Surgical airway management in Pierre Robin sequence: is there a role for tongue-lip adhesion?
OBJECTIVE
The purpose of this study was to examine the efficacy of tongue-lip adhesion (TLA) in the management of clinically significant airway obstruction associated with Pierre Robin sequence.


METHODS
The records of all children admitted to The Children's Hospital of Philadelphia with a diagnosis of Pierre Robin sequence were reviewed. Charts were reviewed for birth data, diagnosis, preoperative airway management methods, and surgical intervention. Records of infants undergoing TLA were analyzed for timing of surgery, operative technique, postoperative complications, length of hospital stay, and treatment outcome.


RESULTS
Over the 28-year period 1971 to 1999, 107 patients (47 boys, 60 girls) meeting the criteria for Pierre Robin sequence were admitted for treatment. Of these, 74 (69.2%) were successfully managed by positioning alone. Surgical management of the airway was performed in the remaining 33 (30.8%) patients, 29 of whom underwent TLA and 4 of whom underwent tracheostomy. Dehiscence of the adhesion occurred in five patients (17.2%), two of whom subsequently required tracheostomy. Within the group of patients who underwent mucosal adhesion alone, the dehiscence rate was 41.6%. When the adhesion included muscular sutures, however, dehiscence was not observed in any patient. Of the 24 patients in whom primary TLA healed uneventfully, airway obstruction was successfully relieved in 20 (83.3%). Failure of a healed TLA to relieve the airway obstruction resulted in conversion to a tracheostomy in four patients. Six patients who underwent TLA (20.7%) ultimately required a tracheostomy; five of these patients (83.3%) were syndromic. Of patients requiring preoperative intubation, 42.9% ultimately required tracheostomy.


CONCLUSIONS
TLA successfully relieves airway obstruction that is unresponsive to positioning alone in the majority of patients with Pierre Robin sequence and should therefore play an important role in the management of these infants.
Kirschner
Richard E
RE
Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. kirschner@email.chop.edu
Low
David W
DW
Randall
Peter
P
Bartlett
Scott P
SP
McDonald-McGinn
Donna M
DM
Schultz
Patricia J
PJ
Zackai
Elaine H
EH
LaRossa
Don
D
D000367:Age Factors; D000402:Airway Obstruction / Q000601:surgery*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007441:Intubation, Gastrointestinal; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008046:Lip / Q000601:surgery*; D008297:Male; D009061:Mouth Mucosa / Q000601:surgery; D019647:Oral Surgical Procedures; D010855:Pierre Robin Syndrome / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013536:Suture Techniques; D014059:Tongue / Q000601:surgery*; D014139:Tracheostomy; D016896:Treatment Outcome