated with a mortality rate of 40% versus 7% in infants with no neurological anomaly (p = 0.016), with an odds ratio of 8.3 (95% CI 1.4–49.0) for neurological anomaly versus no neurological anomaly. Mortality was 15% in infants with syndromic RS versus 2% in infants with isolated RS (p = 0.044). Mortality was not significantly associated with the presence of a cardiac anomaly, surgical treatment for severe respiratory distress in the neonatal period, or prematurity.Conclusion: RS represents a heterogeneous patient population and is associated with a high level of underlying syndromes. The present study reports a mortality rate of 10% significantly associated with syndromic RS and the presence of neurological anomalies. A multidisciplinary approach in all infants born with RS, including genetic testing and examination of neurological anomalies in a standardized way, is crucial to identify infants with underlying syndromes potentially associated with increased mortality. What is Known: • Reported mortality rates in Robin sequence vary from 2% to 26%.• Clinicians mainly focus on the morbidity of Robin sequence that includes respiratory complications due to upper airway obstruction in the period after birth.• Robin sequence represents a heterogeneous patient population and is associated with a high level of underlying syndromes. What is New: • The present study reports a mortality rate of 10% significantly associated with syndromic Robin sequence and the presence of neurological anomalies.• A multidisciplinary approach in all infants born with Robin sequence, including genetic evaluation and standardized workup for neurological anomalies, is crucial to identify infants with underlying syndromes potentially associated with increased mortality.

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Subperiosteal Release of the Floor of the Mouth in Airway Management in Pierre Robin Sequence

Cited by 17 publications

References 29 publications

A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm

A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm

Late detection of cleft palate

Mortality in Robin sequence: identification of risk factors

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