title: Robin sequence: obstructive sleep apnea following pharyngeal flap.
abstract: OBJECTIVE
  We reviewed 24 children with Robin sequence who underwent cleft palate repair.
  
  
  METHODS
  All patients were 5 years of age or older at the time of review, allowing for accurate assessment of speech in relation to velopharyngeal function. All infants had palatal closure between 9 and 14 months of age, either V-Y repair (n = 16) or von Langenbeck repair (n = 8).
  
  
  RESULTS
  Only 1 of 16 children who had V-Y repair had borderline velopharyngeal dysfunction (VPD). For reasons that are unclear, in the von Langenbeck repair group, six of eight children had VPD, and four of six underwent pharyngeal flap. Three additional patients with nonsyndromic Robin sequence had palatoplasty and subsequent pharyngeal flap. Six of the combined total of seven children with nonsyndromic Robin sequence developed obstructive sleep apnea and require flap take-down.
  
  
  CONCLUSIONS
  Since conventional pharyngeal flap for VPD in nonsyndromic Robin sequence children resulted in a high incidence of obstructive sleep apnea, alternative management should be considered: modification of the standard pharyngeal flap, palatal lengthening (V-Y or double-opposing Z-plasty), or construction of a speech bulb.
authors.affiliation: Department of Otolaryngology and Communication Disorders, Children's Hospital, Boston, Massachusetts, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Abramson
authors.forename: E M
authors.initials: EM
authors.lastname: Marrinan
authors.forename: J B
authors.initials: JB
authors.lastname: Mulliken
mesh_terms: D002675:Child, Preschool; D002972:Cleft Palate / Q000150:complications / Q000601:surgery*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010609:Pharyngeal Muscles / Q000601:surgery; D010855:Pierre Robin Syndrome / Q000150:complications*; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000209:etiology*; D013515:Surgery, Oral / Q000379:methods*; D013524:Surgical Flaps / Q000009:adverse effects*; D014681:Velopharyngeal Insufficiency / Q000209:etiology* / Q000601:surgery