Surgical Airway Management in Pierre Robin Sequence: Is There a Role for Tongue-Lip Adhesion?

Objective The purpose of this study was to examine the efficacy of tonguelip adhesion (TLA) in the management of clinically significant airway obstruction associated with Pierre Robin sequence. Design The records of all children admitted to The Children's Hospital of Philadelphia with a diagnosis of Pierre Robin sequence were reviewed. Charts were reviewed for birth data, diagnosis, preoperative airway management methods, and surgical intervention. Records of infants undergoing TLA were analyzed for timing of surgery, operative technique, postoperative complications, length of hospital stay, and treatment outcome. Results Over the 28-year period 1971 to 1999, 107 patients (47 boys, 60 girls) meeting the criteria for Pierre Robin sequence were admitted for treatment. Of these, 74 (69.2%) were successfully managed by positioning alone. Surgical management of the airway was performed in the remaining 33 (30.8%) patients, 29 of whom underwent TLA and 4 of whom underwent tracheostomy. Dehiscence of the adhesion occurred in five patients (17.2%), two of whom subsequently required tracheostomy. Within the group of patients who underwent mucosal adhesion alone, the dehiscence rate was 41.6%. When the adhesion included muscular sutures, however, dehiscence was not observed in any patient. Of the 24 patients in whom primary TLA healed uneventfully, airway obstruction was successfully relieved in 20 (83.3%). Failure of a healed TLA to relieve the airway obstruction resulted in conversion to a tracheostomy in four patients. Six patients who underwent TLA (20.7%) ultimately required a tracheostomy; five of these patients (83.3%) were syndromic. Of patients requiring preoperative intubation, 42.9% ultimately required tracheostomy. Conclusion TLA successfully relieves airway obstruction that is unresponsive to positioning alone in the majority of patients with Pierre Robin sequence and should therefore play an important role in the management of these infants.

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Quantification of Mandibular Morphology in Pierre Robin Sequence to Optimize Mandibular Distraction Osteogenesis

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620913780 ◽

2020 ◽

Vol 57 (8) ◽

pp. 1032-1040 ◽

Cited By ~ 2

Author(s):

Angela S. Volk ◽

Matthew J. Davis ◽

Amit M. Narawane ◽

Amjed Abu-Ghname ◽

Robert F. Dempsey ◽

...

Keyword(s):

Airway Management ◽

Airway Obstruction ◽

Distraction Osteogenesis ◽

Pierre Robin Sequence ◽

Management Decisions ◽

Mandibular Distraction ◽

Robin Sequence ◽

Mandibular Distraction Osteogenesis ◽

Mandibular Body ◽

Pierre Robin

Background: Mandibular distraction osteogenesis (MDO) is the primary surgical intervention to treat airway obstruction in Pierre Robin sequence (PRS). Current morphologic studies of PRS mandibles do not translate into providing airway management decisions. We compare mandibles of infants with nonsyndromic PRS to controls characterizing morphological variances relevant to distraction. We also examine how morphologic measurements and airway grades correlate with airway management. Methods: Patients with PRS under 2 months old were age and sex matched to controls. Demographic and perioperative data, and Cormack-Lehane airway grades were recorded. Computed tomography scans were used to generate mandibular models. Bilateral condylions, gonions, and the menton were identified. Linear and angular measurements were made. Wilcoxon rank sum and 2-sample t tests were performed. Results: Twenty-four patients with PRS and 24 controls were included. Seventeen patients with PRS required MDO. PRS patients had shorter ramus heights (16.7 vs 17.3 mm; P = .346) and mandibular body lengths (35.3 vs 39.3 mm; P < .001), more acute gonial angles (125.3° vs 131.3°; P < .001), and more obtuse intergonial angles (94.2° vs 80.4°; P < .001) compared to controls. No significant differences were found among patients requiring MDO versus conservative management nor among distracted patients with high versus low airway grades. Conclusion: Our study examines the largest and youngest PRS population to date regarding management of early airway obstruction with MDO. Our findings indicate that univector mandibular body distraction allows for normalization in nonsyndromic patients with PRS, and airway obstruction management decisions should remain clinical.

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Management of upper airway obstruction in Pierre Robin sequence

The Journal of Laryngology & Otology ◽

10.1017/s0022215100139581 ◽

1997 ◽

Vol 111 (12) ◽

pp. 1155-1156 ◽

Cited By ~ 40

Author(s):

A. P. Bath ◽

P. D. Bull

Keyword(s):

Airway Obstruction ◽

Surgical Intervention ◽

Neonatal Period ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Pierre Robin Sequence ◽

Severe Respiratory Distress ◽

Feeding Difficulties ◽

Robin Sequence ◽

Pierre Robin

AbstractPierre Robin sequence (PRS) presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress. This is potentially fatal and surgical intervention in these cases is necessary. We present our series of cases with severe PRS requiring surgical relief of their airway obstruction, and the reasons for preferring tracheostomy over glossopexy.

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Surgical Airway Management in Pierre Robin Sequence: Is There a Role for Tongue-Lip Adhesion?

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569(2003)040<0013:samipr>2.0.co;2 ◽

2003 ◽

Vol 40 (1) ◽

pp. 13-18 ◽

Cited By ~ 74

Author(s):

Richard E. Kirschner ◽

David W. Low ◽

Peter Randall ◽

Scott P. Bartlett ◽

Donna M. McDonald-McGinn ◽

...

Keyword(s):

Airway Management ◽

Pierre Robin Sequence ◽

Robin Sequence ◽

Surgical Airway ◽

Pierre Robin

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Faculty Opinions recommendation of Airway management in two of newborns with Pierre Robin Sequence: the use of disposable vs multiple use LMA for fiberoptic intubation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1057755.510698 ◽

2006 ◽

Author(s):

Francis Veyckemans

Keyword(s):

Airway Management ◽

Fiberoptic Intubation ◽

Pierre Robin Sequence ◽

Multiple Use ◽

Robin Sequence ◽

Pierre Robin

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A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211011886 ◽

2021 ◽

pp. 105566562110118

Author(s):

Darren B. Abbas ◽

Christopher Lavin ◽

Evan J. Fahy ◽

HyeRan Choo ◽

Mai Thy Truong ◽

...

Keyword(s):

Airway Obstruction ◽

Distraction Osteogenesis ◽

Literature Search ◽

Oral Feeding ◽

Treatment Modalities ◽

Pierre Robin Sequence ◽

Mandibular Distraction ◽

Robin Sequence ◽

Mandibular Distraction Osteogenesis ◽

Pierre Robin

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.

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Emergency airway management in Pierre Robin Sequence, our nightmare experiences

Trends in Anaesthesia and Critical Care ◽

10.1016/j.tacc.2020.10.003 ◽

2020 ◽

Author(s):

Soumya Sarkar ◽

Anudeep Jafra ◽

Preethy Mathew

Keyword(s):

Airway Management ◽

Pierre Robin Sequence ◽

Emergency Airway Management ◽

Emergency Airway ◽

Robin Sequence ◽

Pierre Robin

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Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

PLoS ONE ◽

10.1371/journal.pone.0250369 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250369

Author(s):

Andreas Moritz ◽

Luise Holzhauser ◽

Tobias Fuchte ◽

Sven Kremer ◽

Joachim Schmidt ◽

...

Keyword(s):

Airway Management ◽

Success Rate ◽

Failure Rate ◽

Dental Trauma ◽

Previous Experience ◽

Pierre Robin Sequence ◽

Vocal Cords ◽

Extensive Experience ◽

Robin Sequence ◽

Pierre Robin

Background Video laryngoscopy is an effective tool in the management of difficult pediatric airway. However, evidence to guide the choice of the most appropriate video laryngoscope (VL) for airway management in pediatric patients with Pierre Robin syndrome (PRS) is insufficient. Therefore, the aim of this study was to compare the efficacy of the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a nonangulated Miller blade (C-MAC® Miller) and a conventional Miller laryngoscope when used by anesthetists with limited and extensive experience in simulated Pierre Robin sequence. Methods Forty-three anesthetists with limited experience and forty-three anesthetists with extensive experience participated in our randomized crossover manikin trial. Each performed endotracheal intubation with the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a Miller blade and the conventional Miller laryngoscope. “Time to intubate” was the primary endpoint. Secondary endpoints were “time to vocal cords”, “time to ventilate”, overall success rate, number of intubation attempts and optimization maneuvers, Cormack-Lehane score, severity of dental trauma and subjective impressions. Results Both hyperangulated and nonangulated VLs provided superior intubation conditions. The Glidescope® Core™ enabled the best glottic view, caused the least dental trauma and significantly decreased the “time to vocal cords”. However, the failure rate of intubation was 14% with the Glidescope® Core™, 4.7% with the Miller laryngoscope and only 2.3% with the C-MAC® Miller when used by anesthetists with extensive previous experience. In addition, the “time to intubate”, the “time to ventilate” and the number of optimization maneuvers were significantly increased using the Glidescope® Core™. In the hands of anesthetists with limited previous experience, the failure rate was 11.6% with the Glidescope® Core™ and 7% with the Miller laryngoscope. Using the C-MAC® Miller, the overall success rate increased to 100%. No differences in the “time to intubate” or “time to ventilate” were observed. Conclusions The nonangulated C-MAC® Miller facilitated correct placement of the endotracheal tube and showed the highest overall success rate. Our results therefore suggest that the C-MAC® Miller could be beneficial and may contribute to increased safety in the airway management of infants with PRS when used by anesthetists with limited and extensive experience.

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