Tongue-lip adhesion in the management of Pierre Robin sequence with airway obstruction: technique and outcome.
BACKGROUND
Airway obstruction and feeding difficulty can occur in patients born with Pierre Robin sequence. In select patients with pronounced micrognathia, surgical intervention to relieve the airway obstruction is necessary. The surgical indications and appropriate surgical procedure continue to have a great deal of controversy. The purpose of this study was to evaluate our experience of tongue-lip adhesion in the management of upper airway obstruction associated with Pierre Robin sequence.


METHODS
From March 1995 through May 2002, a total of 14 patients with Pierre Robin sequence, who were admitted to the pediatric neonatal intensive care unit either with prolong intubation, poor body weight gain, or repeated airway infection, underwent tongue-lip adhesion (TLA). The operation was performed by raising mucosa flaps and approximated the muscles between tongue and lower lip. Retention sutures were used. The patients were evaluated for clinical responses.


RESULTS
Our successful rate with tongue-lip adhesion was 70%. Ten of the 14 patients showed clinical improvements including extubation of the endotraccheal tube, body weight gain, return for home care, reduced episodes of respiratory infection, and improvement in O2 saturation and blood gas. The surgical procedure was simple to perform without major complications.


CONCLUSIONS
This retrospective review showed that with a thorough preoperative airway evaluation, TLA could be successfully used to treat select patients with Pierre Robin sequence suffering from severe upper airway obstruction. Thus, TLA should be first considered when surgical relief of airway obstruction is indicated and when obstruction is limited to the classic tongue base obstruction type.
Huang
Faye
F
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan 833, ROC. spencer-faye@cgmh.org.tw
Lo
Lun-Jou
LJ
Chen
Yu-Ray
YR
Yang
Johnson C
JC
Niu
Chen-Kuang
CK
Chung
Mei-Yung
MY
D000402:Airway Obstruction / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008046:Lip / Q000601:surgery*; D010855:Pierre Robin Syndrome / Q000601:surgery*; D012189:Retrospective Studies; D014059:Tongue / Q000601:surgery*