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de Blacam C, Butler D, Duggan L, Byrne S, Russell J, Javadpour S, White M, Orr DJA. Minimally-invasive airway management and early cleft palate repair in infants born with Robin sequence. J Craniomaxillofac Surg 2024; 52:514-521. [PMID: 38448335 DOI: 10.1016/j.jcms.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
The objective of this study was to report outcomes of early cleft palate repair in infants born with Robin sequence (RS). A retrospective case series in a tertiary referral paediatric hospital was carried out, examining a consecutive series of 69 infants born with RS and cleft palate. A minimally invasive approach was taken to upper airway obstruction, with liberal nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) use, guided by sleep studies. The palate was repaired between 6 and 9 months with a modified Malek technique. The most frequently used airway adjunct (59.4% of patients) was an NPA and the median duration of use was 5.6 months. All patients underwent a modified Malek cleft palate repair at a median of 7 months of age. Overnight oximetry demonstrated higher mean oxygen saturation (SpO2) across the group from initial neonatal admission to discharge (median 96.5% (interquartile range [IQR] 95-98%) vs 97.45% (IQR 96.5-98%) (P = 0.2, N = 34). Of those with a cardiorespiratory polysomnogram, the obstructive apnoea-hypopnea index (OAHI) was significantly lower postoperatively (5.9 vs 2.8, P = 0.028). This study supports the use of non-surgical airway strategies and early cleft palate repair in infants born with RS and cleft palate.
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Affiliation(s)
- Catherine de Blacam
- Dept of Plastic Surgery, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Daryl Butler
- Dept of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Laura Duggan
- Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Sandra Byrne
- Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - John Russell
- Dept of Paediatric Otolaryngology, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Sheila Javadpour
- Royal College of Surgeons in Ireland, Dublin 2, Ireland; Dept of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Martin White
- Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Dept of Neonatology, Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - David J A Orr
- Dept of Plastic Surgery, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Dept of Surgery, Trinity College Dublin, Dublin 2, Ireland
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2
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Blancher A, Mamidi I, Morris L. Tongue and Mandibular Disorders of the Pediatric Patient. Facial Plast Surg Clin North Am 2024; 32:157-167. [PMID: 37981411 DOI: 10.1016/j.fsc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Robin sequence, macroglossia, and ankyloglossia are disorders affecting the tongue and mandible in the pediatric population. Each of these can have a significant impact on breathing, feeding, speech, dentition, and craniofacial growth. This review discusses the interdependent and coordinated development of both the tongue and mandible, the functional impacts of these disorders, and appropriate management strategies.
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Affiliation(s)
- Adam Blancher
- Louisiana State University Health Sciences Center-New Orleans, Department of Otolaryngology-Head and Neck Surgery, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Ishwarya Mamidi
- Louisiana State University Health Sciences Center-New Orleans, Department of Otolaryngology-Head and Neck Surgery, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA
| | - Lisa Morris
- Louisiana State University Health Sciences Center-New Orleans, Department of Otolaryngology-Head and Neck Surgery, 533 Bolivar Street Suite 566, New Orleans, LA 70112, USA.
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Abstract
Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant challenges to experienced neonatologists and paediatric anaesthesiologists, and increased difficulty can be due to anatomical abnormalities, physiological instability or increased situational stress. Neonatal airway obstruction is under recognised, and should be considered an emergency until the diagnosis and physiological implications are understood. When multiple types of difficulties are present or there are multiple levels of anatomical obstruction, the challenge increases exponentially. In these situations, preparation, multi-disciplinary teamwork and a consistent hospital-wide approach will help to reduce errors and morbidity.
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Affiliation(s)
- Toby Kane
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Neonatology, Royal Children's Hospital, Parkville, Australia.
| | - Anastasia Pellicano
- Department of Neonatology, Royal Children's Hospital, Parkville, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Australia
| | - Stefano Sabato
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Australia; Anaesthetics, Murdoch Children's Research Institute, Parkville, Australia
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Wiechers C, Poets C, Hoopmann M, Kagan KO. Fetal Profile Markers for the Detection of Robin Sequence in Fetuses with Retrognathia. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:299-306. [PMID: 34852370 DOI: 10.1055/a-1659-2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine whether the prefrontal space ratio (PSFR), inferior facial (IFA) and maxilla-nasion-mandible angle (MNM), and the fetal profile line (FPL) are helpful in identifying fetuses with Robin sequence (RS) in cases with isolated retrognathia, and thus better predict the likelihood of immediate need for postnatal respiratory support. METHODS This was a retrospective matched case-control study of fetuses/infants with isolated retrognathia with or without RS receiving pre- and postnatal treatment at the University Hospital of Tübingen, Germany between 2008 and 2020. The PFSR, IFA, MNM, and FPL were measured in affected and normal fetuses according to standardized protocols. Cases were stratified into isolated retrognathia and RS. RESULTS 21 (n=7 isolated retrognathia, n=14 RS) affected fetuses and 252 normal fetuses were included. Their median gestational age at ultrasound examination was 23.6 and 24.1 weeks, respectively. In fetuses with isolated retrognathia and RS, the PSFR, IFA, and FPL were significantly different from the normal population. At a false-positive rate of 5%, the detection rate was 76.2% for the PFSR, 85.7% for the IFA, and 90.5% for both parameters combined. However, all parameters failed to distinguish between isolated retrognathia and RS. CONCLUSION PSFR and IFA are simple markers for identifying retrognathia prenatally. However, they are not helpful for the detection of RS in fetuses with isolated retrognathia. Therefore, delivery should take place in a center experienced with RS and potentially life-threatening airway obstruction immediately after birth.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Poets
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
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Effert J, Uhlig S, Wiechers C, Quante M, Poets CF, Schulz MC, Reinert S, Krimmel M, Koos B, Weise C. Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy. J Clin Med 2023; 12:jcm12020448. [PMID: 36675376 PMCID: PMC9864988 DOI: 10.3390/jcm12020448] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To assess the long-term functional orthodontic outcome of the Tübingen palatal plate (TPP) in children with Robin sequence (RS) in comparison to age- and sex-matched healthy controls. METHODS Between 09/2019 and 10/2020, we performed orthodontic assessments in 41 children at our Department of Orthodontics. Included were patients with RS (17 non-syndromic; four syndromic) and healthy controls (n = 22, average age in both groups 9.9 y). Facial analyses of 2D images, digital study casts and cephalometric measurements were made. RESULTS The orthodontic examinations showed no statistically significant group differences regarding functional extraoral, intraoral and pharyngeal parameters, or in skeletal patterns. The relationship between the upper and lower incisors was significantly increased (overjet 4 (2-10) vs. 3 (0-9) mm; p = 0.01) with a significant deficit in the lower face proportions (Jaw Index 4.15 (1.9-9.6) vs. 2.98 (0-9); p = 0.02; Facial convexity angle 157 (149-173) vs. 159 (149-170); p = 0.01). CONCLUSION Children with RS treated with the TPP showed normal long-term functional orthodontic outcomes, thanks to the functional adaption of the stomatognathic system. However, soft tissue growth did not completely match skeletal growth, resulting in a more convex facial profile.
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Affiliation(s)
- Josephine Effert
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Simone Uhlig
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Cornelia Wiechers
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Mirja Quante
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Christian F. Poets
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Matthias C. Schulz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Michael Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
| | - Christina Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-7071-29-62581
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Automation of Measurements for Personalized Medical Appliances by Means of CAD Software-Application in Robin Sequence Orthodontic Appliances. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120773. [PMID: 36550978 PMCID: PMC9774752 DOI: 10.3390/bioengineering9120773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Measuring the dimensions of personalized devices can provide relevant information for the production of future such devices used in various medical specialties. Difficulties with standardizing such measurement and obtaining high accuracy, alongside cost-intensive measuring methodologies, has dampened interest in this practice. This study presents a methodology for automatized measurements of personalized medical appliances of variable shape, in this case an orthodontic appliance known as Tübingen Palatal Plate (TPP). Parameters such as length, width and angle could help to standardize and improve its future use. A semi-automatic and custom-made program, based on Rhinoceros 7 and Grasshopper, was developed to measure the device (via an extraoral scanner digital file). The program has a user interface that allows the import of the desired part, where the user is able to select the necessary landmarks. From there, the program is able to process the digital file, calculate the necessary dimensions automatically and directly export all measurements into a document for further processing. In this way, a solution for reducing the time for measuring multiple dimensions and parts while reducing human error can be achieved.
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Zarean P, Zarean P, Thieringer FM, Mueller AA, Kressmann S, Erismann M, Sharma N, Benitez BK. A Point-of-Care Digital Workflow for 3D Printed Passive Presurgical Orthopedic Plates in Cleft Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1261. [PMID: 36010151 PMCID: PMC9406563 DOI: 10.3390/children9081261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022]
Abstract
Cleft lip and palate are one of the most common congenital craniofacial malformations. As an initial treatment, presurgical orthopedics is considered standard treatment at many cleft centers. Digital impressions are becoming feasible in cleft care. Computer-aided design (CAD) and three-dimensional (3D) printing are manufacturing standards in dentistry. The assimilation of these technologies has the potential to alter the traditional workflow for the fabrication of customized presurgical orthopedic plates. We present a digital workflow comprising three steps: 3D digital image acquisition with an intraoral scanner, open-source CAD modeling, and point-of-care 3D printing for the fabrication of personalized passive presurgical plates for newborns with cleft lip and palate. The digital workflow resulted in patient-related benefits, such as no risk of airway obstruction with quicker data acquisition (range 1-2.5 min). Throughput time was higher in the digital workflow 260-350 min compared to 135 min in the conventional workflow. The manual and personal intervention time was reduced from 135 min to 60 min. We show a clinically useful digital workflow for presurgical plates in cleft treatment. Once care providers overcome procurement costs, digital impressions, and point-of-care 3D printing will simplify these workflows and have the potential to become standard for cleft care.
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Affiliation(s)
- Parichehr Zarean
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland
| | - Paridokht Zarean
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland
| | - Florian M. Thieringer
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland
| | - Andreas A. Mueller
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Facial and Cranial Anomalies Research Group, Department of Clinical Research and Department of Biomedical Engineering, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland
| | - Sabine Kressmann
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Martin Erismann
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Facial and Cranial Anomalies Research Group, Department of Clinical Research and Department of Biomedical Engineering, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland
| | - Neha Sharma
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland
| | - Benito K. Benitez
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Facial and Cranial Anomalies Research Group, Department of Clinical Research and Department of Biomedical Engineering, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland
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Benitez BK, Brudnicki A, Surowiec Z, Wieprzowski Ł, Rasadurai A, Nalabothu P, Lill Y, Mueller AA. Digital Impressions from Newborns to Preschoolers with Cleft Lip and Palate: A Two-Centers Experience. J Plast Reconstr Aesthet Surg 2022; 75:4233-4242. [DOI: 10.1016/j.bjps.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/16/2022] [Indexed: 12/12/2022]
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Wiechers C, Arand J, Koos B, Poets CF. Evidence and practical aspects of treatment with the Tübingen palatal plate. Semin Fetal Neonatal Med 2021; 26:101281. [PMID: 34602352 DOI: 10.1016/j.siny.2021.101281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Tübingen therapy concept centers on an individual orthodontic palatal plate with a spur-like velar extension (Tübingen Palatal or Epiglottic Baton Plate, TPP or PEBP) and intensive feeding training. It was primarily developed for infants with Robin sequence, but has since also be used successfully in infants with other craniofacial malformations. TPP improves not only upper airway obstruction, but also feeding problems, thriving, mandibular growth and was associated with intact neurocognitive outcome. This review provides an overview of the evidence and the clinical and practical aspects of the Tübingen therapy concept.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| | - Jörg Arand
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany; Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany.
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany; Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.
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Poets CF, Abadie V, Breugem C, Wallis C, Abel F, Chalouhi C, Kruisinga F, Sorg AL, Wiechers C. Managing infants with craniofacial malformations - Where to go next? Semin Fetal Neonatal Med 2021; 26:101289. [PMID: 34548245 DOI: 10.1016/j.siny.2021.101289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Treatment of infants with craniofacial malformations, e.g. Robin sequence, is characterized by considerable heterogeneity and a lack of randomized trials to identify an optimal approach. We propose to establish an international register using a common minimal dataset that will better allow for a comparison between key determinants and outcomes in these patients. In infants, this should include an assessment of mandibular micrognathia, glossoptosis, upper airway obstruction, weight gain and mode of feeding. Later on, neurocognition, speech development, hearing and quality of life should also be included. Together, these data will help better to advice parents on which treatment to choose for their baby with a craniofacial malformation.
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Affiliation(s)
- Christian F Poets
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations and Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.
| | - Veronique Abadie
- Department of General Pediatrics, Reference Center for Rare Diseases "Pierre Robin Sequences and Congenital Sucking-swallowing Troubles", Necker University Hospital, Paris University, France
| | - Corstiaan Breugem
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Emma Children's Hospital - Location AMC, University of Amsterdam, the Netherlands
| | - Colin Wallis
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Francois Abel
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - Christel Chalouhi
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Emma Children's Hospital - Location AMC, University of Amsterdam, the Netherlands
| | - Frea Kruisinga
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Emma Children's Hospital - Location AMC, University of Amsterdam, the Netherlands
| | - Anna-Lisa Sorg
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations and Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Interdisciplinary Center for Cleft Palate & Craniofacial Malformations and Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
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11
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Gozal D. Diagnostic approaches to respiratory abnormalities in craniofacial syndromes. Semin Fetal Neonatal Med 2021; 26:101292. [PMID: 34556443 DOI: 10.1016/j.siny.2021.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Craniofacial syndromes are a complex cluster of genetic conditions characterized by embryonic perturbations in the developmental trajectory of the upper airway and related structures. The presence of reduced airway size and maladaptive neuromuscular responses, particularly during sleep, leads to significant alterations in sleep architecture and overall detrimental gas exchange abnormalities that can be life-threatening. The common need for multi-stage therapeutic interventions for these craniofacial problems requires careful titration of anatomy and function, and the latter is currently evaluated by overnight polysomnography in sleep laboratories. The cost, inconvenience, and scarcity of pediatric sleep laboratories preclude the frequent evaluations that could optimize the overall process of treatment and corresponding outcomes. Here, we critically examine reductionist approaches to polysomnography in children to establish the parallel approximation of such techniques to infant with craniofacial disorders. The need for prospective longitudinal multicenter studies with side-by-side comparisons aimed at identifying an optimal diagnostic and long-term monitoring paradigm for these potentially life-threatening conditions is emphasized.
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Affiliation(s)
- David Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA.
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12
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Affiliation(s)
- Christian F Poets
- Department of Neonatology and Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, University of Tuebingen, Tuebingen, Germany
| | - Cornelia Wiechers
- Department of Neonatology and Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, University of Tuebingen, Tuebingen, Germany
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13
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Wiechers C, Iffländer R, Gerdes R, Ciuffolotti M, Arand J, Weise C, Peters K, Grandke B, Reinert S, Koos B, Poets CF. Retrospective study on growth in infants with isolated Robin sequence treated with the Tuebingen Palate Plate. Orphanet J Rare Dis 2021; 16:338. [PMID: 34344420 PMCID: PMC8335857 DOI: 10.1186/s13023-021-01959-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Robin sequence (RS) are at risk of growth failure, mainly due to their increased work of breathing and feeding difficulties. Various conservative and surgical treatment approaches exist, but their impact on weight gain has not yet been adequately addressed. A functional treatment concept, used in our center for > 20 years, includes a pre-epiglottic baton plate (Tuebingen palatal plate) and intensive feeding training. OBJECTIVE To investigate the effect of the Tuebingen treatment protocol on growth and weight trajectories during infancy. METHODS This retrospective study analyzed longitudinal data from infants with isolated RS admitted to Tuebingen University Children's Hospital, Germany between 1998 and 2019. Through our electronic patient database, we evaluated anthropometric parameters until reaching 1-year follow-up. Results are shown as median (IQR). RESULTS In 307 infants analyzed, median Z-score for weight decreased from - 0.28 at birth to - 1.12 upon admission to our center at a median age of 22 days. Z-score then remained largely unchanged until discharge (Z-score difference, - 0.08), while the proportion of infants receiving tube feedings decreased from 55.1 to 13.7%. Z-score subsequently increased from - 1.17 at discharge to - 0.44 at the 1-year follow-up (p < 0.001). CONCLUSION Based on a comparatively large cohort, this functional treatment was associated with better weight gain and improved feeding. As RS infants often show postnatal growth failure, weight monitoring may be a valuable parameter for monitoring treatment effectiveness. Clinical Trial Registration Not necessary due to the retrospective design.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Regina Iffländer
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Rieke Gerdes
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Melissa Ciuffolotti
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany
| | - Jörg Arand
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Christina Weise
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Katharina Peters
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bärbel Grandke
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Siegmar Reinert
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Craniofacial Surgery, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Bernd Koos
- Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstraße 7, 72076, Tuebingen, Germany. .,Interdisciplinary Center for Craniofacial Malformations, Speech Therapy Centre, Tuebingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Center for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Osianderstraße 2, 72076, Tuebingen, Germany.
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14
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Palaska PK, Antonarakis GS, Suri S. A Retrospective Longitudinal Treatment Review of Multidisciplinary Interventions in Nonsyndromic Robin Sequence With Cleft Palate. Cleft Palate Craniofac J 2021; 59:882-890. [PMID: 34212762 PMCID: PMC9260470 DOI: 10.1177/10556656211026477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To document and analyze the overall longitudinal institutional treatment
experience of children with nonsyndromic Robin sequence (RS) from infancy to
early adulthood. Design: Retrospective longitudinal treatment review. Setting: A tertiary-care, referral, teaching hospital. Patients: Children with nonsyndromic RS and cleft palate (N = 117) born between
December, 1985, and January, 2012. Interventions: Data regarding airway management, nutritional management, audiological
interventions, orthodontic treatment, and surgical interventions were
documented and analyzed in different growth/developmental stages.
Comparative data from other international centers were collected from the
literature. Results: Airway management during infancy involved prone positioning (92%),
nasopharyngeal airway (6%), tracheostomy (2%), and mandibular distraction
osteogenesis (1%). Feeding with nasogastric, gastrostomy, and/or
gastrojejunostomy tubes was used in 44%, Haberman feeders in 53%, and Mead
Johnson feeders in 3%. Gastroesophageal reflux disease was documented in 6%
of the sample. During childhood and early adolescent years, pharyngeal flap
surgery was carried out in 22% of the children, while 11% had secondary
palatal surgery. Audiological management included the use of tympanostomy
tubes in 62%, with several children needing multiple tube replacements. At
least 18% were diagnosed with obstructive sleep apnea. Adenoidectomy or
adenotonsillectomy was undertaken in 4%. Analysis of data pertaining to
middle childhood and adolescent years showed that orthodontic treatment was
conducted for most children for crowding, tooth agenesis, and skeletal
and/or dental dysplasia. Orthognathic surgery frequency (<18%) was
low. Conclusions: Institutional treatment experience of children with nonsyndromic RS involves
multidisciplinary care at different ages and stages of their
development.
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Affiliation(s)
- Pinelopi K Palaska
- Private Practice, Dubai, UAE.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory S Antonarakis
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Orthodontics, University of Geneva, Switzerland
| | - Sunjay Suri
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Dentistry, University of Toronto, Ontario, Canada
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