Tongue-Lip Adhesion in the Treatment of Pierre Robin Sequence

Bijnen, C.L.; Griot, J. Peter W. Don; Mulder, J. W.; Haumann, T.J.; Hagen, A.J. Van

doi:10.1097/scs.0b013e31819ba5ce

Cited by 63 publications

(43 citation statements)

References 10 publications

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“…Partial wound dehiscence occurred in three of the 15 tongue-lip adhesion patients; all of the cases were managed nonoperatively by close observation and continuous pulse oximetry. This 20 percent dehiscence rate is similar to that reported in other series 7,27,31,32 ; however, other reports make specific mention of lower dehiscence rates through following specific surgical modifications. 6,9 Three of the patients underwent scar revision of the cutaneous aspect of the lower lip for contractures or unsightly scars.…”

Section: Discussionsupporting

confidence: 86%

The Surgical Correction of Pierre Robin Sequence

Flores

Tholpady

Sati

et al. 2014

Plastic &Amp; Reconstructive Surgery

111

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Section: Discussionsupporting

confidence: 86%

The Surgical Correction of Pierre Robin Sequence

Flores

Tholpady

Sati

et al. 2014

Plastic &Amp; Reconstructive Surgery

111

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“…Numerous studies have shown its efficacy in protecting the airway of this vulnerable group of children. 42,43,49,62,63 The detractors of TLA point to the high failure rate and rate of dehiscence. 48,64 The dehiscence rate seems to be mainly caused by technical problems.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

Controversies in the Diagnosis and Management of the Robin Sequence

Mackay

2011

Journal of Craniofacial Surgery

117

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The Robin sequence, previously known as the Pierre Robin syndrome, is characterized by the sequence of clinical events that result from a small mandible. The tongue becomes posteriorly displaced (glossoptosis) and obstructs the airway. The obstructing tongue also makes oral feeding difficult and, in severe cases, impossible. Patients with Robin sequence may also present with a cleft palate, although this is not necessary to make the diagnosis. The small mandible either results from an inherent growth problem (genetic or syndromic) or is deformational where intrauterine growth of the mandible is restricted. Conditions of syndromic patients are generally more severe and difficult to treat. The phenomenon of "catch-up" growth is disputed, although it is likely to occur in deformational but not syndromic patients. Patients with Robin sequence are best managed by a multidisciplinary team familiar with the diagnoses and treatment of difficult pediatric airways. Approximately 70% of Robin infants are successfully managed by prone positioning alone. Tracheostomy is necessary in approximately 10% of these patients, especially for subglottic obstructions including laryngomalacia and tracheomalacia. Tracheostomy should be avoided if possible. Treatment of the remaining 20% remains highly contentious. Tongue-lip adhesion, nasopharyngeal airways, and distraction osteogenesis all have strong advocates. Ideally, treatment should be individualized. Patients who will have catch-up growth of the mandible will only need a tongue-lip or nasopharyngeal airway as a temporary measure. Patients who we know will not have catch-up growth will benefit from early distraction osteogenesis.

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“…Positioning, however, requires constant vigilance, may increase the risk for sudden infant death syndrome, and may make already tenuous feeding more difficult, whereas TLA has historically high dehiscence rates. [8][9][10] Mandibular distraction osteogenesis remains the only currently accepted treatment modality that directly addresses micrognathia in patients with TBAO.…”

mentioning

confidence: 99%

Mandibular Distraction Osteogenesis for the Treatment of Neonatal Tongue-Based Airway Obstruction

Goldstein

Chung²,

Paliga³

et al. 2015

Journal of Craniofacial Surgery

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Early postnatal tracheostomy for airway compromise is associated with high morbidity and cost. In certain patients with tongue-base airway obstruction (TBAO), mandibular distraction osteogenesis may be preferred. We present a comprehensive analysis of surgical, airway, and cephalometric outcomes in a large series of neonatal patients with TBAO. A retrospective review was performed of patients with laryngoscopically proven TBAO who underwent mandibular distraction osteogenesis before 1 year of age at our institution. Demographic, operative, postoperative, polysomnographic, and radiographic data were analyzed with the appropriate statistical test. Between 2010 and 2013, 28 patients younger than 1 year underwent mandibular distraction for TBAO. Distraction was performed for documented TBAO and failure to thrive at an average age of 58 days (range, 11-312) days with distractor removal after an average of 90 days. Preoperative polysomnograms were obtained on 20 patients with an average apnea-hypopnea index of 39.3 ± 22.0/h; the apnea-hypopnea index on postoperative polysomnograms obtained after distraction completion was significantly reduced in all 14 patients in whom it was measured (mean, 3.0 ± 1.5/h; P < 0.0001). Twenty patients transitioned to oral feeding, and cephalometric and airway diameters were improved (P < 0.0001). Distraction was successful in all but 4 patients including all patients with GILLS scores of 2 or less and 66% of patients with GILLS scores of 3 or greater. Neonatal mandibular distraction is a powerful tool to treat critical obstructive apnea in patients with TBAO. Appropriate patient selection remains a challenge; however, mandibular distraction represents a compelling treatment modality.

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Tongue-Lip Adhesion in the Treatment of Pierre Robin Sequence

Abstract: Tongue-lip adhesion is a good surgical treatment for most children with PRS who have an isolated tongue-base airway obstruction. More invasive procedures such as mandibular distraction can be reserved for patients where a tongue-lip adhesion has not been successful.

Cited by 63 publications

References 10 publications

The Surgical Correction of Pierre Robin Sequence

The Surgical Correction of Pierre Robin Sequence

Controversies in the Diagnosis and Management of the Robin Sequence

Mandibular Distraction Osteogenesis for the Treatment of Neonatal Tongue-Based Airway Obstruction

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