The Pierre Robin Syndrome

Robin sequence: changes in thinking leading to changes in patient care

Robin sequence is now understood to be a grouping of clinical findings that does not represent a distinct multiple anomaly syndrome. Previously known as the "Pierre Robin syndrome," this fairly common association of micrognathia with cleft palate and upper airway obstruction was initially thought to be a specific disease, and entire treatment regimens were established to deal with presumed problems. Until recently, the management of Robin has not been excellent and mortality has been high. It is only a better understanding of the basic mechanisms leading to this sequence that has resulted in better care. This article reviews the history of the delineation of Robin sequence and how the perception of Robin has led directly to management decisions.

Incidence of the Robin Anomalad (Pierre Robin syndrome)

Reliable estimates of the incidence of the Robin Anomalad (Pierre Robin Syndrome) are not readily available in standard texts. An analysis of admissions to the Mersey Regional Cleft Palate Unit (Alder Hey Children's Hospital, Liverpool and the Royal Liverpool Children's Hospital, Heswall) over a 23-year period suggests an incidence of 1:8500 live births.

Congenital heart disease in the Pierre Robin syndrome

Congenital heart disease occurs in about 20 percent of patients with Pierre Robin syndrome. Ventricular septal defect, patent ductus arteriosus, and atrial septal defect are the most common congenital cardiac lesions in this syndrome. The associated upper airway obstruction can produce cor pulmonale, cardiomegaly, pulmonary edema, and cyanosis.

The Robin anomalad (Pierre Robin syndrome)--a follow up study

During a 10-year period 55 patients with the Robin anomalad were admitted to the Liverpool Regional Cleft Palate Units. Fourteen (25%) children died. All deaths were within 3 months of birth. Congenital abnormalities other than mandibular retrognathia and cleft palate were present in 14 (26%) children. Peripheral limb defects were particularly common. Thirty children were recalled and reviewed to assess speech, hearing, growth, and educational achievement. There was a clear association between severe nasal escape of air in speech and atypical articulatory patterns. Almost half the children tested had abnormal articulation. Only 4 (13%) of 30 children showed delayed language development. Half the children tested audiometrically showed a binaural handicap but in only one patient was this sufficiently severe to warrant amplification. There was no trend towards abnormalities of growth and only 2 children could be firmly classified as educationally subnormal.

Prosthodontic treatment for Pierre Robin syndrome

A brief review of the Pierre Robin syndrome and the various methods of treatment employed for children with the condition have been outlined. A suggested treatment approach utilizing an acrylic resin obturator with an adjustable wire tongue restraint has been discussed.