1
|
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.
Collapse
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
| |
Collapse
|
2
|
Čverha M, Varga I, Trenčanská T, Šufliarsky B, Thurzo A. The Evolution of Robin Sequence Treatment Based on the Biomimetic Interdisciplinary Approach: A Historical Review. Biomimetics (Basel) 2023; 8:536. [PMID: 37999177 PMCID: PMC10669884 DOI: 10.3390/biomimetics8070536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
The Robin sequence is a congenital anomaly characterized by a triad of features: micrognathia, glossoptosis, and airway obstruction. This comprehensive historical review maps the evolution of approaches and appliances for its treatment from the past to the current modern possibilities of an interdisciplinary combination of modern engineering, medicine, materials, and computer science combined approach with emphasis on designing appliances inspired by nature and individual human anatomy. Current biomimetic designs are clinically applied, resulting in appliances that are more efficient, comfortable, sustainable, and safer than legacy traditional designs. This review maps the treatment modalities that have been used for patients with a Robin sequence over the years. Early management of the Robin sequence focused primarily on airway maintenance and feeding support, while current management strategies involve both nonsurgical and surgical interventions and biomimetic biocompatible personalized appliances. The goal of this paper was to provide a review of the evolution of management strategies for patients with the Robin sequence that led to the current interdisciplinary biomimetic approaches impacting the future of Robin Sequence treatment with biomimetics at the forefront.
Collapse
Affiliation(s)
- Martin Čverha
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty Comenius University in Bratislava and National Institute of Children’s Diseases, 83101 Bratislava, Slovakia;
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 81372 Bratislava, Slovakia;
| | - Tereza Trenčanská
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty Comenius University in Bratislava and National Institute of Children’s Diseases, 83101 Bratislava, Slovakia;
| | - Barbora Šufliarsky
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, 81372 Bratislava, Slovakia;
| | - Andrej Thurzo
- Department of Orthodontics, Regenerative and Forensic Dentistry, Faculty of Medicine, Comenius University in Bratislava, 81102 Bratislava, Slovakia
| |
Collapse
|
3
|
Effert J, Wiechers C, Kreutzer K, Poets CF, Schulz MC, Krimmel M, Aretxabaleta M, Finke H, Koos B, Weise C. Retrospective evaluation of the orthodontic treatment needs in primary school children with Robin sequence following Tübingen palatal plate therapy in infancy. J Craniomaxillofac Surg 2023; 51:528-535. [PMID: 37460350 DOI: 10.1016/j.jcms.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/16/2023] [Accepted: 06/25/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate the orthodontic treatment needs (OTN) of children with RS treated with the TPP in infancy compared to age- and sex-matched controls. METHODS The aim of this study was to investigate the orthodontic treatment needs (OTN) of children with RS treated with the TPP in infancy compared to age- and sex-matched controls. RESULTS In 21 children with RS (n = 23; 19 non-syndromic, 4 syndromic; average age 9.9 years) showed high OTN, which was significantly higher than in controls (n = 21). The latter of 9 controls had minor OTN, followed by 8 participants with borderline OTN. Regarding the intraoral picture, patients with RS had an increased open bite tendency. Without considering the presence of a cleft palate, 16 children with RS had high or very high OTN, compared to 4 of controls. CONCLUSIONS Patients with RS have significantly higher OTN than healthy controls, independent of cleft occurrence. RS is associated with dental anomalies and special skeletal growth patterns, both increasing malocclusion and negatively affecting dentoalveolar growth. This should raise awareness for identifying these needs and provide a comprehensive orthodontic treatment, where functional rehabilitation should be favored over aesthetic results.
Collapse
Affiliation(s)
- J Effert
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - C Wiechers
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - K Kreutzer
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - C F Poets
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - M C Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - M Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - M Aretxabaleta
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - H Finke
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - B Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - C Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany.
| |
Collapse
|
4
|
Wiechers C, Poets C, Hoopmann M, Kagan KO. Fetal Profile Markers for the Detection of Robin Sequence in Fetuses with Retrognathia. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:299-306. [PMID: 34852370 DOI: 10.1055/a-1659-2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine whether the prefrontal space ratio (PSFR), inferior facial (IFA) and maxilla-nasion-mandible angle (MNM), and the fetal profile line (FPL) are helpful in identifying fetuses with Robin sequence (RS) in cases with isolated retrognathia, and thus better predict the likelihood of immediate need for postnatal respiratory support. METHODS This was a retrospective matched case-control study of fetuses/infants with isolated retrognathia with or without RS receiving pre- and postnatal treatment at the University Hospital of Tübingen, Germany between 2008 and 2020. The PFSR, IFA, MNM, and FPL were measured in affected and normal fetuses according to standardized protocols. Cases were stratified into isolated retrognathia and RS. RESULTS 21 (n=7 isolated retrognathia, n=14 RS) affected fetuses and 252 normal fetuses were included. Their median gestational age at ultrasound examination was 23.6 and 24.1 weeks, respectively. In fetuses with isolated retrognathia and RS, the PSFR, IFA, and FPL were significantly different from the normal population. At a false-positive rate of 5%, the detection rate was 76.2% for the PFSR, 85.7% for the IFA, and 90.5% for both parameters combined. However, all parameters failed to distinguish between isolated retrognathia and RS. CONCLUSION PSFR and IFA are simple markers for identifying retrognathia prenatally. However, they are not helpful for the detection of RS in fetuses with isolated retrognathia. Therefore, delivery should take place in a center experienced with RS and potentially life-threatening airway obstruction immediately after birth.
Collapse
Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Poets
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| |
Collapse
|
5
|
Sullivan NAT, Smit JA, Lachkar N, Logjes RJH, Kruisinga FH, Reinert S, Persson M, Davies G, Breugem CC. Differences in analysis and treatment of upper airway obstruction in Robin sequence across different countries in Europe. Eur J Pediatr 2023; 182:1271-1280. [PMID: 36633656 DOI: 10.1007/s00431-022-04781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
The goal of this study was to explore the availability of diagnostic and treatment options for managing upper airway obstruction (UAO) in infants with Robin Sequence (RS) in Europe. Countries were divided in lower- (LHECs, i.e., PPP per capita < $4000) and higher-health expenditure countries (HHECs, i.e., PPP per capita ≥ $4000). An online survey was sent to European healthcare professionals who treat RS. The survey was designed to determine the availability of diagnostic tools such as arterial blood gas analysis (ABG), pulse oximetry, CO2 analysis, polysomnography (PSG), and sleep questionnaires, as well as to identify the used treatment options in a specific center. Responses were received from professionals of 85 centers, originating from 31 different countries. It was equally challenging to provide care for infants with RS in both LHECs and HHECs (3.67/10 versus 2.65/10, p = 0.45). Furthermore, in the LHECs, there was less access to ABG (85% versus 98%, p = 0.03), CO2 analysis (45% versus 70%, p = 0.03), and PSG (54% versus 93%, p < 0.01). There were no significant differences in the accessibility concerning pulse oximetry, sleep questionnaires, home saturation monitoring, nasopharyngeal tubes, Tuebingen plates, and mandibular distraction. Conclusion: This study demonstrates a large difference in available care for infants with RS throughout Europe. LHECs have less access to diagnostic tools in RS when compared to HHECs. There is, however, no difference in the availability of treatment modalities between LHECs and HHECs. What is Known: • Patients with Robin sequence (RS) require complex and multidisciplinary care. They can present with moderate to severe upper airway obstruction (UAO). There exists a large variety in the use of diagnostics for both UAO treatment indications and evaluations. In most cases, conservative management of UAO in RS is sufficient. Patients with UAO that persist despite conservative management ultimately need surgical intervention. To determine which intervention is best suitable for the individual RS patient, the level of UAO needs to be determined through diagnostic testing. • There is a substantial variation among institutions across Europe for both diagnostics and treatment options in UAO. A standardized, internationally accepted protocol for the assessment and management of UAO in RS could guide healthcare professionals in the timing of assessment and indications to prevent escalation of UAO. Creating such a protocol might be a challenge, as there are large financial differences between countries in Europe (e.g., health expenditure per capita in purchasing power parity in international dollars ranges from $600 to over $8500). What is New: • There is a substantial variation in the availability of objective diagnostic tools between European countries. Arterial blood gas analysis, CO2 analysis and polysomnography are not equally accessible for lower-healthcare expenditure countries (LHECs) compared to higher-healthcare expenditure countries (HHECs). These differences are not only limited to availability; there is also a difference in quality of these diagnostic tools. Surprisingly, there is no difference in access to treatment tools between LHECs and HHECs. • There is national heterogeneity in access to tools for diagnosis and treatment of RS, which suggests centralization of health care, showing that specialized care is only available in tertiary centers. By centralization of care for RS infants, diagnostics and treatment can be optimized in the best possible way to create a uniform European protocol and ultimately equal care across Europe. Learning what is necessary for adequate monitoring could lead to better allocation of resources, which is especially important in a low-resource setting.
Collapse
Affiliation(s)
- Nathaniel A T Sullivan
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Johannes A Smit
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Nadia Lachkar
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Robrecht J H Logjes
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Frea H Kruisinga
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Department of Pediatrics, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Osianderstrasse 2-8, Tuebingen, 72076, Germany
| | - Martin Persson
- Faculty of Health Science, Kristianstad University, Elmetorpsvägen 15, Kristianstad, 291 39, Sweden
| | - Gareth Davies
- European Cleft Organisation, Verrijn Stuartlaan 28, Rijswijk, ZH, 2288 EL, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
- Department of Pediatrics, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
| |
Collapse
|
6
|
Pang SL, Ho CHA, Law CML, Yang Y, Leung YY. Pre-Epiglottic Baton Plate in the Management of Upper Airway Obstruction in an Infant with Femoral Facial Syndrome: A Case Report. Cleft Palate Craniofac J 2023; 60:367-375. [PMID: 34787010 DOI: 10.1177/10556656211059705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Femoral facial syndrome (FFS) is a rare condition which may present with hypoplasia or aplasia of the femora and unusual facies characterized by long philtrum, thin upper lip and micrognathia. We present the case of a ten-month old infant with FFS who had retroglossal obstruction and who was treated with a pre-epiglottic baton plate. The pre-epiglottic baton plate can be a simple, non-invasive and effective tool for the clinical management of syndromic patients with mild-to-moderate upper airway obstruction due to micrognathia.
Collapse
Affiliation(s)
- Si Ling Pang
- Oral and Maxillofacial Surgery, Faculty of Dentistry, 25809The University of Hong Kong, Hong Kong
| | - Cheuk Hin Angus Ho
- Department of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Chun Man Lorie Law
- Maxillofacial Department, Dental Laboratory, 66392The Prince Philip Dental Hospital, Hong Kong
| | - Yanqi Yang
- Department of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, 25809The University of Hong Kong, Hong Kong
| |
Collapse
|
7
|
Effert J, Uhlig S, Wiechers C, Quante M, Poets CF, Schulz MC, Reinert S, Krimmel M, Koos B, Weise C. Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy. J Clin Med 2023; 12:jcm12020448. [PMID: 36675376 PMCID: PMC9864988 DOI: 10.3390/jcm12020448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To assess the long-term functional orthodontic outcome of the Tübingen palatal plate (TPP) in children with Robin sequence (RS) in comparison to age- and sex-matched healthy controls. METHODS Between 09/2019 and 10/2020, we performed orthodontic assessments in 41 children at our Department of Orthodontics. Included were patients with RS (17 non-syndromic; four syndromic) and healthy controls (n = 22, average age in both groups 9.9 y). Facial analyses of 2D images, digital study casts and cephalometric measurements were made. RESULTS The orthodontic examinations showed no statistically significant group differences regarding functional extraoral, intraoral and pharyngeal parameters, or in skeletal patterns. The relationship between the upper and lower incisors was significantly increased (overjet 4 (2-10) vs. 3 (0-9) mm; p = 0.01) with a significant deficit in the lower face proportions (Jaw Index 4.15 (1.9-9.6) vs. 2.98 (0-9); p = 0.02; Facial convexity angle 157 (149-173) vs. 159 (149-170); p = 0.01). CONCLUSION Children with RS treated with the TPP showed normal long-term functional orthodontic outcomes, thanks to the functional adaption of the stomatognathic system. However, soft tissue growth did not completely match skeletal growth, resulting in a more convex facial profile.
Collapse
Affiliation(s)
- Josephine Effert
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Simone Uhlig
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Cornelia Wiechers
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Mirja Quante
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Christian F. Poets
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Matthias C. Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Michael Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Christina Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-7071-29-62581
| |
Collapse
|
8
|
Automation of Measurements for Personalized Medical Appliances by Means of CAD Software-Application in Robin Sequence Orthodontic Appliances. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120773. [PMID: 36550978 PMCID: PMC9774752 DOI: 10.3390/bioengineering9120773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Measuring the dimensions of personalized devices can provide relevant information for the production of future such devices used in various medical specialties. Difficulties with standardizing such measurement and obtaining high accuracy, alongside cost-intensive measuring methodologies, has dampened interest in this practice. This study presents a methodology for automatized measurements of personalized medical appliances of variable shape, in this case an orthodontic appliance known as Tübingen Palatal Plate (TPP). Parameters such as length, width and angle could help to standardize and improve its future use. A semi-automatic and custom-made program, based on Rhinoceros 7 and Grasshopper, was developed to measure the device (via an extraoral scanner digital file). The program has a user interface that allows the import of the desired part, where the user is able to select the necessary landmarks. From there, the program is able to process the digital file, calculate the necessary dimensions automatically and directly export all measurements into a document for further processing. In this way, a solution for reducing the time for measuring multiple dimensions and parts while reducing human error can be achieved.
Collapse
|
9
|
Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Pädiatrie“. SOMNOLOGIE 2022; 26:174-178. [PMID: 35991291 PMCID: PMC9379224 DOI: 10.1007/s11818-022-00383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/22/2022]
|
10
|
Poets CF, Wiechers C, Koos B, Muzaffar AR, Gozal D. Pierre Robin and breathing: What to do and when? Pediatr Pulmonol 2022; 57:1887-1896. [PMID: 33580741 DOI: 10.1002/ppul.25317] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/09/2023]
Abstract
Robin sequence is characterized by mandibular retrognathia, airway obstruction, and glossoptosis; 80%-90% also have a cleft palate. Various treatment approaches exist, and although controlled studies are rare, objective assessment of treatment outcomes that address the leading clinical issues, namely obstructive sleep apnea and failure to thrive, are essential. Sleep-disordered breathing may be detected using cardiorespiratory polygraphy or polysomnography. Pulse oximetry alone may miss infants with frequent obstructive apneas, yet no intermittent hypoxia. Among conservative treatment options, the Tubingen Palatal Plate with a velar extension shifting the tongue base forward is the only approach that corrects the underlying anatomy and that has undergone appropriate evaluation. Of the surgical treatment options, which are not necessarily the first line of therapy, mandibular distraction osteogenesis (MDO) is effective and has been most extensively adopted. Notwithstanding, it is puzzling that MDO is frequently used in some countries, yet hardly ever in others, despite similar tracheostomy rates. Thus, prospective multicenter studies with side-by-side comparisons aimed at identifying an optimal treatment paradigm for this potentially life-threatening condition are urgently needed.
Collapse
Affiliation(s)
- Christian F Poets
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Bernd Koos
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Arshad R Muzaffar
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | - David Gozal
- Department of Child Health, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
11
|
Choo H, Kim SH, Ahn HW, Poets CF, Chung KR. Split orthodontic airway plate: An innovation to the utilization method of conventional orthodontic airway plate for neonates with Robin sequence. Korean J Orthod 2022; 52:308-312. [PMID: 35466088 PMCID: PMC9314212 DOI: 10.4041/kjod21.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Since the emergence of neonatal infant orthodontics for treatments of cleft lip and palate with or without Robin sequence (RS) in Europe in the 1950s, advancements in design and scope of its application have been remarkable. As the first institution to adopt orthodontic airway plate (OAP) treatment in the United States in 2019, we saw a need for innovation of the original design to streamline the most labor-intensive and time-consuming aspects of OAP utilization. A solution is introduced using a systematic split expansion mechanism to re-size the OAP periodically to accommodate the neonate’s maxillary growth. To date, seven RS patients have received this modified treatment protocol at our institution. Each patient completed full treatment using only one OAP. This innovative utilization method is aptly named the split orthodontic airway plate (S-OAP). Details of the S-OAP and its modifications from conventional OAP are reported.
Collapse
|
12
|
Neurocognitive development in isolated Robin sequence treated with the Tuebingen palatal plate. Clin Oral Investig 2022; 26:4817-4823. [PMID: 35306608 PMCID: PMC9276560 DOI: 10.1007/s00784-022-04448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/13/2022] [Indexed: 11/03/2022]
Abstract
Abstract
Objectives
We aimed to determine the neurocognitive development of cleft palate patients with and without Robin sequence (RS).
Materials and methods
Children with isolated RS with cleft palate and children with cleft palate only (CPO) were contacted at the age of 5–6 years. All RS children had undergone initial polygraphic sleep study (PG) with a mixed-obstructive apnea index (MOAI) of ≥ 3/h and were consequently treated with the Tuebingen palatal plate. A standardized clinical examination as well as a neuropediatric and neuropsychological examination included the Wechsler Pre-school and Primary Scale of Intelligence (WPPSI-III), Kaufman Assessment Battery for Children (K-ABC), and an assessment of developmental milestones.
Results
In total, 44 children (22RS, 22CPO) were included. RS children were younger at study (70.5 ± 7.3 and 75.2 ± 7.5 months; P = .035). Both groups achieved the evaluated milestones within the normed time frame. WPPSI-III and K-ABC results showed no group differences. Mean values for Verbal IQ (101.8 ± 11.1 vs. 97.1 ± 15.7), Performance IQ (102.9 ± 12.1 vs. 99.6 ± 14.5), Processing Speed Quotient (98.9 ± 15.6 vs. 94.5 ± 15.7), Full-Scale IQ (103.2 ± 12.1 vs. 98.4 ± 15.3), and Sequential Processing Scale (102.1 ± 13.1 vs. 94.2 ± 17.3) were within the reference range (IQ 85–115) for RS and CPO children, respectively, indicating average performance of both groups.
Conclusion
No neurocognitive, physical, or mental impairments were detected suggesting that RS children having upper airway obstruction (UAO) treated early and effectively may use their potential for an age-appropriate neurocognitive development.
Clinical relevance
Tuebingen palatal plate treatment successfully releases UAO. Thus, isolated RS does not necessarily result in developmental delay or an impaired neurocognitive outcome.
Trial registration
Deutsches Register Klinischer Studien, DRKS00006831, https://www.drks.de/drks_web/
Collapse
|
13
|
Chandrasekar I, Tablizo MA, Witmans M, Cruz JM, Cummins M, Estrellado-Cruz W. Obstructive Sleep Apnea in Neonates. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030419. [PMID: 35327791 PMCID: PMC8947507 DOI: 10.3390/children9030419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/03/2022]
Abstract
Neonates have distinctive anatomic and physiologic features that predispose them to obstructive sleep apnea (OSA). The overall prevalence of neonatal OSA is unknown, although an increase in prevalence has been reported in neonates with craniofacial malformations, neurological disorders, and airway malformations. If remained unrecognized and untreated, neonatal OSA can lead to impaired growth and development, cardiovascular morbidity, and can even be life threatening. Polysomnography and direct visualization of the airway are essential diagnostic modalities in neonatal OSA. Treatment of neonatal OSA is based on the severity of OSA and associated co-morbidities. This may include medical and surgical interventions individualized for the affected neonate. Based on this, it is expected that infants with OSA have more significant healthcare utilization.
Collapse
Affiliation(s)
- Indira Chandrasekar
- Division of Neonatology, Department of Pediatrics, Valley Children’s Hospital, Madera, CA 94305, USA
- Correspondence: (I.C.); (W.E.-C.)
| | - Mary Anne Tablizo
- Division of Pulmonary and Sleep Medicine, Valley Children’s Hospital, Madera, CA 94305, USA; or
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Jose Maria Cruz
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
| | - Marcus Cummins
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA;
| | - Wendy Estrellado-Cruz
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
- Correspondence: (I.C.); (W.E.-C.)
| |
Collapse
|
14
|
Speech Development in Cleft Palate with and without Robin Sequence. Plast Reconstr Surg 2021; 149:443-452. [PMID: 34898524 DOI: 10.1097/prs.0000000000008730] [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]
Abstract
BACKGROUND Robin sequence is defined as the triad of micrognathia, glossoptosis, and upper airway obstruction. In up to 85 percent, it is associated with cleft palate. Many studies have reported worse speech development in Robin sequence children after cleft palate repair. The authors investigated speech development in isolated Robin sequence with cleft palate versus children with cleft palate only at the age of 5 to 6 years. METHODS All Robin sequence children were treated with the Tübingen palatal plate after birth. Data were collected using the German version of the Great Ormond Street Speech Assessment. Audio and video recordings were reviewed and analyzed separately by two blinded senior phoniatricians based on the German version of the Universal Reporting Parameters for Cleft Palate Speech, and scored to enable comparability of speech outcomes. RESULTS Forty-four children (Robin sequence, n = 22; cleft palate only, n = 22) were included. Robin sequence children were significantly older at surgery (11.8 months versus 7.1 months; p < 0.001) but younger at study (70.5 months versus 75.2 months; p = 0.035). They also had more severe cleft of the palate (p = 0.006). All children studied showed good to very good speech development without serious impairment. None of the reported parameters on the German version of the Universal Reporting Parameters for Cleft Palate Speech showed significant group differences; the median total score in the Robin sequence group was 23 (interquartile range, 16.5 to 27.5) versus 19 (interquartile range, 17 to 23) in the cleft palate-only group. Statistical analysis revealed no significant effect of group (Z = -1.47; p = 0.14). CONCLUSIONS No group differences in speech development were found at age 5 to 6 years. Isolated Robin sequence does not necessarily represent a risk for impaired speech development. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
|
15
|
Abstract
A Robin sequence parent presents the view that Robin sequence healthcare providers are engaging in practices which may be outdated, excessively invasive, and unnecessarily detrimental to quality of life, and proposes possible areas of research to improve patient outcomes.
Collapse
|
16
|
Wiechers C, Arand J, Koos B, Poets CF. Evidence and practical aspects of treatment with the Tübingen palatal plate. Semin Fetal Neonatal Med 2021; 26:101281. [PMID: 34602352 DOI: 10.1016/j.siny.2021.101281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Tübingen therapy concept centers on an individual orthodontic palatal plate with a spur-like velar extension (Tübingen Palatal or Epiglottic Baton Plate, TPP or PEBP) and intensive feeding training. It was primarily developed for infants with Robin sequence, but has since also be used successfully in infants with other craniofacial malformations. TPP improves not only upper airway obstruction, but also feeding problems, thriving, mandibular growth and was associated with intact neurocognitive outcome. This review provides an overview of the evidence and the clinical and practical aspects of the Tübingen therapy concept.
Collapse
Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| | - Jörg Arand
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany; Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany.
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| |
Collapse
|
17
|
Dulfer K, Joosten K. Quality of life in children undergoing treatment for Robin Sequence in infancy. Semin Fetal Neonatal Med 2021; 26:101287. [PMID: 34556442 DOI: 10.1016/j.siny.2021.101287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Karolijn Dulfer
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands.
| | - Koen Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| |
Collapse
|
18
|
Wiechers C, Iffländer R, Gerdes R, Ciuffolotti M, Arand J, Weise C, Peters K, Grandke B, Reinert S, Koos B, Poets CF. Retrospective study on growth in infants with isolated Robin sequence treated with the Tuebingen Palate Plate. Orphanet J Rare Dis 2021; 16:338. [PMID: 34344420 PMCID: PMC8335857 DOI: 10.1186/s13023-021-01959-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Robin sequence (RS) are at risk of growth failure, mainly due to their increased work of breathing and feeding difficulties. Various conservative and surgical treatment approaches exist, but their impact on weight gain has not yet been adequately addressed. A functional treatment concept, used in our center for > 20 years, includes a pre-epiglottic baton plate (Tuebingen palatal plate) and intensive feeding training. OBJECTIVE To investigate the effect of the Tuebingen treatment protocol on growth and weight trajectories during infancy. METHODS This retrospective study analyzed longitudinal data from infants with isolated RS admitted to Tuebingen University Children's Hospital, Germany between 1998 and 2019. Through our electronic patient database, we evaluated anthropometric parameters until reaching 1-year follow-up. Results are shown as median (IQR). RESULTS In 307 infants analyzed, median Z-score for weight decreased from - 0.28 at birth to - 1.12 upon admission to our center at a median age of 22 days. Z-score then remained largely unchanged until discharge (Z-score difference, - 0.08), while the proportion of infants receiving tube feedings decreased from 55.1 to 13.7%. Z-score subsequently increased from - 1.17 at discharge to - 0.44 at the 1-year follow-up (p < 0.001). CONCLUSION Based on a comparatively large cohort, this functional treatment was associated with better weight gain and improved feeding. As RS infants often show postnatal growth failure, weight monitoring may be a valuable parameter for monitoring treatment effectiveness. Clinical Trial Registration Not necessary due to the retrospective design.
Collapse
Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Regina Iffländer
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Rieke Gerdes
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Melissa Ciuffolotti
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Jörg Arand
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Christina Weise
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Katharina Peters
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bärbel Grandke
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Siegmar Reinert
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Craniofacial Surgery, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany. .,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.
| |
Collapse
|
19
|
Blanc F, Harrewijn I, Duflos C, Maggiulli F, Captier G. Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases. Cleft Palate Craniofac J 2021; 59:891-898. [PMID: 34313144 DOI: 10.1177/10556656211031105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders. DESIGN A retrospective single-center study of 150 children with PRS. SETTING Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS. PATIENTS A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment. MAIN OUTCOME MEASURES Evolution and results of the initial treatment of PRS. RESULTS Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 (P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children. CONCLUSIONS Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.
Collapse
Affiliation(s)
- Fabian Blanc
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Inge Harrewijn
- Neonatal Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Claire Duflos
- Department of Medical Information, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Frederica Maggiulli
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Guillaume Captier
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France.,School of Medicine, University of Montpellier, Montpellier, France
| |
Collapse
|
20
|
Abbas DB, Lavin C, Fahy EJ, Choo H, Truong MT, Bruckman KC, Khosla RK, Lorenz HP, Momeni A, Wan DC. A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence. Cleft Palate Craniofac J 2021; 59:365-376. [PMID: 34075816 DOI: 10.1177/10556656211011886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Mandibular distraction osteogenesis (MDO) is frequently performed to address airway obstruction in patients with Pierre Robin sequence (PRS), though more recently the technique of orthodontic airway plating (OAP) has gained traction. We aimed to evaluate OAP compared to MDO for airway obstruction in PRS. DESIGN A systematic literature search across PubMed, Embase, and Google Scholar identified all studies published in English, which involved MDO or any form of OAP as treatments for PRS. All relevant articles were reviewed in detail and reported on, adhering to PRISMA guidelines. MAIN OUTCOME MEASURES Airway (tracheostomy avoidance, decannulation rate), feeding (full oral feeding tolerance). RESULTS Literature search identified 970 articles, of which 42 MDO studies and 9 OAP studies met criteria for review. A total of 1159 individuals were treated with MDO, and 322 individuals were treated with OAP. Primary outcomes appear similar for MDO and OAP at face value; however, this must be interpreted with different pretreatment contexts in mind. CONCLUSIONS Orthodontic airway plating may be considered for airway obstruction in PRS, as some airway-related and feeding-related outcomes appear similar with MDO, per existing evidence in the literature. However, since PRS severity differed between studies, OAP cannot be uniformly considered a replacement for MDO. Further research is required to more comprehensively assess these treatment modalities inclusive of metrics that allow for direct comparison.
Collapse
Affiliation(s)
- Darren B Abbas
- Hagey Laboratory for Pediatric Regenerative Medicine, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher Lavin
- Hagey Laboratory for Pediatric Regenerative Medicine, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Evan J Fahy
- Hagey Laboratory for Pediatric Regenerative Medicine, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - HyeRan Choo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Mai Thy Truong
- Division of Pediatric Otolaryngology, Department of Otolaryngology, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Karl C Bruckman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Rohit K Khosla
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - H Peter Lorenz
- Hagey Laboratory for Pediatric Regenerative Medicine, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Arash Momeni
- Hagey Laboratory for Pediatric Regenerative Medicine, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, 10624Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
21
|
Choo H, Khosla RK, Meister KD, Wan DC, Lin HFC, Feczko R, Bruckman K, Hopkins E, Truong MT, Lorenz HP. Nonsurgical Orthodontic Airway Plate Treatment for Newborns With Robin Sequence. Cleft Palate Craniofac J 2021; 59:403-410. [PMID: 33845627 DOI: 10.1177/10556656211007689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite promising outcomes for >50 years, nonsurgical orthodontic airway plates (OAP) are only infrequently offered for babies with Robin sequence in a few parts of the world. This article demonstrates possibility of providing functional improvement using an OAP to help these babies overcome their functional and structural difficulties on their own. Two consecutively treated cases are presented exemplifying that OAP treatment that had originated from Europe is reproducible and effective in an institution in the United States.
Collapse
Affiliation(s)
- HyeRan Choo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Palo Alto, CA, USA.,Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.,Craniofacial and Airway Orthodontic Clinic, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Rohit K Khosla
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Palo Alto, CA, USA.,Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Kara D Meister
- Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.,Division of Head and Neck Surgery, Department of Otolaryngology, 10624Stanford University School of Medicine, Palo Alto, CA, USA
| | - Derrick C Wan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Palo Alto, CA, USA.,Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Hung-Fu C Lin
- Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Robert Feczko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Palo Alto, CA, USA.,Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Karl Bruckman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Palo Alto, CA, USA.,Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Elena Hopkins
- Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Mai Thy Truong
- Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.,Division of Head and Neck Surgery, Department of Otolaryngology, 10624Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hermann P Lorenz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 10624Stanford University School of Medicine, Palo Alto, CA, USA.,Cleft and Craniofacial Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| |
Collapse
|
22
|
Goryachkina YA, Goryachkin AM. [Treatment of infants with Pierre Robin syndrome using the orthodontic device PEBP (pre-epiglottic baton plate)]. STOMATOLOGII︠A︡ 2021; 99:29-32. [PMID: 33416230 DOI: 10.17116/stomat20209906229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the method of treatment of Pierre Robin syndrome using the orthodontic device PEBP (pre-epiglottic baton plate). MATERIALS AND METHODS The study involved 5 patients with moderate SPD aged 1 to 3 months. All patients showed signs of respiratory failure and impaired swallowing. Respiratory failure was assessed based on oxygen concentration by pulse oximetry, respiratory rate (BPD), and skin color. Swallowing was evaluated for the possibility of taking food through the mouth and refusing a nasogastric tube. To eliminate violations, the orthodontic device PEBP was used, which was made in the dental laboratory from plastic and metal ligatures. RESULTS Against the background of treatment with an orthodontic device, there was an increase in blood oxygen levels, a decrease in BPD, and normalization of skin color. In all patients, in the first two days from the start of treatment, nutrition was restored through the oral cavity and the ability to refuse nutrition through a nasogastric tube. CONCLUSIONS The use of the PEBP orthodontic device makes it possible to effectively eliminate respiratory and nutritional disorders in the first months in patients with SPD.
Collapse
Affiliation(s)
- Yu A Goryachkina
- Novosibirsk State Medical University, Novosibirsk, Russia.,«Clinic of Maxillofacial Surgery and Dentistry Dental-Service» Ltd., Novosibirsk, Russia
| | - A M Goryachkin
- Novosibirsk State Medical University, Novosibirsk, Russia.,«Clinic of Maxillofacial Surgery and Dentistry Dental-Service» Ltd., Novosibirsk, Russia
| |
Collapse
|
23
|
Kruse T, Neuschulz J, Wilhelm L, Ritgen J, Braumann B. Prenatal Diagnosis of Robin Sequence: Sensitivity, Specificity, and Clinical Relevance of an Index for Micrognathia. Cleft Palate Craniofac J 2020; 58:1012-1019. [PMID: 33228397 DOI: 10.1177/1055665620972297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Micrognathia in connection with glossoptosis (called Robin sequence) may lead to life-threatening respiratory problems immediately after birth. An objective detection during prenatal routine ultrasound sonography is possible using an index that relates fetal lower jaw length to femur length or gestational age. The aim of this study was to test the method's sensitivity and specificity and to discuss its predictive power concerning neonatal respiratory insufficiency. DESIGN Patients with subjectively identified suspicious signs in the sagittal profile view were included in the study: Two-dimensional serial ultrasound scans of their fetal mandible were used to measure the lower jaw lengths and compare them to predicted values according to an index, derived from 313 healthy fetuses. Follow-up data provided additional information on the clinical appearance of the newborns. RESULTS The index showed a high sensitivity: 15 of the 16 cases with a micrognathia were correctly diagnosed (sensitivity of 93.75%). Follow-up data showed that newborns with similar index values differed in terms of their upper airway obstruction and treatment need. CONCLUSION Fetal mandibular micrognathia can be objectively evaluated with the help of the index. The method allows an early detection of micrognathia, which helps to take the necessary steps for proper treatment of potential life-threatening respiratory impairment. Observations ranging outside the prediction interval could prompt the ultrasonographer to check for other associated malformations.
Collapse
Affiliation(s)
- Teresa Kruse
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - Julia Neuschulz
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - Lucas Wilhelm
- Practice for Prenatal Diagnostics and Fetal Echocardiography, Frankfurt, Germany
| | - Jochen Ritgen
- Practice for Prenatal Medicine and Genetics, Cologne, Germany
| | - Bert Braumann
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
24
|
Remy F, Godio-Raboutet Y, Captier G, Bonnaure P, Burgart P, Guyot L, Thollon L. The Hypoplasic Mandible: What Makes it Different From the Healthy Child? Cleft Palate Craniofac J 2020; 58:966-973. [PMID: 33167677 DOI: 10.1177/1055665620972301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the morphology of the hypoplasic mandible and its evolution during the growth period to better understand how it differs from the pediatric healthy mandible. METHOD Three-dimensional mandibular models of hypoplasic and healthy children aged from 39 gestational weeks to 7 years old were analyzed with a morphometric method including data clustering. Morphological distinctions between pathological and healthy mandibles were highlighted. Bilateral and unilateral mandibular hypoplasia were distinguished. RESULTS The study sample was composed of 31 hypoplasic children and as many sex- and age-matched healthy children. Morphological distinctions between pathological and healthy mandibles were highlighted only from the first year of life. In bilateral hypoplasia, the overall mandibular dimensions were reduced while there was only a ramus asymmetry in unilateral mandibular hypoplasia (mean ± SD of the difference between the Grp03c and Grp03b subgroups: 6.80 ± 6.37 - P value = 1.64e-3 for the height of the left ramus versus 0.18 ± 4.18 - P value = .82 for the height of the right ramus). Supervised classification trees were built to identify the pathology and discriminate unilateral from bilateral mandibular hypoplasia (prediction rates = 81% and 84%, respectively). CONCLUSIONS Based on a morphometric analysis, we demonstrated that mandibular hypoplasia significantly impacts the mandibular morphology only from the first year of life, with a distinction between bilateral and unilateral hypoplasia.
Collapse
Affiliation(s)
- Floriane Remy
- Aix-Marseille Univ, yUniv Gustave Eiffel, LBA, Marseille, France.,YooMed, Montpellier, France
| | | | - Guillaume Captier
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Montpellier, France
| | | | | | - Laurent Guyot
- Department of Oral-Maxillofacial, Plastic and Reconstructive Surgery, A.P.-H.M., North University Hospital, Marseille, France.,Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Aix-Marseille Univ, yUniv Gustave Eiffel, LBA, Marseille, France
| |
Collapse
|
25
|
Müller-Hagedorn S, Arand J, Scholz T, Poets CF, Wiechers C. An innovative method for manufacturing the Tuebingen palatal plate for infants with Robin sequence. BMC Pediatr 2020; 20:103. [PMID: 32126980 PMCID: PMC7055044 DOI: 10.1186/s12887-020-2009-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Robin sequence (RS) is characterized by mandibular micro- and retrognathia, glossoptosis, upper airway obstruction and optionally a cleft palate. With an incidence of 1:8000, it belongs to the so-called rare diseases; 30-50% of patients have RS as part of a syndrome. A comparatively well-studied treatment option is the Tuebingen Palatal Plate (TPP), which has proven effective in both, isolated and syndromic RS, but often requires multiple endoscopies for perfect fit and effectiveness. We report on a new method for fitting the TPP with only one session of nasopharyngeal endoscopy resulting in the plate being finished in one day. METHODS AND RESULTS First, a prototype is produced, consisting of a traditional acrylic palatal part and a velar extension made of thermoplastic resin, usually measuring 10x40mm. Using polymerization, a scale is added to the posterior part of the extension to help with determining its optimal length during endoscopic evaluation. The extension is pre-bent in the dental laboratory to achieve an approximate shape. During endoscopy, the prototype can be adjusted to the infant's anatomy: first, the angulation is customized by controlled heating, bending and cooling of the thermoplastic spur. Second, the length of the spur is adapted by grinding its tip. Then the prototype is returned to the dental laboratory for completion; the final plate can be delivered to the patient on the same day. It acts by shifting the tongue into a more anterior position, thereby opening the airway and releasing upper airway obstruction, as well as by acting as a functional orthodontic appliance that stimulates mandibular growth through exerting pressure on the base of the tongue. CONCLUSIONS With the thermoplastic spur presented here, a TPP can be produced within one day, requiring only one endoscopy. This approach may facilitate fabricating the TPP.
Collapse
Affiliation(s)
- Silvia Müller-Hagedorn
- Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
- Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Jörg Arand
- Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, D-72076 Tübingen, Germany
| | - Thilo Scholz
- Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
- Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Christian F. Poets
- Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
- Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, D-72076 Tübingen, Germany
| |
Collapse
|
26
|
Ho ACH, Wong RWK, Cheung T, Ng DK, Siu KK, Fung SC. Orthodontic plate for management of obstructive sleep apnoea in infants with Pierre Robin sequence: experience and protocol in Hong Kong. J Orthod 2019; 46:367-373. [DOI: 10.1177/1465312519880557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To present the application of the pre-epiglottic baton plate (PEBP) in infants with Pierre Robin sequence (PRS) in the Southern Chinese population (Hong Kong) and to present the diagnosis and management protocol of these infants in our centre. Design: Retrospective case series of three patients with PRS. Setting: Neonatal Intensive Care Unit in Kwong Wah Hospital and Craniofacial Orthodontic Centre in United Christian Hospital, Hong Kong. Participants: Three new-born infants (two girls, one boy) with PRS and upper airway obstruction due to glossoptosis. Methods: A protocol for the diagnosis and management of these infants in the Southern Chinese population (Hong Kong) was presented. The three patients received nasal high-flow oxygen and/or continuous positive airway pressure (CPAP) as first-line respiratory support, followed by PEBP for 3–5 months. A two-stage approach was undertaken to ensure accurate positioning of the PEBP. Results: All three infants had improvement in clinical signs, symptoms and polysomnography upon discharge. PEBP and other respiratory aids were weaned off at 3–6 months. Conclusions: The PEBP, combined with other respiratory support, is a useful modality in the treatment of obstructive sleep apnoea in infants with PRS.
Collapse
Affiliation(s)
- Angus CH Ho
- Department of Dentistry and Maxillofacial Surgery, United Christian Hospital, Hong Kong
| | - Ricky WK Wong
- Department of Dentistry and Maxillofacial Surgery, United Christian Hospital, Hong Kong
| | | | - Daniel K Ng
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
| | - KK Siu
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
| | - SC Fung
- Department of Dentistry and Maxillofacial Surgery, United Christian Hospital, Hong Kong
| |
Collapse
|
27
|
Galluccio G, Mazzoli V, Vernucci R, Silvestri A, Barbato E. Neonatal Functional Treatment for Pierre Robin Sequence. Turk J Orthod 2019; 32:151-159. [PMID: 31565690 DOI: 10.5152/turkjorthod.2019.18057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/25/2018] [Indexed: 12/22/2022]
Abstract
Objective Pierre Robin Sequence (PRS) is a heterogeneous pathological condition characterized by the coexistence of micrognathia, glossoptosis, and cleft palate, resulting in upper airway tract obstruction. Among the treatment modalities, the orthodontic approach is one part of the comprehensive care of those patients and will be present in the treatment modalities during all the growth period of the child. Methods All patients with PRS observed in the period 2013-2017 were treated with a definite functional approach. The results were retrospectively analyzed with regard to functional outcome, total treatment time, and number of plates provided for a single patient. Results In all the patients, the indicated treatment protocol has been applied as early impression and plate supply, stimulation of bottle feeding with the use of the plate, eventual substitution of the plate if no more adequate to the transverse and sagittal growth of the palate, and continuing the use until the surgical closure of the cleft. All the patients showed a positive outcome to the proposed treatment approach, evaluated with regard to the incidence of feeding improvement and weight gain, to the limit for the surgical phase, in the absence of adverse effects. Conclusion The use of a functional obturator plate, removing functional alterations to mandibular growth, reduces and, in some cases, eliminates the need for surgical intervention. As also stated in the literature, if despite the presence of the plate nutritional problems persist, immediate different surgical approaches, mainly mandibular osteodistraction, become necessary.
Collapse
Affiliation(s)
- Gabriella Galluccio
- Department of Orthodontics and Maxillofacial Surgery, Sapienza University of Rome School of Dentistry, Rome, Italy
| | - Valentina Mazzoli
- Department of Orthodontics and Maxillofacial Surgery, Sapienza University of Rome School of Dentistry, Rome, Italy
| | - Roberto Vernucci
- Department of Orthodontics and Maxillofacial Surgery, Sapienza University of Rome School of Dentistry, Rome, Italy
| | - Alessandro Silvestri
- Department of Orthodontics and Maxillofacial Surgery, Sapienza University of Rome School of Dentistry, Rome, Italy
| | - Ersilia Barbato
- Department of Orthodontics and Maxillofacial Surgery, Sapienza University of Rome School of Dentistry, Rome, Italy
| |
Collapse
|
28
|
Poets CF, Koos B, Reinert S, Wiechers C. The Tübingen palatal plate approach to Robin sequence: Summary of current evidence. J Craniomaxillofac Surg 2019; 47:1699-1705. [PMID: 31477439 DOI: 10.1016/j.jcms.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
Various treatments, many of them considerably invasive, are currently applied to infants with Robin sequence (RS) and accompanying upper airway obstruction (UAO). We present a narrative review of our data on the Tübingen palatal plate (TPP) which show the following: a) in a randomized trial, the TPP was superior to a sham procedure in alleviating UAO; b) children treated with the TPP in infancy showed an intellectual development within the reference range; c) prone positioning is no alternative, as it is ineffective and associated with an increased risk of sudden death; d) the TPP reduces the mixed-obstructive apnea index to near-normal values, both in isolated and most (83%) syndromic RS, e) of 443 infants (129 syndromic) treated with the TPP in our center, 23 (5%) ultimately received a tracheostomy (all with syndromic RS), f) recent data suggest that the TPP may induce mandibular catch-up growth, g) the TPP may also help to reduce respiratory complications following cleft closure in RS, and h) TPP treatment is applied by various centers around the world, although it is unclear if its effectiveness is invariably controlled by endoscopy and sleep studies, although both are necessary. Given these data from peer-reviewed studies, it may be questioned whether the "First do no harm" principle is always adhered to when subjecting RS infants to more invasive procedures such as mandibular distraction osteogenesis or tongue-lip adhesion.
Collapse
Affiliation(s)
- Christian F Poets
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Neonatology and Pediatric Sleep Lab, Tübingen University Hospital, Germany.
| | - Bernd Koos
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Orthodontics, Tübingen University Hospital, Germany
| | - Siegmar Reinert
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Craniomaxillofacial Surgery, Tübingen University Hospital, Germany
| | - Cornelia Wiechers
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Germany; Department of Neonatology and Pediatric Sleep Lab, Tübingen University Hospital, Germany
| |
Collapse
|
29
|
Wiechers C, Buchenau W, Arand J, Oertel AF, Peters K, Müller-Hagedorn S, Koos B, Poets CF. Mandibular growth in infants with Robin sequence treated with the Tübingen palatal plate. Head Face Med 2019; 15:17. [PMID: 31228944 PMCID: PMC6588871 DOI: 10.1186/s13005-019-0200-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/06/2019] [Indexed: 12/28/2022] Open
Abstract
Background Robin sequence (RS) is characterized by mandibular retrognathia, glossoptosis and upper airway obstruction. Whether mandibular catch-up growth may occur in RS is yet controversial. Our functional and less invasive treatment including the Tübingen Palatal Plate (TPP), early oral feeding and orofacial stimulation may promote mandibular catch-up growth. We evaluated the effect of the Tübingen Palatal Plate on mandibular growth, expressed by the Jaw index, sleep study results and weight gain in infants admitted with isolated and syndromic RS, born at or referred to our center between 6/2015 and 5/2018. Methods Retrospective analysis of our electronic patient database that included data on jaw index measurements, sleep study results and standard deviation (Z-)scores for weight. Results Of 31 patients referred for RS treatment (22 isolated, 9 syndromic), we had data on the above parameters, determined at admission, discharge and 3 months after discharge, in 20. Jaw index at admission and 3-month follow-up was 8.8 (6.3–11.3) and 2.1 (2.0–4.0), respectively (median (IQR); p < 0.0001). Mixed-obstructive apnea index (MOAI) decreased from 9.7 (4.8–24.2) to 0.0 (0–1.3; p < 0.002). No significant correlation was observed between MOAI and Jaw Index, but MOAI correlated with the Maxillary/Mandibular arch ratio (r = 0.58; p < 0.001). Z-scores for weight were similar at both time points at − 1.34 (− 1.76 – − 0.57) and − 1.50 (− 1.89 – − 0.54), while the proportion of infants requiring nasogastric tube feeding decreased from 84 to 8%. No infant had craniofacial surgery; one with syndromic RS required tracheostomy. Conclusion These longitudinal cohort data suggest that the Tübingen Palatal Plate as used here may alleviate upper airway obstruction by promoting mandibular growth. Trial registration N.A.
Collapse
Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, D-72076, Tübingen, Germany.,Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Wolfgang Buchenau
- Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, D-72076, Tübingen, Germany.,Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Jörg Arand
- Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, D-72076, Tübingen, Germany.,Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Anne-Friederike Oertel
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Katharina Peters
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Silvia Müller-Hagedorn
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Rostock University Hospital, Rostock, Germany
| | - Bernd Koos
- Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, D-72076, Tübingen, Germany. .,Interdisciplinary Center for Cleft Palate and Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.
| |
Collapse
|
30
|
MacLean JE. Understanding the Spectrum of Treatment Options for Infants With Pierre Robin Sequence and Airway Obstruction. J Clin Sleep Med 2019; 15:373-374. [PMID: 30853057 DOI: 10.5664/jcsm.7654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics and Women and Children's Health Research Institute, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada
| |
Collapse
|
31
|
Resnick CM, Calabrese CE, Sahdev R, Padwa BL. Is Tongue-Lip Adhesion or Mandibular Distraction More Effective in Relieving Obstructive Apnea in Infants With Robin Sequence? J Oral Maxillofac Surg 2019; 77:591-600. [DOI: 10.1016/j.joms.2018.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
|
32
|
Tongue Lip Adhesion in the Treatment of Robin Sequence: Respiratory, Feeding, and Surgical Outcomes. J Craniofac Surg 2018; 29:2327-2333. [PMID: 30339599 DOI: 10.1097/scs.0000000000004975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Objective evaluation of the efficacy of tongue lip adhesion (TLA) in the management of Robin sequence (RS). STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral hospital. PATIENTS, PARTICIPANTS The craniofacial database of Amsterdam UMC, Vrije Universiteit Amsterdam was searched to identify infants with RS who underwent tong lip adhesion (TLA). Forty-one RS infants who underwent TLA from 1993 to 2016 were identified. INTERVENTIONS TLA. MAIN OUTCOME MEASURE The outcome measures were pre- and postoperative polysomnography results, nutritional status, weight gain, age at operation, hospital stay length, extubation time after TLA, and complications. RESULTS Forty-one RS patients were included who had TLA at an average age of 26.6 days. In 16 cases a pre- and postoperative polysomnography was performed. In 13 of these cases (81.3%) improvement was observed, in 2 (12.5%) the results were inconclusive, and in 1 (6.3%) no improvement was seen. Patients were extubated after a mean of 2.2 days.The mean hospital stay was 40.2 days. Reintervention was needed in 7 patients because of a wound dehiscence. The mean age of TLA release was 9.7 months. At discharge, 9 (22%) children still needed total nutritional support for persistent feeding difficulties. The average growth from birth to adhesion release was 4.6 kg. CONCLUSION This cohort demonstrates that TLA is a successful procedure in children with RS in terms of respiratory, feeding, and growth outcome. Only minor complications were seen in our cohort.
Collapse
|
33
|
Müller-Hagedorn S, Wiechers C, Arand J, Buchenau W, Bacher M, Krimmel M, Reinert S, Poets CF. Less invasive treatment of sleep-disordered breathing in children with syndromic craniosynostosis. Orphanet J Rare Dis 2018; 13:63. [PMID: 29688857 PMCID: PMC5914055 DOI: 10.1186/s13023-018-0808-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants and children with syndromic craniosynostosis (SCS), such as Apert-, Crouzon- or Pfeiffer syndrome, are prone to sleep disordered breathing (SDB) including obstructive sleep apnea and upper airway resistance syndrome (OSAS, UARS), potentially leading to tracheostomy. We modified the Tübingen Palatal Plate (TPP), an oral appliance with a velar extension effectively treating airway obstruction in Robin sequence, by attaching a tube to its velar extension to bridge the narrow pharyngeal airway in SCS patients. Here, we evaluated this treatment concept. METHODS Our hospital's electronic patient files were searched for all children with a diagnosis of SCS admitted between 01/01/2004 and 31/12/2016. Children with isolated craniosynostosis were excluded. OSAS was defined as a mixed-obstructive apnea-hypopnea index (MOAHI) > 1, and UARS as more than 1 episode with nasal flow limitation/h, but absent OSAS. Children with a diagnosis of OSAS received the TPP and fiberoptic nasopharyngoscopy to assess the type of obstruction and to adjust the plate. Growth and weight gain, determined as standard deviation scores, were also evaluated before and during treatment. RESULTS Of 34 patients included, 24 presented with SDB (19 OSAS, 5 UARS) and 27 had midface hypoplasia. Proportions of SDB were 78% in those with, and 22% in those without midface hypoplasia. In the OSAS group (n = 19), 13 patients were treated with palatal plates, with the remaining receiving continuous positive airway pressure, midface surgery or tracheal intubation. The MOAHI decreased across all children receiving palatal plate treatment from 14.6 (range 0.0-50.7) at admission to 0.9 (range 0.0-3.5) at discharge (p = 0.002). SDS for weight and body length also improved (p < 0.05 for weight and p = 0.05 for body length). Only one child required tracheostomy. CONCLUSION Treatment of upper airway obstruction by a modified TPP in these children with SCS was shown to be mostly effective and safe. If confirmed in larger prospective studies, it may help to avoid more invasive interventions.
Collapse
Affiliation(s)
- Silvia Müller-Hagedorn
- Department of Orthodontics, Rostock University Hospital, Rostock, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany.,Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Jörg Arand
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Wolfgang Buchenau
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | | | - Michael Krimmel
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Maxillofacial Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Siegmar Reinert
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Maxillofacial Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Christian F Poets
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany. .,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany.
| |
Collapse
|