Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
권호 표지

SURGICAL TREATMENT OF AIRWAY OBSTRUCTION IN INFANTS WITH PIERRE ROBIN SEQUENCE

Pierre Robin sequence 환자에서 기도 폐색의 외과적 치료

  • Ryu, Sun-Youl (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dental Science Research Institute, Chonnam National University) ;
  • Lee, Young-Uk (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dental Science Research Institute, Chonnam National University) ;
  • Seo, Il-Young (Department of Oral and Maxillofacial Surgery, College of Dentistry, Dental Science Research Institute, Chonnam National University)
  • 유선열 (전남대학교 치과대학 구강악안면외과학교실, 치의학연구소) ;
  • 이용욱 (전남대학교 치과대학 구강악안면외과학교실, 치의학연구소) ;
  • 서일영 (전남대학교 치과대학 구강악안면외과학교실, 치의학연구소)
  • Published : 2004.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

The deformities of micrognathia and glossoptosis in the newborn are frequently associated with a cleft palate, which is known as Pierre Robin sequence. Upper airway obstruction is the most serious problem in these patients. Treatment of Pierre Robin sequence includes either positional or surgical intervention. Mild cases are often managed in the prone position. However, when the patient fails to thrive due to chronic upper airway obstruction, or severe respiratory distress ensures despite positional treatment, surgical intervention is mandatory to relieve the obstruction. We experienced three infants with Pierre Robin sequence who showed a symptom triad of micrognathia, glossoptosis, and cleft palate. Intermittent cyanosis, depression of the chest, respiratory difficulty and feeding problems were also observed. To relieve severe upper airway obstruction caused by micrognathia and glossoptosis, we simultaneously performed modified tongue lip adhesion (TLA) and a subperiosteal release of the floor of the mouth (SRFM). Respiratory and feeding difficulties were relieved, the tongue positioned anteriorly, body weight increased, and mandibular growth improved. Simultaneous TLA and SRFM may constitute a simple and reliable method for surgical treatment of airway obstruction in patients with Pierre Robin sequence.

왜소악, 설하수, 구개열의 세 가지 특징적 증상과 더불어 간헐적인 청색증, 흉곽의 함몰, 기도 폐색에 의한 호흡 곤란과 수유곤란 등의 임상소견을 나타낸 3례의 Pierre Robin sequence 환아에서, 혀의 위치를 교정하기 위한 구강저골막하박리술과 혀를 전방으로 위치시켜 호흡 곤란과 기도 폐색을 예방하기 위한 설구순접합술과 동시에 시행하고 약 1년 경과 후 설구순분리술을 시행한 결과 호흡 곤란과 수유장애의 해소, 혀의 전방 재위치, 체중 증가 및 하악골의 성장 증진 등 만족할 만한 결과를 얻었다. 구강저골막하박리술과 구순접합술 동시 시술은 Pierre Robin sequence 환아에서 기도 폐색의 외과적 치료를 위한 간단하고도 신뢰할만한 방법이라고 사료된다.

Keywords

References

  1. Randall P: The Robin sequence: micrognathia and glossoptosis with airway obstruction. In Converse J (ed): Reconstructive Plastic Surgery, 3rd ed. Vol 4, Philadelphia, Saunders, 1999;3123-3134
  2. Robin P: Backward lowering of the root of the tongue causing respiratory disturbance. Bull Acad Natl Med 1923;89:37-41
  3. Smith JD : Treatment of airway obstruction in Pirre Robin syndrome. Arch Otolaryngol 1981;107:419-421 https://doi.org/10.1001/archotol.1981.00790430021005
  4. Caouette-Laberge L, Bayet B, Larocque Y: The Pierre Robin sequence: review of 125 cases and evolution of treatment modalities. Plast Reconstr Surg 1994;93:934-942 https://doi.org/10.1097/00006534-199404001-00006
  5. Sher AE : Mechanisms of airway obstruction in Robin sequence: implication for treatment. Cleft Palate-Craniofac J 1992;29:224-23 https://doi.org/10.1597/1545-1569(1992)029<0224:MOAOIR>2.3.CO;2
  6. Myer CM, Reed JM, Cotton RT, Willging JP, Shott SR: Airway management in Pierre Robin sequence. Otolayngol Head Neck Surg 1998;118:630-635 https://doi.org/10.1016/S0194-5998(98)70232-3
  7. Argamaso AE: Glossopexy for upper airway obstruction in Robin sequence. Cleft Palate Craniofac J 1992;29:232-238 https://doi.org/10.1597/1545-1569(1992)029<0232:GFUAOI>2.3.CO;2
  8. Parsons RW, Smith DJ : A modified tongue-lip adhesion for Pierre-Robin anomalad. Cleft Palate J 1980;17:144-147
  9. Douglas B: The treatment of micrognathia associated with obstruction by a plastic procedure. Plast Reconstr Surg 1946;1:300-308 https://doi.org/10.1097/00006534-194611000-00007
  10. Delorme R-P, Larocque Y, Caouette-Laberge L : Innovative surgical approach for the Pirre Robin anomalad: Subperiosteal release of the floor of the mouth musculature. Plast Reconst Surg 1989;83:960-966 https://doi.org/10.1097/00006534-198906000-00004
  11. Cruz MJ, Kerschner JE, Beste DJ, Conley SF: Pierre Robin sequence: secondary respiratory difficulties and intrinsic feeding abnormalities. Laryngoscope 1999;109:1632-1636 https://doi.org/10.1097/00005537-199910000-00016
  12. Frohberg U, Lange R: Surgical treatment of Robin sequence and sleep apnea syndrome: case report and review of literature. J Oral Maxillofac Surg 1993;51: 1274-1277 https://doi.org/10.1016/S0278-2391(10)80302-7
  13. Augarten A, Sagy M, Yahav J, Barzilay Z: Management of upper airway obstruction in the Pierre Robin syndrome. Br J Oral Maxillofac Surg 1990;28:105-108 https://doi.org/10.1016/0266-4356(90)90133-6
  14. Pruzansky S, Richmond JB: Growth of the mandible in infants with micrognathia. Am J Dis Child 1954;88:29
  15. Pashayan HM, Lewis MB: Clinical experience with the Robin sequence. Cleft Palate J 1984;21:270-276
  16. Farnsworth PB, Pacik PT: Glossoptotic hypoxia and micrognathia: the Pierre Robin syndrome revisited. Clin Pediatr 1971;10:600
  17. Routledge RT: The Pierre Robin syndrome: A surgical emergency in the neonatal period. Br J Plast Surg. 1960;13:204-218 https://doi.org/10.1016/S0007-1226(60)80039-2