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Davies A, Davies A, Wren Y, Deacon S, Cobb A, McLean N, David D, Chummun S. Syndromes associated with Robin sequence: a national prospective cohort study. Arch Dis Child 2023; 108:42-46. [PMID: 36376018 DOI: 10.1136/archdischild-2022-324722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prevalence of syndromic Robin sequence (RS) in the UK and if this group of patients had an increased need for airway and feeding management compared with a non-syndromic RS cohort. DESIGN A prospective national multicentre study of cases submitted to the Cleft Collective cohort studies. SETTING Specialist cleft services in the UK. PATIENTS 259 participants who fulfilled the diagnosis of RS. This group was compared with 548 participants with cleft palate only (CPO). MAIN OUTCOME MEASURES The primary outcome measure was the presence of a syndrome in patients with RS and CPO. Secondary outcome measures included the use of airway and feeding adjuncts. RESULTS An associated syndrome was seen in 28% of patients with RS and 14% of patients with CPO. The most common syndrome for the RS group was Stickler syndrome (27%). Syndromic status was significantly higher among patients with RS compared with those with CPO (OR 2.36, 95% CI 1.65 to 3.39; p<0.001). Patients with syndromic RS have an increased reliance on airway adjuncts compared with the patients without syndromic RS (OR 2.02, 95% CI 1.13 to 3.64; p=0.018). There was no evidence of a difference in the use of feeding adjuncts between syndromic and non-syndromic RS groups (OR 2.43, 95% CI 0.78 to 7.58; p=0.126). CONCLUSION The presence of a syndrome has implications for management of patients with RS. Early identification of a syndrome may help prevent the consequences of a missed syndromic diagnosis. Routine ophthalmological and genetic screening for Stickler syndrome should be mandatory for all patients with RS.
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Affiliation(s)
- Alex Davies
- South West Cleft Service, University of Bristol Dental Hospital, Bristol, UK .,The Cleft Collective, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Amy Davies
- The Cleft Collective, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Yvonne Wren
- The Cleft Collective, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Scott Deacon
- South West Cleft Service, University of Bristol Dental Hospital, Bristol, UK
| | - Alistair Cobb
- South West Cleft Service, University of Bristol Dental Hospital, Bristol, UK
| | - Neil McLean
- Craniofacial Australia, North Adelaide, South Australia, Australia
| | - David David
- Craniofacial Australia, North Adelaide, South Australia, Australia
| | - Shaheel Chummun
- South West Cleft Service, University of Bristol Dental Hospital, Bristol, UK
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2
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Cleary B, Loane M, Addor MC, Barisic I, de Walle HEK, Matias Dias C, Gatt M, Klungsoyr K, McDonnell B, Neville A, Pierini A, Rissmann A, Tucker DF, Zurriaga O, Dolk H. Methadone, Pierre Robin sequence and other congenital anomalies: case-control study. Arch Dis Child Fetal Neonatal Ed 2020; 105:151-157. [PMID: 31229957 DOI: 10.1136/archdischild-2019-316804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Methadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS. DESIGN/SETTING This case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995-2011. PATIENTS Cases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks' gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview. RESULTS Among 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1-12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2). CONCLUSIONS These findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk-benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.
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Affiliation(s)
- Brian Cleary
- Pharmacy Department, Rotunda Hospital, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, INHR, Ulster University, Newtowanbbey, UK
| | - Marie-Claude Addor
- Division Autonome de Genetique Medicale, Registre Vaudois des Malformations, Vaud, Switzerland
| | - Ingeborg Barisic
- Children's Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Hermien E K de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Miriam Gatt
- Department of Health Information, Malta Congenital Anomalies Registry, G'mangia, Malta
| | - Kari Klungsoyr
- Medical Birth Register of Norway, Nasjonalt folkehelseinstitutt, Oslo, Norway
| | | | - Amanda Neville
- Azienda Ospedaliero - Universitaria di Ferrara, Registro IMER, Ferrara, Italy
| | | | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - David F Tucker
- Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, UK
| | - Oscar Zurriaga
- Centro Superior de Investigación en Salud Pública, Valencia, Spain.,Direccion General de Investigación y Salud Pública, Valencia, Spain
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3
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Wright M, Mehendale F, Urquhart DS. Epidemiology of Robin sequence with cleft palate in the East of Scotland between 2004 and 2013. Pediatr Pulmonol 2018; 53:1040-1045. [PMID: 29736909 DOI: 10.1002/ppul.24038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/13/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Robin sequence (RS) is a congenital disorder characterized by cleft palate, micrognathia, and glossoptosis which can result in clinically significant upper airway obstruction (UAO). Historically, incidence of RS in the UK has been estimated as 1 in 8500 live births. Our study describes birth prevalence, clinical characteristics, and management of RS in the East of Scotland (EoS) region. METHODS Retrospective case note review of infants born in EoS from 2004 to 2013 with a clinical diagnosis of RS. Cases were identified by searching the regional cleft service patient database and review of Hospital Activity Statistics data. Regional live birth rate provided the denominator for incidence calculations. RESULTS A total of 105 cases of RS were identified, giving a birth prevalence of 1:2685 live births. No trends in annual incidence were observed over the 10-year period. Intrauterine exposure to potentially teratogenic agents was identified in 17% cases, including Methadone in 8% cases. Signs of UAO were present in 93% of infants, 63% of whom required active airway management. Nasopharyngeal airway (NPA) was the most commonly used intervention (53% cases), whilst only 7% required surgical management. Infants with an underlying syndrome or additional anomalies (RS+) were significantly more likely to be admitted to a tertiary center and require surgical airway or feeding support compared to those with isolated RS. CONCLUSIONS RS incidence in EoS is substantially higher than that reported within other populations, and than previously reported in the UK. A possible association with intrauterine Methadone exposure warrants further investigation.
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Affiliation(s)
- Marie Wright
- Department of Pediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom.,Department of Pediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Felicity Mehendale
- Department of Cleft Surgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom.,Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Don S Urquhart
- Department of Pediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom.,Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
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5
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Logjes RJH, Breugem CC, Van Haaften G, Paes EC, Sperber GH, van den Boogaard MJH, Farlie PG. The ontogeny of Robin sequence. Am J Med Genet A 2018; 176:1349-1368. [PMID: 29696787 DOI: 10.1002/ajmg.a.38718] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 12/17/2017] [Accepted: 03/23/2018] [Indexed: 02/06/2023]
Abstract
The triad of micrognathia, glossoptosis, and concomitant airway obstruction defined as "Robin sequence" (RS) is caused by oropharyngeal developmental events constrained by a reduced stomadeal space. This sequence of abnormal embryonic development also results in an anatomical configuration that might predispose the fetus to a cleft palate. RS is heterogeneous and many different etiologies have been described including syndromic, RS-plus, and isolated forms. For an optimal diagnosis, subsequent treatment and prognosis, a thorough understanding of the embryology and pathogenesis is necessary. This manuscript provides an update about our current understanding of the development of the mandible, tongue, and palate and possible mechanisms involved in the development of RS. Additionally, we provide the reader with an up-to-date summary of the different etiologies of this phenotype and link this to the embryologic, developmental, and genetic mechanisms.
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Affiliation(s)
- Robrecht J H Logjes
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - Gijs Van Haaften
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emma C Paes
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - Geoffrey H Sperber
- Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
| | | | - Peter G Farlie
- Royal Children's Hospital, Murdoch Children's Research Institute, Parkville, Australia
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6
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Smarius B, Loozen C, Manten W, Bekker M, Pistorius L, Breugem C. Accurate diagnosis of prenatal cleft lip/palate by understanding the embryology. World J Methodol 2017; 7:93-100. [PMID: 29026689 PMCID: PMC5618146 DOI: 10.5662/wjm.v7.i3.93] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/09/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
Cleft lip with or without cleft palate (CP) is one of the most common congenital malformations. Ultrasonographers involved in the routine 20-wk ultrasound screening could encounter these malformations. The face and palate develop in a very characteristic way. For ultrasonographers involved in screening these patients it is crucial to have a thorough understanding of the embryology of the face. This could help them to make a more accurate diagnosis and save time during the ultrasound. Subsequently, the current postnatal classification will be discussed to facilitate the communication with the CP teams.
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Affiliation(s)
- Bram Smarius
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Charlotte Loozen
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Wendy Manten
- Division of Gynecology and Obstetrics, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Mireille Bekker
- Division of Gynecology and Obstetrics, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
| | - Lou Pistorius
- Division of Gynecology and Obstetrics, Stellenbosch University and Tygerberg Hospital, Cape Town 7500, South Africa
| | - Corstiaan Breugem
- Division of Pediatric Plastic Surgery, Cleft Palate Team, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
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7
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Manica D, Schweiger C, Sekine L, Fagondes SC, Kuhl G, Vinicius Collares M, Marostica PJC. Diagnostic accuracy of current glossoptosis classification systems: A nested cohort cross-sectional study. Laryngoscope 2017; 128:502-508. [DOI: 10.1002/lary.26882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/11/2017] [Accepted: 08/03/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Denise Manica
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Cláudia Schweiger
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Leo Sekine
- Programa de Pós-Graduação em Epidemiologia; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Simone Chaves Fagondes
- Department of Pulmonology; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Gabriel Kuhl
- Department of Otolaryngology-Head and Neck Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Marcus Vinicius Collares
- Department of Surgery; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Paulo José Cauduro Marostica
- Department of Pediatric Pulmonology; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
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8
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Prenatal ultrasound detection of micrognathia and its association with Robin sequence. J Plast Reconstr Aesthet Surg 2017; 70:1308-1311. [DOI: 10.1016/j.bjps.2017.06.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 11/19/2022]
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9
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Permanent tooth agenesis in non-syndromic Robin sequence and cleft palate: prevalence and patterns. Clin Oral Investig 2016; 21:2273-2281. [PMID: 27933446 PMCID: PMC5559566 DOI: 10.1007/s00784-016-2020-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 11/25/2016] [Indexed: 11/25/2022]
Abstract
Objectives Partial tooth agenesis is frequently observed in Robin sequence. Tooth anomalies are increasingly considered as an extended phenotype of the cleft palate population. The study objective was to compare the prevalence and patterns of tooth agenesis in a group of patients with non-syndromic Robin sequence (ns-RS) and a group with non-syndromic cleft palate (ns-CP). Materials and methods The panoramic radiographs of 115 ns-RS and 191 ns-CP patients were assessed for agenesis of the permanent dentition (excluding third molars) and the patterns recorded using the Tooth Agenesis Code. Results Partial tooth agenesis was observed in 47.8% of ns-RS and 29.8% of ns-CP patients with a greater prevalence in the mandibula than in the maxilla, particularly in ns-RS. The teeth most frequently absent in both groups were the mandibular second premolars and maxillary lateral incisors. Tooth agenesis was bilateral in two-thirds of affected ns-RS patients and one-half of ns-CP patients. In ns-RS, bilateral agenesis of the mandibular second premolars was more frequently observed in female than that in male patients. Completely symmetrical patterns of hypodontia were found in around 45% of ns-RS patients with tooth agenesis compared to 35% in ns-CP. No association was found between the extent of the palatal cleft and the severity of hypodontia. Conclusion Tooth agenesis is more prevalent in ns-RS than that in ns-CP, demonstrates a much greater predilection for the mandible in ns-RS, and bears no relation to the extent of the palatal cleft. Clinical relevance When compared to ns-CP, additional developmental disturbances are likely involved in the etiology of tooth agenesis in ns-RS. Future research could help identify the underlying genetic traits and aid in classifying patients in those with and without expected tooth agenesis in order to facilitate orthodontic management strategies.
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10
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Paes EC, de Vries IAC, Penris WM, Hanny KH, Lavrijsen SW, van Leerdam EK, Rademaker MM, Veldhoen ES, Eijkemans RMJC, Kon M, Breugem CC. Growth and prevalence of feeding difficulties in children with Robin sequence: a retrospective cohort study. Clin Oral Investig 2016; 21:2063-2076. [PMID: 27868158 PMCID: PMC5487830 DOI: 10.1007/s00784-016-1996-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/01/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES In addition to breathing problems, patients with Robin sequence (RS) often encounter feeding difficulties (FD). Data regarding the occurrence of FD and possible influencing factors are scarce. The study aim was to elucidate these factors to improve treatment strategies. MATERIAL AND METHODS A retrospective comparative cohort study was conducted, consisting of 69 infants diagnosed with both RS and a cleft palate and 64 isolated cleft palate only (iCPO) infants. Data regarding FD, growth, and airway intervention were collected during the first 2 years of life. A systematic review of the literature was conducted to identify reported FD in RS patients. RESULTS RS patients had more FD (91 %) than iCPO patients (72 %; p = 0.004). Also, nasogastric (NG)-tube feeding was necessary more frequently and for a longer period (both p < 0.001). Growth was lower in RS than iCPO infants (p = 0.008) and was not affected by the kind of airway management (conservative/surgical; p = 0.178), cleft palate grade (p = 0.308), or associated disorders (p = 0.785). By contrast, surgical intervention subtype did significantly affect growth. Mean reported FD for RS in the literature is 80 % (range = 47-100 %), and 55 % (range = 11-100 %) of infants need NG-tube feeding. CONCLUSIONS FD is present in a large proportion of infants with RS, which indicates the need for early recognition and proper treatment to ensure optimal growth. Growth during the first 2 years of life is significantly lower in RS patients than iCPO patients, which indicates the need for careful attention and long-term follow-up. CLINICAL RELEVANCE This study indicates the need for early recognition and proper treatment of FD in RS to ensure optimal growth. In addition, growth needs careful attention and long-term follow-up.
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Affiliation(s)
- Emma C Paes
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Iris A C de Vries
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Wouter M Penris
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Karlijn H Hanny
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Selma W Lavrijsen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Elselien K van Leerdam
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Maaike M Rademaker
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Rene M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Centre, PO Box 85500, 3508, GA, Utrecht, The Netherlands
- Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
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Abstract
Glossoptosis causes varying degrees of airway obstruction and feeding difficulties. It can occur as a consequence of micrognathia in Robin Sequence, but can also occur in children with hypotonia. Despite several attempts to classify severity in Robin Sequence patients, taking into account symptoms, presence of concomitant syndromes or malformations, and even endoscopic findings, there is still no general consensus. Furthermore, several management recommendations have been reported without an agreement about indications, efficacy, or risks of each treatment option. The present article provides an overview of clinical presentation, diagnosis, management, and prognosis of patients with glossoptosis.
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Affiliation(s)
- Cláudia Schweiger
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-903, Porto Alegre, Brazil.
| | - Denise Manica
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-903, Porto Alegre, Brazil
| | - Gabriel Kuhl
- Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Basart H, König A, Bretschneider J, Hoekstra C, Oomen K, Pullens B, Rinkel R, van Gogh C, van der Horst C, Hennekam R. Awake Flexible Fiberoptic Laryngoscopy to diagnose glossoptosis in Robin Sequence patients. Clin Otolaryngol 2016; 41:467-71. [DOI: 10.1111/coa.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. Basart
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - A.M. König
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | | | - C.E.L. Hoekstra
- Department of Otolaryngology; Academic Medical Center; Amsterdam Netherlands
| | - K.P.Q. Oomen
- Department of Otolaryngology; Utrecht Medical Center/Wilhelmina Children's Hospital; Utrecht Netherlands
| | - B. Pullens
- Department of Otolaryngology; Erasmus Medical Center/Sophia Pediatric Hospital; Rotterdam Netherlands
| | - R.N.P.M. Rinkel
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.D.L. van Gogh
- Department of Otolaryngology; VU Medical Center; Amsterdam Netherlands
| | - C.M.A.M. van der Horst
- Department of Plastic, Reconstructive and Hand Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - R.C. Hennekam
- Department of Pediatrics; Academic Medical Center/Emma Pediatric Hospital; Amsterdam Netherlands
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13
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van Lieshout MJ, Joosten KF, Mathijssen IM, Koudstaal MJ, Hoeve HL, van der Schroeff MP, Wolvius EB. Robin sequence: A European survey on current practice patterns. J Craniomaxillofac Surg 2015; 43:1626-31. [DOI: 10.1016/j.jcms.2015.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/19/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022] Open
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14
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Basart H, Paes EC, Maas SM, van den Boogaard MJH, van Hagen JM, Breugem CC, Cobben JM, Don Griot JPW, Lachmeijer AMA, Lichtenbelt KD, van Nunen DPF, van der Horst CM, Hennekam RC. Etiology and pathogenesis of robin sequence in a large Dutch cohort. Am J Med Genet A 2015; 167A:1983-92. [DOI: 10.1002/ajmg.a.37154] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/05/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Hanneke Basart
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
- Department of Plastic and Reconstructive Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Emma C. Paes
- Department of Plastic; Reconstructive and Hand Surgery; University Medical Center Utrecht/ Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Saskia M. Maas
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | | | | | - Corstiaan C. Breugem
- Department of Plastic; Reconstructive and Hand Surgery; University Medical Center Utrecht/ Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Jan Maarten Cobben
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - J. Peter W. Don Griot
- Department of Plastic; Reconstructive and Hand Surgery; VU Medical Center; Amsterdam Netherlands
| | | | - Klaske D. Lichtenbelt
- Department of Clinical Genetics; Utrecht Medical Center/Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Daan P. F. van Nunen
- Department of Plastic; Reconstructive and Hand Surgery; University Medical Center Utrecht/ Wilhelmina Children's Hospital; Utrecht Netherlands
| | - Chantal M. van der Horst
- Department of Plastic and Reconstructive Surgery; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Raoul C. Hennekam
- Department of Pediatrics; Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
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Paes EC, van Nunen DPF, Basart H, Don Griot JPW, van Hagen JM, van der Horst CMAM, van den Boogaard MJH, Breugem CC. Birth prevalence of Robin sequence in the Netherlands from 2000-2010: a retrospective population-based study in a large Dutch cohort and review of the literature. Am J Med Genet A 2015; 167A:1972-82. [DOI: 10.1002/ajmg.a.37150] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Emma C. Paes
- Department of Plastic; Reconstructive and Hand Surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Daan P. F. van Nunen
- Department of Plastic; Reconstructive and Hand Surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
| | - Hanneke Basart
- Department of Plastic; Reconstructive and Hand Surgery; Academic Medical Hospital; Amsterdam The Netherlands
| | - J. Peter W. Don Griot
- Department of Plastic; Reconstructive and Hand Surgery; VU Medical Center; Amsterdam The Netherlands
| | | | | | | | - Corstiaan C. Breugem
- Department of Plastic; Reconstructive and Hand Surgery; Wilhelmina Children's Hospital; Utrecht The Netherlands
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Kaufman MG, Cassady CI, Hyman CH, Lee W, Watcha MF, Hippard HK, Olutoye OA, Khechoyan DY, Monson LA, Buchanan EP. Prenatal Identification of Pierre Robin Sequence: A Review of the Literature and Look towards the Future. Fetal Diagn Ther 2015; 39:81-9. [PMID: 25967128 DOI: 10.1159/000380948] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/13/2015] [Indexed: 11/19/2022]
Abstract
Fetal ultrasonography is an important tool used to prenatally diagnose many craniofacial conditions. Pierre Robin sequence (PRS) is a rare congenital deformation characterized by micrognathia, glossoptosis, and airway obstruction. PRS can present as a perinatal emergency when the retropositioned tongue obstructs the airway leading to respiratory compromise. More predictable and reliable diagnostic studies could help the treating medical team as well as families prepare for these early airway emergencies. The medical literature was reviewed for different techniques used to prenatally diagnose PRS radiologically. We have reviewed these techniques and suggested a possible diagnostic pathway to consistently identify patients with PRS prenatally.
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Affiliation(s)
- Matthew G Kaufman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex., USA
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17
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Wan T, Chen Y, Wang G. Do patients with isolated Pierre Robin Sequence have worse outcomes after cleft palate repair: A systematic review. J Plast Reconstr Aesthet Surg 2015; 68:1095-9. [PMID: 26187812 DOI: 10.1016/j.bjps.2015.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/13/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
Abstract
Cleft palate repair for Pierre Robin Sequence (PRS) patients has always been a challenge for surgeons and anesthetists. The aim of this systematic review is to investigate the outcome of cleft palate repair for PRS patients compared with cleft palate-only patients. All papers published before October 2014 were searched in the databases PubMed and MEDLINE. Search terms included "Pierre Robin Sequence," "cleft palate repair," and "speech result." Additional studies were identified by hand searching the reference lists of the papers retrieved from electronic search. Two independent reviewers assessed the eligibility of studies for inclusion, extracted the data, and assessed the quality of the studies. Six studies met the inclusion criteria. All but one study had multiple deficiencies in study designs. Four studies assessed the fistula rate of both groups, and all studies assessed some aspect of the speech results. Conflicting results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the outcome of cleft palate repair for PRS patients was better or worse than cleft palate-only patients. Further well-designed, well-controlled, and long-term studies are needed.
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Affiliation(s)
- Teng Wan
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, PR China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Yang Chen
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, PR China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China
| | - Guomin Wang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, PR China; Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China.
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18
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Paes EC, van Nunen DPF, Speleman L, Muradin MSM, Smarius B, Kon M, Mink van der Molen AB, Niers TLEM, Veldhoen ES, Breugem CC. A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm. Clin Oral Investig 2015; 19:2101-14. [PMID: 25680705 PMCID: PMC4592702 DOI: 10.1007/s00784-015-1407-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/14/2015] [Indexed: 11/26/2022]
Abstract
Objectives Initial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution’s approach and a review of the current literature. Material and methods A retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996–2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS. Results Forty-four infants (59 %) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25 %, p = .014). A mandibular distraction was conducted in 24 % (n = 18) of cases, a tracheotomy in 9 % (n = 7), and a tongue–lip adhesion in 8 % (n = 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described. Conclusions RS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended. Clinical Relevance We provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics.
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Affiliation(s)
- Emma C Paes
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Daan P F van Nunen
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Lucienne Speleman
- Department of Otorhinolaryngology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Marvick S M Muradin
- Department of Oral and Cranio-Maxillofacial Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Bram Smarius
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Moshe Kon
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Titia L E M Niers
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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19
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Will the right Robin patient rise, please? Definitions and criteria during management of Robin sequence patients in the Netherlands and Belgium. J Craniomaxillofac Surg 2015; 43:92-6. [DOI: 10.1016/j.jcms.2014.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 11/17/2022] Open
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20
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21
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van Nunen DPF, Filip C, Feragen KJB, van den Boogaard MJH, Breugem CC. Reaction to: Persson et al. Educational achievements in Pierre Robin sequence. J Plast Surg Hand Surg 2013;47(1):36-9. J Plast Surg Hand Surg 2014; 48:287-8. [PMID: 24909823 DOI: 10.3109/2000656x.2014.924956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Daan P F van Nunen
- Division of Plastic and Reconstructive Surgery, University of Utrecht Medical Center , Utrecht , The Netherlands
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22
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Antonarakis GS, Suri S. Prevalence and patterns of permanent tooth agenesis in patients with nonsyndromic Pierre Robin sequence. Am J Orthod Dentofacial Orthop 2014; 145:452-60. [DOI: 10.1016/j.ajodo.2013.11.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/26/2022]
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23
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Breugem CC, de Graaff J. Anesthetic implications of infants with mandibular hypoplasia treated with mandibular distraction osteogenesis. Paediatr Anaesth 2014; 24:227-8. [PMID: 24387153 DOI: 10.1111/pan.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Corstiaan C Breugem
- Division of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
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24
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Vatlach S, Maas C, Poets CF. Birth prevalence and initial treatment of Robin sequence in Germany: a prospective epidemiologic study. Orphanet J Rare Dis 2014; 9:9. [PMID: 24433508 PMCID: PMC3899445 DOI: 10.1186/1750-1172-9-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 01/12/2014] [Indexed: 12/03/2022] Open
Abstract
Background We conducted a monthly epidemiological survey to determine the birth prevalence of Robin sequence (RS) and the use of various therapeutic approaches for it. Methods Between August 2011 and July 2012, every pediatric department in Germany was asked to report new admissions of infants with RS to the Surveillance Unit for Rare Pediatric Diseases in Germany. RS was defined as retro- or micrognathia and at least one of the following: clinically evident upper airway obstruction including recessions, snoring or hypoxemia; glossoptosis; feeding difficulties; failure to thrive; cleft palate or RS-associated syndrome. Hospitals reporting a case were asked to return an anonymized questionnaire and discharge letter. Results Of 96 cases reported, we received detailed information on 91. Of these, 82 were included; seven were duplicates and two erroneous reports. Given 662,712 live births in Germany in 2011, the birth prevalence was 12.4 per 100,000 live births. Therapeutic approaches applied included prone positioning in 50 infants, followed by functional therapy in 47. Conventional feeding plates were used in 34 infants and the preepiglottic baton plate (PEBP) in 19. Surgical therapy such as mandibular traction was applied in 2 infants, tracheotomy in 3. Conclusion Compared to other cohort studies on RS, surgical procedures were relatively rarely used as an initial therapy for RS in Germany. This may be due to differences in phenotype or an underrecognition of upper airway obstruction in these infants.
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Affiliation(s)
| | | | - Christian F Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstr 7, Tuebingen 72076, Germany.
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25
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Dong CB, Zheng S, Shen C, Li H. Mandible traction with wires for the treatment of upper airway obstruction caused by Pierre Robin sequence in Chinese infants: preliminary findings. J Craniomaxillofac Surg 2014; 42:1122-7. [PMID: 24530075 DOI: 10.1016/j.jcms.2014.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/25/2013] [Accepted: 01/08/2014] [Indexed: 12/31/2022] Open
Abstract
Pierre Robin sequence (PRS) is a congenital abnormality that may cause upper airway obstruction requiring surgical intervention. This preliminary study aimed to examine the feasibility and effectiveness of mandible traction with wires for the treatment of upper airway obstruction caused by PRS in Chinese infants. Measures of interest included transcutaneous oxygen saturation before and after surgery, duration of surgery and traction, complications, and CT findings. Seven infants were included in the study (mean birth weight: 2485 g, range: 2405-2570 g); four were born preterm and three were born full term. Mean age at surgery was 13.7 days (range: 2-28 days), mean duration of surgery was 16.6 min (range: 13-25 min) and mean duration of traction was 26.6 days (range: 21-35 days). Mean follow-up was 6.2 months (range: 1-11 months). No infant experienced severe complications. All infants experienced increases in transcutaneous oxygen saturation after surgery. Mean transcutaneous oxygen saturation was 82% before surgery and 98% after surgery. Follow-up morphology of the mandible was excellent. There was no upper airway obstruction, and short-term growth and development were satisfactory. These preliminary findings suggest that mandibular traction with wires may be an effective treatment for upper airway obstruction caused by PRS in Chinese infants.
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Affiliation(s)
- Chen-Bin Dong
- Department of Plastic Surgery, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Shan Zheng
- Department of Plastic Surgery, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Chun Shen
- Department of Plastic Surgery, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Hao Li
- Department of Plastic Surgery, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai 201102, China.
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26
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van Lieshout MJS, Joosten KFM, Hoeve HLJ, Mathijssen IMJ, Koudstaal MJ, Wolvius EB. Unravelling Robin sequence. Laryngoscope 2013; 124:E203-9. [DOI: 10.1002/lary.24437] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Manouk J. S. van Lieshout
- Department of Oral and Maxillofacial Surgery; Dutch Craniofacial Center, Erasmus Medical Center; Rotterdam the Netherlands
| | - Koen F. M. Joosten
- Department of Pediatrics; Dutch Craniofacial Center, Erasmus Medical Center; Rotterdam the Netherlands
| | - Hans L. J. Hoeve
- Department of Otorhinolaryngology-Head and Neck Surgery; Dutch Craniofacial Center, Erasmus Medical Center; Rotterdam the Netherlands
| | - Irene M. J. Mathijssen
- Department of Plastic, Reconstructive and Hand Surgery; Dutch Craniofacial Center, Erasmus Medical Center; Rotterdam the Netherlands
| | - Maarten J. Koudstaal
- Department of Oral and Maxillofacial Surgery; Dutch Craniofacial Center, Erasmus Medical Center; Rotterdam the Netherlands
| | - Eppo B. Wolvius
- Department of Oral and Maxillofacial Surgery; Dutch Craniofacial Center, Erasmus Medical Center; Rotterdam the Netherlands
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de Vries IAC, Breugem CC, van der Heul AMB, Eijkemans MJC, Kon M, Mink van der Molen AB. Prevalence of feeding disorders in children with cleft palate only: a retrospective study. Clin Oral Investig 2013; 18:1507-15. [PMID: 24122307 DOI: 10.1007/s00784-013-1117-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 09/24/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study in children with cleft palate only (CPO) is to (1) explore the prevalence of feeding problems on a retrospective basis, (2) investigate rates of nasogastric (NG) feeding, (3) examine the prevalence of associated disorders and/or syndromes (AssD/S), (4) investigate if there are certain risk factors associated with feeding difficulties, NG feeding, and failure of breastfeeding, and (5) investigate the effect of palatoplasty on feeding difficulties. MATERIALS AND METHODS In total, 90 questionnaires were included in this study. The medical records were reviewed. RESULTS Feeding difficulties were reported in 67% (n = 60) of all cases. NG feeding was given in 32% (n = 28) of all children. Forty-nine children (54%) have associated malformations. There is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. The severity of the cleft is significantly related to the prevalence of AssD/S. After palatoplasty, feeding difficulties improved in 79% of the CPO children. CONCLUSIONS AND CLINICAL RELEVANCE First, our results clearly indicate that children with CPO are at high risk of developing feeding difficulties (67%); NG feeding is often necessary (32%). Second, our results also indicate that the more severe the cleft, the more likely the chance for AssD/S. Third, the severity of the cleft is significantly related to the prevalence of AssD/S. Fourth, there is no significant relation for gender, gestational age, and birth weight as risk factors for feeding difficulties, NG feeding, and failure of breastfeeding. Fifth, improvement of feeding difficulties after surgery supports the importance of the soft palate closure in relation to sucking patterns and feeding skills.
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Affiliation(s)
- I A C de Vries
- Department of Paediatric Plastic Surgery, Wilhelmina Children's Hospital, PO Box 85500, 3508, GA, Utrecht, The Netherlands,
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28
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A systematic review on the outcome of mandibular distraction osteogenesis in infants suffering Robin sequence. Clin Oral Investig 2013; 17:1807-20. [DOI: 10.1007/s00784-013-0998-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
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The nutrition status of mild form Pierre Robin sequence before cleft palate repair: an analysis of 34 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 118:43-6. [PMID: 23312544 DOI: 10.1016/j.oooo.2012.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 09/02/2012] [Accepted: 10/08/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the nutrition status before cleft palate repair in patients with mild form isolated Pierre Robin Sequence (PRS). METHODS Detailed history and physical examination of 34 patients with mild form isolated PRS were compared with those of the control group with isolated cleft palate (ICP) at the age of 2 and 12 months. RESULTS The height and weight of the 2 groups at 2 months were significantly different, whereas there was no significant difference at 12 months. The height and weight grades for PRS improved from 2 to 12 months. The feeding grades differed significantly at 2 months between the 2 groups, but showed no significant difference at 12 months. CONCLUSIONS Patients with mild form isolated PRS had a nutrition status similar to patients with ICP at the age of 12 months. General conditions of mild form isolated PRS pose no problem with cleft palate repair at 12 months.
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Breugem C, Paes E, Kon M, Mink van der Molen AB, van der Molen ABM. Bioresorbable distraction device for the treatment of airway problems for infants with Robin sequence. Clin Oral Investig 2011; 16:1325-31. [PMID: 22009183 PMCID: PMC3400032 DOI: 10.1007/s00784-011-0624-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/02/2011] [Indexed: 11/28/2022]
Abstract
Pierre Robin sequence is a well known craniofacial entity. There are numerous ways to treat the respiratory insufficiency, but sometimes surgical intervention is needed. Tracheotomy could be associated with morbidity, and distraction osteogenesis has been established as a stable method to obtain a safe airway. Distraction osteogenesis has traditionally been performed with an external device. In this manuscript we describe the feasibility of an internal bioresorbable device. Retrospective descriptive study was performed in a tertiary academic children’s hospital. After multidisciplinary team consultation, 12 consecutive patients with Robin sequence were treated with this internal distraction device. The mean age at surgery was 32 days, and the average amount of mandibular distraction was 18 mm. All patients were extubated after an average of 7.5 days after the surgery. The average length of stay in the hospital was 17 days after surgery. There were no major surgical complications. A tracheotomy was prevented in all our patients, and complications were limited. Long-term studies are needed to evaluate the influence that internal distraction has on the growth of the mandible and teeth. The internal distraction system seems safe for infants with micrognathia and has certain benefits when compared to the external distractor.
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Affiliation(s)
- Corstiaan Breugem
- Cleft Palate Team, Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, PO Box 85090, 3508 AB Utrecht, The Netherlands.
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