Mandibular growth in infants with Robin sequence treated with the T\xfcbingen palatal plate

Cornelia Wiechers,Anne-Friederike Oertel,Silvia Müller-Hagedorn,Wolfgang Buchenau,Christian F Poets,Jörg Arand,Bernd Koos,Katharina Peters

doi:10.1186/s13005-019-0200-1

Cornelia Wiechers, Anne-Friederike Oertel + Show 6 more

Open Access

https://doi.org/10.1186/s13005-019-0200-1

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Abstract

BackgroundRobin sequence (RS) is characterized by mandibular retrognathia, glossoptosis and upper airway obstruction. Whether mandibular catch-up growth may occur in RS is yet controversial. Our functional and less invasive treatment including the Tübingen Palatal Plate (TPP), early oral feeding and orofacial stimulation may promote mandibular catch-up growth. We evaluated the effect of the Tübingen Palatal Plate on mandibular growth, expressed by the Jaw index, sleep study results and weight gain in infants admitted with isolated and syndromic RS, born at or referred to our center between 6/2015 and 5/2018.MethodsRetrospective analysis of our electronic patient database that included data on jaw index measurements, sleep study results and standard deviation (Z-)scores for weight.ResultsOf 31 patients referred for RS treatment (22 isolated, 9 syndromic), we had data on the above parameters, determined at admission, discharge and 3 months after discharge, in 20. Jaw index at admission and 3-month follow-up was 8.8 (6.3–11.3) and 2.1 (2.0–4.0), respectively (median (IQR); p < 0.0001). Mixed-obstructive apnea index (MOAI) decreased from 9.7 (4.8–24.2) to 0.0 (0–1.3; p < 0.002). No significant correlation was observed between MOAI and Jaw Index, but MOAI correlated with the Maxillary/Mandibular arch ratio (r = 0.58; p < 0.001).Z-scores for weight were similar at both time points at − 1.34 (− 1.76 – − 0.57) and − 1.50 (− 1.89 – − 0.54), while the proportion of infants requiring nasogastric tube feeding decreased from 84 to 8%. No infant had craniofacial surgery; one with syndromic RS required tracheostomy.ConclusionThese longitudinal cohort data suggest that the Tübingen Palatal Plate as used here may alleviate upper airway obstruction by promoting mandibular growth.Trial registrationN.A.

Highlights

Robin sequence (RS) is characterized by mandibular retrognathia, glossoptosis and upper airway obstruction
We observed disappearance of the maxillomandibular discrepancy during the first postnatal months in most infants treated in our center, suggesting mandibular catch-up growth. To assess this more objectively, we introduced a determination of the Jaw Index into our standard clinical protocol upon admission to our center and 3 months after initiation of treatment
Participants Thirty-one infants with RS were admitted to our department between 6/2015 and 05/2018; in 20 (65%) complete data including the jaw index were available

Summary

Introduction

Robin sequence (RS) is characterized by mandibular retrognathia, glossoptosis and upper airway obstruction. Our functional and less invasive treatment including the Tübingen Palatal Plate (TPP), early oral feeding and orofacial stimulation may promote mandibular catch-up growth. We evaluated the effect of the Tübingen Palatal Plate on mandibular growth, expressed by the Jaw index, sleep study results and weight gain in infants admitted with isolated and syndromic RS, born at or referred to our center between 6/2015 and 5/2018. Robin sequence (RS) is characterized by retrognathia, glossoptosis and upper airway obstruction (UAO) with or without cleft palate. Most studies assessing mandibular growth used lateral cephalograms at 2 or 3 time points in preschool and school age [9,10,11,12], the largest growth potential of the mandible is probably during infancy.

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