Airway management in neonates with robin sequence: the role of early mandibular distraction osteogenesis

Background and objectives : Robin sequence (RS) is associated with glossoptosis, micrognathia, and airway obstruction. A U-shaped cleft palate may or may not be present. The retro-positioned mandible pushes the tongue posteriorly and as such obstructs the airway, especially during feeding. In extreme cases surgical interventions such as tracheostomy and gastrostomy have been utilized. Alternatively, distraction osteogenesis (DO) relieves both airway obstruction and feeding difficulties by lengthening the jaw. The objective of this study was to evaluate the effectiveness of DO in RS.

Methods : A review of the current literature was performed to study the effectiveness of DO in managing airway and feeding problems in neonates with RS.

Results : In over 80% of the patients, conservative measures such as prone positioning and nasopharyngeal airway provides relief. In children who fail conservative therapy, DO provided resolution of airway obstruction and obviates the need of tracheotomy or allowed early decannulation, by increasing posterior airway space. In addition DO, resolved GERD and OSA severity in RS patients.

Conclusion : The underlying cause of airway obstruction and feeding difficulties in Robin sequence can be safely and effectively managed with DO. DO provide long-term improved outcomes with limited complications.

Key words : Robin sequence; distraction osteogenesis; airway

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Airway management in neonates with robin sequence: the role of early mandibular distraction osteogenesis
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