title: Severity of clinical manifestations and laryngeal exposure difficulty predicted by glossoptosis endoscopic grades in Robin sequence patients.
abstract: OBJECTIVE
  To evaluate the performance of two glossoptosis airway obstruction classifications in predicting symptom severity and laryngeal exposure difficulty in Robin Sequence (RS) patients.
  
  
  METHODS
  Public tertiary hospital otolaryngology section (Hospital de Clínicas de Porto Alegre - HCPA).
  
  
  METHODS
  All RS patients diagnosed at HCPA from October 2012 to February 2015 were enrolled, a total of 58 individuals. They were classified in isolated RS, RS-Plus and syndromic RS.
  
  
  METHODS
  Patients were submitted to sleep endoscopy and a score was attributed according to Yellon and de Sousa by a blinded researcher. Symptom severity evaluation was performed as defined by Cole classification.
  
  
  METHODS
  Association between endoscopic findings and clinical symptoms severity and laryngeal exposure difficulty.
  
  
  RESULTS
  Twenty four patients were identified as isolated RS (41.4%), 19 patients presented as RS-Plus (32.7%) and 15 patients had well defined diagnosed syndromes (25.9%). Concomitant airway anomalies were found in 18 patients (31%). Specifically 17.4% in isolated RS, 55.6% in RS- Plus and 28.6% in the syndromic group had such anomalies (P = 0,03). Probability of presenting severe clinical symptoms as graded by Cole was higher in grade 3 Yellon classification (68.4%, P = 0.012) and in moderate and severe de Sousa classification (61.5% and 62.5%, respectively, P = 0.015) than in milder grades of obstruction. This findings were considered significant even after controlling for patient age. Laryngeal exposure difficulty was correlated with de Sousa and Yellon (Rho = 0,41 and Rho = 0,43, respectively; P < 0,05).
  
  
  CONCLUSIONS
  Patients with higher degrees of obstruction in sleep endoscopy had a higher probability of presenting a more severe clinical manifestation and a more difficult laryngeal exposure. Since the number of patients included in this study was small for subgroup analyses, it is not clear if this association is restricted to a specific group of RS.
authors.affiliation: Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Electronic address: denisemanica@gmail.com.
authors.forename: Denise
authors.initials: D
authors.lastname: Manica
authors.affiliation: Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Schweiger
authors.affiliation: Programa de Pós Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Leo
authors.initials: L
authors.lastname: Sekine
authors.affiliation: Pneumology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Simone Chaves
authors.initials: SC
authors.lastname: Fagondes
authors.affiliation: Programa de Pós Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Marisa
authors.initials: M
authors.lastname: Gasparin
authors.affiliation: Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Deborah Salle
authors.initials: DS
authors.lastname: Levy
authors.affiliation: Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Kuhl
authors.affiliation: Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Marcus Vinicius
authors.initials: MV
authors.lastname: Collares
authors.affiliation: Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Pediatric Pneumology Department, Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Paulo José Cauduro
authors.initials: PJ
authors.lastname: Marostica
mesh_terms: D000402:Airway Obstruction / Q000145:classification* / Q000503:physiopathology; D004724:Endoscopy; D005260:Female; D065710:Glossoptosis / Q000145:classification* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007828:Laryngoscopy; D008297:Male; D010855:Pierre Robin Syndrome / Q000145:classification* / Q000503:physiopathology; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Endoscopy; Intubation; Laryngoscopy; Mandible; Pierre Robin syndrome