A New Strategy to Avoid Tracheostomy in Neonates with Pierre Robin Sequence

Abstract

Plastic Surgery| November 01 2002 A New Strategy to Avoid Tracheostomy in Neonates with Pierre Robin Sequence AAP Grand Rounds (2002) 8 (5): 57. https://doi.org/10.1542/gr.8-5-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation A New Strategy to Avoid Tracheostomy in Neonates with Pierre Robin Sequence. AAP Grand Rounds November 2002; 8 (5): 57. https://doi.org/10.1542/gr.8-5-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: pierre robin syndrome, tracheostomy Source: Denny A, Kalantarian B. Mandibular distraction in neonates: a strategy to avoid tracheostomy. Plast Reconstr Surg. 2002;109:896–904. The authors from the Medical College of Wisconsin report on their experience with mandibular distraction in 5 neonates with Pierre Robin sequence (mean age 14.5 days). Mandibular distraction employs surgically placed pins, wires and orthopedic devices to allow advancement of the mandible by 1–2 mm per day. All patients had retrognathia, glossoptosis, incomplete cleft palate, inability to control the airway during feeding, and resting oxygen saturations in the 70–80% range. Subjects underwent a multispecialty evaluation. Multimodal objective measurements of airway obstruction included weight gain, oral intake, computerized tomography, direct laryngoscopy, and flexible fiber optic bronchoscopy. A pediatric intensivist, pediatric anesthesiologist, pediatric otolaryngologist, and the authors reached a consensus that each patient would require a tracheostomy if mandibular distraction was not performed promptly. After a linear, external mandibular distraction device was applied at surgery, distraction rates of 2 mm per day were employed for the first 3 days and then decreased to 1 mm per day. All patients were extubated by distraction day 5, and bottle-feeding was initiated within 24 hours of the procedure. All patients experienced complete elimination of airway symptoms, gained a minimum of 500 g per month following the procedure, and avoided tracheostomy. Routine palatoplasty was performed without incident at a later date in all patients. Mandibular hypoplasia with resultant airway obstruction can be a life-threatening problem, often requiring prolonged or permanent tracheostomy.1 Tracheostomy has an associated mortality rate of from 1 to 5% and may result in speech and developmental problems.2 Pierre Robin sequence has been reported to occur as frequently as 1 in 2,000 births with varying degrees of airway and feeding impairment.3 Mandibular distraction has been shown to be effective in lengthening the mandible allowing for decannulation in older children. There have been many reports on techniques and devices designed to improve the airway and avoid tracheostomy, which have had variable success. These include suturing the tongue to the lip, prolonged use of a nasopharyngeal airway, bonnets attached to the mandible to thrust it forward, and infant positioning devices. The authors are among the first to report the application of distraction in the neonatal period to avoid tracheostomy. The multidisciplinary evaluation with multimodal measurements advocated by the authors should be considered essential to successful diagnosis and treatment of neonates with Pierre Robin sequence. You do not currently have access to this content.