Subperiosteal Release of the Floor of the Mouth to Correct Airway Obstruction in Pierre Robin Sequence: Review of 31 Cases

Caouette‐Laberge, Louise; Borsuk, Daniel E.; Bortoluzzi, Patricia

doi:10.1597/10-173

Cited by 18 publications

(9 citation statements)

References 27 publications

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“…This trial reported that only 23% of children had OSA resolution; however, the pooling of procedures makes it hard to generalize these results. Subperiosteal release of the floor of mouth was also reported in two studies from a single institution. The first reported an improvement in the mean oxygen saturation in the six children who were evaluated with pulse oximetry.…”

Section: Discussionmentioning

confidence: 67%

“…Five studies investigated other therapies for the treatment of persistent OSA (Table ). Two of these studies (n = 43) carried out at a single institution employed subperiosteal release of the floor of mouth musculature as a primary treatment for children with Pierre Robin sequence. Authors found significant improvements in oxygen saturation and a decrease in the AHI from 46.5 to 17.4 events per hour, reporting that 84% of patients had correction of respiratory obstruction.…”

Section: Resultsmentioning

confidence: 99%

“…The first reported an improvement in the mean oxygen saturation in the six children who were evaluated with pulse oximetry. The second used PSG to determine a resolution rate of 84%; however, the criterion for resolution was not clearly defined. Lastly, a single study reported on the efficacy of montelukast medical therapy to resolve residual mild OSA and noted a decrease in the AHI of 3.6 events/hour; a resolution rate was not reported.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of site of obstruction identification and non‐CPAP treatment options for children with persistent pediatric obstructive sleep apnea

et al. 2015

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Drug-induced sleep endoscopy and cine MRI are the most commonly reported tools to identify sites of obstruction for children with persistent OSA; however, these techniques have not yet been clearly linked to outcomes. Evidence for treatment is extremely limited and focuses primarily on lingual tonsillectomy and supraglottoplasty. Also, reports regarding appropriate patient selection and outcomes in obese or otherwise healthy children are scant.

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Section: Discussionmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Systematic review of site of obstruction identification and non‐CPAP treatment options for children with persistent pediatric obstructive sleep apnea

et al. 2015

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“…12 Some authors reserve MDO for patients with failed TLA or FMR. [13][14][15] Due to the relatively low incidence of PRS, coupled by the fact that only a minority of patients require surgical intervention, there is a lack of prospective comparison studies between MDO, TLA, and FMR. The ultimate goal in these infants is to perform a single operation that will successfully manage the airway, improve the ability to feed, and avoid the morbidity of tracheostomy.…”

Section: Introductionmentioning

confidence: 99%

Airway Management in Pierre Robin Sequence: The Vancouver Classification

Poon

Courtemanche

et al. 2017

Plast Surg (Oakv)

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Background: Pierre Robin sequence (PRS) is a triad of micrognathia, glossoptosis, and respiratory distress. There is no standard clinical classification used in the management of neonatal airway in patients with PRS. The goal of our study was to review the presentation and management of patients with PRS and formulate a clinical grading system and treatment algorithm. Methods: A 10-year retrospective review of all neonates diagnosed with PRS was performed after obtaining institutional ethics approval. Patients were identified using our cleft lip and palate program database. Inclusion criteria were 2 of the following 3 clinical features-glossoptosis, retrognathia, or airway obstruction. We collected demographic data, clinical information (coexisting airway morbidity, maxillary-mandibular discrepancy, type of intervention used, complications, and outcomes (feeding, length of stay, and airway status) during the first year of life. Results: Sixty-three patients met our inclusion criteria. Of these, 55 (87%) had cleft palate and 17 (27%) were syndromic. Forty-eight (76%) patients were managed by prone positioning. Of the 15 surgically managed patients, the initial procedure was floor of mouth release in 7, mandibular distraction osteogenesis (MDO) in 4, and tongue-lip adhesion in 4. Five patients with coexisting airway morbidity needed a second surgery; 2 had MDO and 3 tracheostomies (one patient was later decannulated). Seven (47%) of the surgically managed patients required a gastrostomy tube. Conclusion: At present, there is no consensus on neonatal airway management in infants with PRS. From our review of 63 patients with PRS, we hereby propose a simple 4-point classification system and treatment algorithm, based on clinical features. Résumé Historique : Le syndrome de Pierre-Robin (SPR) désigne une triade de micrognathie, de glossoptose et de détresse respiratoire. Aucune classification clinique standard n'est utilisée pour assurer l'ouverture des voies respiratoires chez les nouveau-nés présentant un SPR. La présenteétude visait à examiner la présentation et la prise en charge des patients ayant un SPR ainsi qu'à formuler un système de classement clinique et un algorithme de traitement. Méthodologie : Après avoir obtenu l'approbation du comité d'éthique de leurétablissement, les chercheurs ont procédé à une analyse rétrospective sur dix ans de tous les nouveau-nés ayant reçu un diagnostic de SPR. Ils ont recensé les patients dans leur base de données de fentes labiales et palatines. Deux des trois caractéristiques cliniques suivantes constituaient les critères d'inclusion : glossoptose, rétrognatie ou obstruction

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“…Airway compromise is assessed with oxygen saturation recordings and polysomnographic studies, the need for oxygen supplementation and appropriate weight gain (with or without gavage feeding). 25,26 Following release, the tongue can adopt a more anterior position. As primary measures, management of airway compromise secondary to glossoptosis include prone or semi-prone positioning and placement of a nasopharyngeal airway with or without continuous positive airway pressure.…”

Section: Associated Syndromesmentioning

confidence: 99%

Cleft palate and velopharyngeal dysfunction

Cugno

Sommerlad

2015

Plastic and Reconstructive Surgery

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Subperiosteal Release of the Floor of the Mouth to Correct Airway Obstruction in Pierre Robin Sequence: Review of 31 Cases

Abstract: The SRFM is effective for the treatment of severe airway obstruction in patients with Pierre Robin sequence. The procedure is simple and has fewer complications and secondary procedures than other surgical options for correction of the airway obstruction.

Cited by 18 publications

References 27 publications

Systematic review of site of obstruction identification and non‐CPAP treatment options for children with persistent pediatric obstructive sleep apnea

Systematic review of site of obstruction identification and non‐CPAP treatment options for children with persistent pediatric obstructive sleep apnea

Airway Management in Pierre Robin Sequence: The Vancouver Classification

Cleft palate and velopharyngeal dysfunction

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