Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Factors Associated with the Non-Operative Airway Management of Patients with Robin Sequence

  • Albino, Frank P. (Division of Plastic Surgery, Children's National Medical Center) ;
  • Wood, Benjamin C. (Division of Plastic Surgery, Children's National Medical Center) ;
  • Han, Kevin D. (Division of Plastic Surgery, Children's National Medical Center) ;
  • Yi, Sojung (Division of Plastic Surgery, Children's National Medical Center) ;
  • Seruya, Mitchel (Division of Plastic Surgery, Children's National Medical Center) ;
  • Rogers, Gary F. (Division of Plastic Surgery, Children's National Medical Center) ;
  • Oh, Albert K. (Division of Plastic Surgery, Children's National Medical Center)
  • Received : 2015.12.21
  • Accepted : 2016.06.21
  • Published : 2016.11.18
Download PDF
⟨ Previous Next ⟩

Abstract

Background The indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention. Methods The authors retrospectively reviewed the medical charts of infants with RS evaluated for potential surgical airway management between 1994 and 2014. Patients who were successfully managed without surgical intervention were included. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG) findings were recorded. Results Thirty-two infants met the inclusion criteria. The average hospital stay was 16.8 days (range, 5-70 days). Oxygen desaturation (<70% by pulse oximetry) occurred in the majority of patients and was managed with temporary oxygen supplementation by nasal cannula (59%) or endotracheal intubation (31%). Seventy-five percent of patients required a temporary nasogastric tube for nutritional support, and a gastrostomy tube placed was placed in 9%. All patients continued to gain weight following the implementation of these conservative measures. PSG data (n=26) demonstrated mild to moderate obstruction, a mean apneahypopnea index (AHI) of $19.2{\pm}5.3events/hour$, and an oxygen saturation level <90% during only 4% of the total sleep time. Conclusions Nonsurgical airway management was successful in patients who demonstrated consistent weight gain and mild to moderate obstruction on PSG, with a mean AHI of <20 events/hour.

Keywords

References

  1. Bush PG, Williams AJ. Incidence of the Robin Anomalad (Pierre Robin syndrome). Br J Plast Surg 1983;36:434-7. https://doi.org/10.1016/0007-1226(83)90123-6
  2. Marques IL, de Sousa TV, Carneiro AF, et al. Clinical experience with infants with Robin sequence: a prospective study. Cleft Palate Craniofac J 2001;38:171-8. https://doi.org/10.1597/1545-1569(2001)038<0171:CEWIWR>2.0.CO;2
  3. Anderson KD, Cole A, Chuo CB, et al. Home management of upper airway obstruction in Pierre Robin sequence using a nasopharyngeal airway. Cleft Palate Craniofac J 2007;44:269-73. https://doi.org/10.1597/06-020
  4. Marques IL, Peres SP, Bettiol H, et al. Growth of children with isolated Robin sequence treated by nasopharyngeal intubation: importance of a hypercaloric diet. Cleft Palate Craniofac J 2004;41:53-8. https://doi.org/10.1597/02-043
  5. Mondini CC, Marques IL, Fontes CM, et al. Nasopharyngeal intubation in Robin sequence: technique and management. Cleft Palate Craniofac J 2009;46:258-61. https://doi.org/10.1597/08-042.1
  6. Wagener S, Rayatt SS, Tatman AJ, et al. Management of infants with Pierre Robin sequence. Cleft Palate Craniofac J 2003;40:180-5. https://doi.org/10.1597/1545-1569(2003)040<0180:MOIWPR>2.0.CO;2
  7. Delorme RP, Larocque Y, Caouette-Laberge L. Innovative surgical approach for the Pierre Robin anomalad: subperiosteal release of the floor of the mouth musculature. Plast Reconstr Surg 1989;83:960-4. https://doi.org/10.1097/00006534-198906000-00004
  8. Abramowicz S, Bacic JD, Mulliken JB, et al. Validation of the GILLS score for tongue-lip adhesion in Robin sequence patients. J Craniofac Surg 2012;23:382-6. https://doi.org/10.1097/SCS.0b013e318240fc7b
  9. Argamaso RV. Glossopexy for upper airway obstruction in Robin sequence. Cleft Palate Craniofac J 1992;29:232-8. https://doi.org/10.1597/1545-1569(1992)029<0232:GFUAOI>2.3.CO;2
  10. Cozzi F, Totonelli G, Frediani S, et al. The effect of glossopexy on weight velocity in infants with Pierre Robin syndrome. J Pediatr Surg 2008;43:296-8. https://doi.org/10.1016/j.jpedsurg.2007.10.015
  11. Denny AD, Amm CA, Schaefer RB. Outcomes of tongue-lip adhesion for neonatal respiratory distress caused by Pierre Robin sequence. J Craniofac Surg 2004;15:819-23. https://doi.org/10.1097/00001665-200409000-00023
  12. Hoffman W. Outcome of tongue-lip plication in patients with severe Pierre Robin sequence. J Craniofac Surg 2003;14:602-8. https://doi.org/10.1097/00001665-200309000-00002
  13. Kirschner RE, Low DW, Randall P, et al. Surgical airway management in Pierre Robin sequence: is there a role for tongue-lip adhesion? Cleft Palate Craniofac J 2003;40:13-8. https://doi.org/10.1597/1545-1569(2003)040<0013:SAMIPR>2.0.CO;2
  14. Parsons RW, Smith DJ. A modified tongue-lip adhesion for Pierre Robin anomalad. Cleft Palate J 1980;17:144-7.
  15. Demke J, Bassim M, Patel MR, et al. Parental perceptions and morbidity: tracheostomy and Pierre Robin sequence. Int J Pediatr Otorhinolaryngol 2008;72:1509-16. https://doi.org/10.1016/j.ijporl.2008.07.002
  16. Tomaski SM, Zalzal GH, Saal HM. Airway obstruction in the Pierre Robin sequence. Laryngoscope 1995;105:111-4. https://doi.org/10.1288/00005537-199502000-00001
  17. Burstein FD, Williams JK. Mandibular distraction osteogenesis in Pierre Robin sequence: application of a new internal single-stage resorbable device. Plast Reconstr Surg 2005;115:61-7.
  18. Dauria D, Marsh JL. Mandibular distraction osteogenesis for Pierre Robin sequence: what percentage of neonates need it? J Craniofac Surg 2008;19:1237-43. https://doi.org/10.1097/SCS.0b013e3181843293
  19. Denny A, Kalantarian B. Mandibular distraction in neonates: a strategy to avoid tracheostomy. Plast Reconstr Surg 2002;109:896-904. https://doi.org/10.1097/00006534-200203000-00011
  20. Denny AD. Distraction osteogenesis in Pierre Robin neonates with airway obstruction. Clin Plast Surg 2004;31:221-9. https://doi.org/10.1016/S0094-1298(03)00131-7
  21. Denny AD, Talisman R, Hanson PR, et al. Mandibular distraction osteogenesis in very young patients to correct airway obstruction. Plast Reconstr Surg 2001;108:302-11. https://doi.org/10.1097/00006534-200108000-00004
  22. Monasterio FO, Drucker M, Molina F, et al. Distraction osteogenesis in Pierre Robin sequence and related respiratory problems in children. J Craniofac Surg 2002;13:79-83. https://doi.org/10.1097/00001665-200201000-00018
  23. Monasterio FO, Molina F, Berlanga F, et al. Swallowing disorders in Pierre Robin sequence: its correction by distraction. J Craniofac Surg 2004;15:934-41. https://doi.org/10.1097/00001665-200411000-00009
  24. Wittenborn W, Panchal J, Marsh JL, et al. Neonatal distraction surgery for micrognathia reduces obstructive apnea and the need for tracheotomy. J Craniofac Surg 2004;15:623-30. https://doi.org/10.1097/00001665-200407000-00018
  25. Caouette-Laberge L, Bayet B, Larocque Y. The Pierre Robin sequence: review of 125 cases and evolution of treatment modalities. Plast Reconstr Surg 1994;93:934-42. https://doi.org/10.1097/00006534-199404001-00006

Cited by

  1. Current Trends in Surgical Airway Management of Neonates with Robin Sequence vol.6, pp.11, 2016, https://doi.org/10.1097/gox.0000000000001973
  2. Sleep and respiratory outcomes in neonates with Pierre Robin sequence: a concise review vol.24, pp.1, 2016, https://doi.org/10.1007/s11325-019-01876-6