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de Blacam C, Butler D, Duggan L, Byrne S, Russell J, Javadpour S, White M, Orr DJA. Minimally-invasive airway management and early cleft palate repair in infants born with Robin sequence. J Craniomaxillofac Surg 2024; 52:514-521. [PMID: 38448335 DOI: 10.1016/j.jcms.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
The objective of this study was to report outcomes of early cleft palate repair in infants born with Robin sequence (RS). A retrospective case series in a tertiary referral paediatric hospital was carried out, examining a consecutive series of 69 infants born with RS and cleft palate. A minimally invasive approach was taken to upper airway obstruction, with liberal nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) use, guided by sleep studies. The palate was repaired between 6 and 9 months with a modified Malek technique. The most frequently used airway adjunct (59.4% of patients) was an NPA and the median duration of use was 5.6 months. All patients underwent a modified Malek cleft palate repair at a median of 7 months of age. Overnight oximetry demonstrated higher mean oxygen saturation (SpO2) across the group from initial neonatal admission to discharge (median 96.5% (interquartile range [IQR] 95-98%) vs 97.45% (IQR 96.5-98%) (P = 0.2, N = 34). Of those with a cardiorespiratory polysomnogram, the obstructive apnoea-hypopnea index (OAHI) was significantly lower postoperatively (5.9 vs 2.8, P = 0.028). This study supports the use of non-surgical airway strategies and early cleft palate repair in infants born with RS and cleft palate.
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Affiliation(s)
- Catherine de Blacam
- Dept of Plastic Surgery, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Daryl Butler
- Dept of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Laura Duggan
- Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Sandra Byrne
- Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - John Russell
- Dept of Paediatric Otolaryngology, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Sheila Javadpour
- Royal College of Surgeons in Ireland, Dublin 2, Ireland; Dept of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Martin White
- Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Dept of Neonatology, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - David J A Orr
- Dept of Plastic Surgery, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Dept of Surgery, Trinity College Dublin, Dublin 2, Ireland
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Wang C, Shi B, Li J. Management of cleft palate among patients with Pierre Robin sequence. Br J Oral Maxillofac Surg 2023; 61:475-481. [PMID: 37453893 DOI: 10.1016/j.bjoms.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
Pierre Robin Sequence (PRS) is a congenital craniofacial anomaly distinguished by the presence of micrognathia, glossoptosis, and upper airway obstruction. Cleft palate occurs in over 3/4 of patients with PRS. The wide U-shape cleft and airway dysfunction create challenges in clinical management. Currently, disputes exist on the treatment protocol and prognosis of cleft palate management among patients with PRS. This review is focused on the deformity features, intervention timing, technique selection, airway support, and outcome evaluation of cleft palate among patients with PRS, aiming to provide reference to further evolution in the management of PRS-related cleft palate.
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Affiliation(s)
- Chunyi Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Bing Shi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China.
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Kosyk MS, Carlson AR, Zapatero ZD, Kalmar CL, Swanson JW, Bartlett SP, Taylor JA. Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion. Cleft Palate Craniofac J 2023; 60:151-158. [PMID: 34730034 DOI: 10.1177/10556656211055019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To evaluate the timing and safety of cleft palate (CP) repair in patients with Robin sequence (RS) treated with mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA) for airway obstruction. DESIGN Retrospective cohort study. SETTING Tertiary Pediatric Hospital during 2004-2020. PATIENTS 148 patients with RS underwent MDO, 66 met inclusion by having MDO and followed by palatoplasty. 26 patients with RS underwent TLA, 14 met inclusion by having TLA and followed by palatoplasty. MAIN OUTCOME MEASURES Patient characteristics, hospital/operative details, postoperative complications, and polysomnographic (PSG) data were compared. RESULTS Groups were well-matched except more patients with syndromes underwent MDO (N = 27, 41%, P ≤ .002). In the MDO and TLA cohorts, mean CP repair age was 12.8 ± 1.9 months and 14.6 ± 1.6 months, respectively (P ≤ .002). Despite the earlier CP repair in the MDO group, there were no differences in peri-operative complication rates after palatoplasty in either group. All sleep respiratory parameters improved after MDO/TLA prior to palatoplasty P ≤ .050. All PSG parameters remained significantly improved after palatoplasty compared to preoperative values, P ≤ .043. Obstructive apnea hypopnea index and Oxygen saturation nadir further improved after palatoplasty within the MDO group, P ≤ .050, while no changes in the TLA group, P ≥ .500. CONCLUSIONS MDO was associated with earlier age at palatoplasty than TLA with a similar perioperative risk profile. In those patients with pre- and post-palatoplasty PSG data, palatoplasty was not associated with a deterioration in PSG parameters, and in fact in the MDO group, PSG data improved.
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Affiliation(s)
- Mychajlo S Kosyk
- Division of Plastic and Reconstructive Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anna R Carlson
- Division of Plastic and Reconstructive Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zachary D Zapatero
- Division of Plastic and Reconstructive Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, 6567The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Speech Outcomes following Mandibular Distraction Osteogenesis for Robin Sequence: Midchildhood Results. Plast Reconstr Surg 2023; 151:149-157. [PMID: 36576825 DOI: 10.1097/prs.0000000000009784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to compare midchildhood speech outcomes in patients with nonsyndromic Robin sequence with cleft palate (RSCP) treated with mandibular distraction osteogenesis (MDO) to patients with nonsyndromic Veau class I and Veau class II cleft palate (CP). METHODS The authors performed a retrospective review of patients with nonsyndromic Robin sequence from 2000 to 2017, comparing those who underwent MDO to patients with nonsyndromic CP. Demographics, operative details, length of hospital stay, complications, and Pittsburgh Weighted Speech Scale scores were collected. RESULTS Thirty-three patients met inclusion criteria in the MDO group with 127 patients as controls. Despite similar median age (RSCP, 4.5 years; CP only, 4.6 years) and Veau cleft type at early evaluation, there was a significant increase in composite Pittsburgh Weighted Speech Scale score within the MDO cohort ( P ≤ 0.002); specifically, with worse visible nasal emission ( P ≤ 0.007), hypernasality ( P ≤ 0.001), and compensatory articulation ( P ≤ 0.015). However, these differences were not present at age-matched midchildhood evaluation (median, RSCP, 6.5; CP only, 7.1; P ≥ 0.092). Median age-matched follow-up was 6.4 years in the MDO group and 7.1 years in the control group ( P ≥ 0.136). There was also no difference in the rate of secondary speech surgery at midchildhood evaluation ( P ≥ 0.688). CONCLUSIONS The authors' retrospective comparison of speech outcomes in RSCP versus CP only demonstrates no difference in midchildhood speech, conflicting with recent reports. Although patients with Robin sequence treated with MDO had worse visible nasal emission, hypernasality, and compensatory articulation in early childhood, this appears to have resolved in the interim without additional intervention. Longitudinal follow-up is needed to fully understand the speech ramifications of RSCP. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Thouvenin B, Soupre V, Caillaud MA, Henry-Mestelan C, Chalouhi C, Houssamo B, Chapuis C, Lind K, Royer A, Vegas N, Amiel J, Couly G, Picard A, Vaivre-Douret L, Abadie V. Quality of life and phonatory and morphological outcomes in cognitively unimpaired adolescents with Pierre Robin sequence: a cross-sectional study of 72 patients. Orphanet J Rare Dis 2021; 16:442. [PMID: 34670591 PMCID: PMC8527704 DOI: 10.1186/s13023-021-02072-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/10/2021] [Indexed: 01/28/2023] Open
Abstract
Background Pierre Robin sequence (PRS) is a heterogeneous condition involving retro(micro)gnathia, glossoptosis and upper airway obstruction, very often with posterior cleft palate. Patients with PRS, either isolated or associated with Stickler syndrome have good intellectual prognosis. Nevertheless, the quality of life in adolescence and the phonatory and morphological outcomes are rarely analysed. We assessed the phonatory and morphological outcomes of 72 cognitively unimpaired adolescents with PRS, studied their oral (COHIP-SF19), vocal (VHI-9i) and generic quality of life (QoL; KIDSCREEN-52), and searched for determinants of these outcomes.
Results Two-thirds of our adolescents retained low or moderate phonation difficulties, but risk factors were not identified. For 14%, morphological results were considered disharmonious, with no link to neonatal retrognathia severity. Only one vs two-stage surgery seemed to affect final aesthetic results. The oral QoL of these adolescents was comparable to that of control patients and was significantly better than that of children with other craniofacial malformations (COHIP-SF19 = 17.5, 15.4 and 25.7, respectively). The oral QoL of the adolescents with non-isolated PRS was significantly worse (COHIP-SF19 = 24.2) than that of control patients and close to that of children with other craniofacial malformations. The vocal QoL of the adolescents (mean [SD] VHI-9i = 7.5 [5.4]) was better than that of patients with other voice pathologies and better when phonation was good. The generic QoL of the adolescents was satisfactory but slightly lower than that of controls, especially in dimensions concerning physical well-being, relationships and autonomy. QoL results were lower for adolescents with non-isolated than isolated PRS. Only non-isolated PRS and low oral QoL affected generic QoL. Conclusion Morphological or phonatory impairments remain non-rare in adolescents with PRS but do not seem to be directly responsible for altered QoL. These adolescents, especially those with non-isolated PRS, show self-confidence and social-relation fragility. We must focus on long-term functional and psychological results for PRS patients and improve therapy protocols and follow-up, notably those affecting the oral aspects of the disease.
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Affiliation(s)
- Béatrice Thouvenin
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Véronique Soupre
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | | | - Charlotte Henry-Mestelan
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France
| | - Christel Chalouhi
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Bachar Houssamo
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | - Cécile Chapuis
- Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France
| | - Katia Lind
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France
| | - Aurélie Royer
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France
| | - Nancy Vegas
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France.,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Imagine Institute, Paris, France
| | - Jeanne Amiel
- Imagine Institute, Paris, France.,Genetics Department, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Gérard Couly
- Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Arnaud Picard
- Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France.,Paediatric Maxillofacial and Plastic Surgery Unit, Necker University Hospital, APHP, Paris, France.,Paris University, Paris, France
| | - Laurence Vaivre-Douret
- Imagine Institute, Paris, France.,Paris University, Paris, France.,INSERM Unit 1178, CESP, Paris, France
| | - Véronique Abadie
- General Paediatrics Unit, Necker University Hospital, APHP, 149 rue de Sèvres, 75015, Paris, France. .,Referral Centre for Rare Diseases "Syndrome de Pierre Robin et troubles de succion-déglutition congénitaux», Necker University Hospital, APHP, Paris, France. .,Imagine Institute, Paris, France. .,Paris University, Paris, France. .,INSERM Unit 1178, CESP, Paris, France.
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Effects of Mandibular Distraction Osteogenesis on Three-Dimensional Upper Airway Anatomy in Newborns Affected by Isolated Pierre Robin Sequence. J Craniofac Surg 2021; 32:1459-1463. [PMID: 34403227 DOI: 10.1097/scs.0000000000007339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Effective airway management is critical to Pierre Robin Sequence treatment. The goal of this study is to assess the three-dimensional changes in airway size and shape in 117 newborns with isolated Pierre Robin sequence who underwent mandibular distraction osteogenesis. Methods During the study period (11/29/2016 to 11/26/2019), 117 newborns affected by isolated Pierre Robin sequence met the inclusion criteria for the present study. All 117 included patients underwent linear distraction. Demographic variables were recorded and analyzed. Cone-beam computed tomography were performed before and after mandibular distraction osteogenesis. A systemic quantitative three-dimensional analysis of size and shape of upper airway was performed. Results The mean age was 71 day (range 12 to 213). The mean weight was 3.9 kg (range 2.3-6.8). A total of 53 patients are female and 64 are male. When the distraction device was removed, the upper and lower jaws were symmetrically aligned. Pre- and post-distraction comparison clearly showed osteogenesis. For the size of the upper airway, airway volume, anteroposterior dimension of the retroglossal airway, lateral dimension of retroglossal airway, minimum retropalatal area, minimum retroglossal area, average cross-sectional area and minimum cross-sectional area increased significantly after mandibular distraction osteogenesis (P < 0.001). However, the airway length did not change significantly (P > 0.05). For the shape of the upper airway, the lateral/anteroposterior ratio in the retroglossal region and the ratio of the retropalatal airway diameter to the retroglossal airway diameter significantly decreased after mandibular distraction osteogenesis (P < 0.001). The airway uniformity significantly increased after mandibular distraction osteogenesis (P < 0.001). Conclusion Mandibular distraction osteogenesis for isolated Pierre Robin sequence improved size and shape of the upper airway, further confirming mandibular osteogenesis distraction as an effective surgical modality to address the airway obstruction in newborns affected by isolated Pierre Robin sequence. Cone-beam computed tomography scanning and analysis can serve as a safe and effective examination modality for upper airway applications of PRS newborns.
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A Challenging Period After Repair: Etiology and Follow-Up Rates of the Patients With Cleft Lip and Palate in Intensive Care Unit. J Craniofac Surg 2021; 32:2722-2727. [PMID: 34231508 DOI: 10.1097/scs.0000000000007797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The perioperative period is quite challenging because of the featured anatomical and clinical properties of the babies with cleft lip and palate (CLP). Therefore follow-up in the intensive care unit (ICU) is a crucial parameter for managing these patients. Although various studies in cleft literature, limited studies have analyzed the ICU admission rate and its etiology in the cleft population. At this point, the present study aims to reveal the etiology and rate of ICU admission of babies with an orofacial cleft to contribute to taking preventive precautions.The rate of primary CLP patients was 69.5% (937 of 1348 patients). Intensive care unit admission rate of primary CLP patients was 6.2% (n = 58). The expected and unexpected ICU admission rate was 4.8% and 1.4%, respectively. Of the patients admitted to the ICU, 53.4% (n = 31) were boys and 46.6% (n = 27) were girls. There was no statistically significant association between gender and ICU admission (P = 0.896). However, the association between cleft type and ICU follow-up was statistically significant (P < 0.001).The findings of the present study reveal the high ICU admission rate of cleft patients within all patients admitted to ICU. Due to many unique statuses of cleft babies, attentive assessment in the preoperative period and determining the postoperative need for ICU follow-up would contribute to preventing postoperative complications.
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Effect of Cleft Palate Repair Timing on Inpatient Complication Rate: Review of a National Database. J Craniofac Surg 2021; 32:466-468. [PMID: 33704961 DOI: 10.1097/scs.0000000000007069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Timing of cleft palate repair is controversial. We aim to assess whether timing of cleft palate repair affects rates of inpatient complications, length of stay (LOS), and cost of stay. METHODS The Healthcare Cost and Utilization Project Kids' Inpatient Database 2009 was queried for all admissions with a primary diagnosis of cleft palate during which cleft palate repair was performed as a primary procedure. Age 6 months or less was termed "early" repair, while age >6 months was termed "standard" repair. Patients age >3 years old, inpatient stays >30 days, and those stays in which a cleft lip repair was performed were excluded. Logistic regressions were used to model the probability of complications. Generalized linear models and a natural log link function were used for LOS and hospital charges, using SAS 9.4. RESULTS We included 223 early and 1482 standard repair patients. Early repairs were exclusively performed in urban hospitals (P < 0.001). Eighty-nine patients experienced a total of 100 complications, including respiratory failure (N = 53), airway obstruction (N = 18), and oropharyngeal hemorrhage (N = 13). We found no significant difference in complication rate or total hospital charges in the 2 groups. The earlier repair group had a slightly longer LOS (P = 0.048). CONCLUSION Over 85% of United States cleft palate repairs are performed after 6 months of age. All early repairs were performed at urban hospitals, and had slightly longer LOS. There was a 5.1% overall complication rate. Available data revealed no significant difference in complication rates between early repair and standard repair groups. LEVEL OF EVIDENCE 3b.
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Duarte DW, Schweiger C, Manica D, Fagondes S, Fleith IJ, Rojas JJC, Zanin EM, Portinho CP, Collares MVM. Predictors of Respiratory Dysfunction at Diagnosis of Robin Sequence. Laryngoscope 2021; 131:2811-2816. [PMID: 34117782 DOI: 10.1002/lary.29685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/22/2021] [Accepted: 06/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Robin sequence (RS) consists of associated micrognathia, glossoptosis, and respiratory dysfunction, with or without cleft palate. Studies on how different patient characteristics impact the severity of respiratory dysfunction are scarce and contradictory; this study investigates how different features affect respiratory obstruction severity at diagnosis of RS in controlled analysis. STUDY DESIGN Retrospective cohort study that enrolled 71 RS patients under 90 days old who received care in our institution from 2009 to 2020. METHODS The primary outcome, respiratory dysfunction, was categorized into four severity groups and analyzed using a multinomial logistic regression model that considered age, sex, mandible length, cleft palate, syndromic diagnosis, other airway anomalies, and degree of glossoptosis. RESULTS Mandible length, syndromic diagnosis, and Yellon grade 3 glossoptosis were related to poorer respiratory outcomes (need for respiratory support). In univariate analysis, for each additional 1 mm of mandible length at diagnosis, a mean reduction of 28% in the risk of needing respiratory support was observed (OR = 0.72; 0.58-0.89); syndromic diagnosis and grade 3 glossoptosis also raised the risk (OR = 6.50; 1.59-26.51 and OR = 12.75; 1.03-157.14, respectively). In multivariate analysis, only mandible length significantly maintained its effects (OR = 0.73; 0.56-0.96), a 27% reduction. CONCLUSIONS Mandible length was an independent predictor for more severe respiratory dysfunction in RS patients, with larger mandibles showing protective effects. Syndromic diagnosis and Yellon grade 3 glossoptosis are also likely to be associated with poorer respiratory outcomes, although this was not demonstrated in multivariate analysis. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Daniele W Duarte
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Claudia Schweiger
- Department of Othorhinolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Denise Manica
- Department of Othorhinolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Simone Fagondes
- Department of Pulmonology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Iran J Fleith
- Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juan J C Rojas
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo M Zanin
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ciro P Portinho
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcus V M Collares
- Department of Plastic and Craniofacial Surgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Naros A, Krimmel M, Zengerle F, Bacher M, Koos B, Mack U, Wiechers C, Poets CF, Reinert S. Perioperative complications in cleft palate repair with Robin sequence following Tuebingen palatal plate treatment. J Craniomaxillofac Surg 2021; 49:298-303. [PMID: 33612407 DOI: 10.1016/j.jcms.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/03/2020] [Accepted: 02/07/2021] [Indexed: 11/21/2022] Open
Abstract
Our study aimed to evaluate perioperative complications following our institutional pre- and intraoperative management in cleft palate repair with Robin sequence (RS). RS patients who underwent cleft palate repair between 2000 and 2020 were retrospectively analysed. RS children with complete documentation and whose initial treatment involved the Tuebingen palatal plate (TPP) were included. Clinical records and operative charts were reviewed with regard to clinical characteristics as well as the neonatal and perioperative course. Results before and after adjustment of the anesthesiology protocol in 2014 were compared. 143 RS patients (41% male, 59% female) were included. Median pretherapeutic mixed-obstructive apnea index (MOAI) after birth was 9.4/hour (IQR 20.0). TPP treatment was associated with normalisation of the MOAI and adequate weight gain until surgery. At surgery, median age was 10 months (IQR 3), MOAI 0.1/h (IQR 0.5), and weight 8.7 kg (IQR 1.7). In 93% of cases (n = 133), the postoperative course was uneventful. Refinement of the anesthesiology protocol showed positive effects on the perioperative course and led to a reduction in perioperative events (10.7% vs. 2.9%). No severe perioperative complications occurred. We recommend the adoption of TPP treatment in the therapy of RS children. Our favourable results show that early TPP treatment minimizes perioperative complications in cleft palate repair by effectively and sustainably correcting upper airway obstruction.
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Affiliation(s)
- Andreas Naros
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Germany; Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Germany.
| | - Michael Krimmel
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Germany; Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Germany
| | - Franziska Zengerle
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Germany
| | - Margit Bacher
- Department of Orthodontics, Tuebingen University Hospital, Germany; BIP-Orthodontic Practice, Tuebingen, Germany
| | - Bernd Koos
- Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Germany; Department of Orthodontics, Tuebingen University Hospital, Germany
| | - Ulrich Mack
- Department of Anaesthesiology and Intensive Care Medicine, BG Unfallklinik Tuebingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Germany; Department of Neonatology, Tuebingen University Hospital, Germany
| | - Christian F Poets
- Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Germany; Department of Neonatology, Tuebingen University Hospital, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Germany; Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Germany
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钟 建, 罗 向, 黄 振, 仇 书, 程 超, 杨 李, 易 新, 曾 锦, 刘 大. [The significance of evaluation of sleep respiration in infants with Pierre Robin sequence]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:496-498. [PMID: 32842177 PMCID: PMC10128329 DOI: 10.13201/j.issn.2096-7993.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 06/11/2023]
Abstract
Objective:This study aimed to evaluate the sleep disorders of infants with Pierre Robin sequence by PSG, and to understand the sleep breathing characteristics of them. Method:Seventeen patients with Pierre Robin sequence underwent polysomnography lasting over 7 hours. Sleep apnea and oxygen index was recorded and analyzed. Result:14(82.35%) patients with Pierre Robin sequence presented with apnea, hypopnea and hypoxemia with varying degree. The apnea-hypopnea index(12.39±9.86) and lowest arterial oxygen saturation(84.12±8.12) %were not significantly different between sexes. However, age showed a negative impact with apnea-hypopnea index, which was worse in younger infants. Conclusion:Most patients with the Pierre Robin sequence have sleep apnea and hypoxemia, and appropriate management should be implemented in an early age. Polysomnography can provide objective analysis of the treatment.
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Affiliation(s)
- 建文 钟
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 向前 罗
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 振云 黄
- 广州市妇女儿童医疗中心耳鼻咽喉科Department of Oto1aryngology, Guangzhou Women and Children's Medical Center
| | - 书要 仇
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 超 程
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 李强 杨
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 新华 易
- 广州市妇女儿童医疗中心耳鼻咽喉科Department of Oto1aryngology, Guangzhou Women and Children's Medical Center
| | - 锦鸿 曾
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳,518000)Department of Pediatric Oto1aryngology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China
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Current Trends in Surgical Airway Management of Neonates with Robin Sequence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1973. [PMID: 30881787 PMCID: PMC6414126 DOI: 10.1097/gox.0000000000001973] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/15/2018] [Indexed: 12/23/2022]
Abstract
Background Robin sequence is defined by the clinical triad of micrognathia, glossoptosis, and upper airway obstruction, and is frequently associated with cleft palate and failure to thrive. Though the efficacy of certain surgical interventions to relieve airway obstruction has been well established, algorithms dictating decision making and perioperative protocols are poorly defined. Methods A 22-question survey was sent via e-mail to members of the American Cleft Palate-Craniofacial Association and International Society of Craniofacial Surgeons. Questions were related to surgeon experience in treating neonates with Robin sequence, and specific perioperative protocols. Results One hundred fifty-one responses were collected. Most respondents were surgeons practicing in North America(82.8%), in a university hospital setting (81.5%) and had completed a fellowship in pediatric plastic surgery or craniofacial surgery (76.2%). Preoperative protocols varied widely by years in training and location of practice. Although 78.8% of respondents always performed direct laryngoscopy, only 49.7% of respondents routinely obtained preoperative polysomnography. Mandibular distraction osteogenesis was the most common primary surgical airway intervention reported by 74.2%, with only 12.6% primarily utilizing tongue-lip adhesion. Slightly less than half of respondents ever performed tongue-lip adhesion. Operative selection was influenced by surgeon experience, with 80% of those in practice 0-5 years primarily utilizing mandibular distraction, compared with 56% of respondents in practice >15 years. Conclusions This study documents wide variations in preoperative, operative, and postoperative protocols for the surgical airway management of neonates with severe Robin sequence. These results underscore the need to acquire more objective data, to compare different protocols and outcome measures.
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