38 results on '"tongue-lip adhesion"'
Search Results
2. Systematic review and meta-analysis of surgical approaches for improving airway stability in infants with Robin sequence: evaluating complications and outcomes.
- Author
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Pendem, Sneha, Jayakumar, Naveen Kumar, Gopalakrishnan, Sreejee, and Arakeri, Gururaj
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INDEPENDENT variables ,SLEEP apnea syndromes ,OPERATIVE surgery ,RESPIRATORY obstructions ,ODDS ratio - Abstract
The purpose of this systematic review and meta-analysis was to determine the most effective and least morbid surgical technique for relieving retroglossal airway obstruction in infants with Robin sequence (RS). The study adhered to PRISMA guidelines and included 25 studies (24 cohorts and one case series) that investigated interventions for airway improvement, including conservative measures, tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and tracheostomy. The primary outcome variable was complication rate, while predictor variable was the use of interventions for airway improvement. Results showed that conservative measures were the preferred initial management strategy in most studies, while TLA was recommended for infants with mild obstruction, and MDO or tracheostomy was reserved for severe cases. Only complications could be analysed via meta-analysis due to data heterogeneity, revealing that tracheostomy had a summary odds ratio of 5.39 in favour of TLA, while MDO had a ratio of 2.8 over TLA, and the complication rates were similar between MDO and tracheostomy. If conservative measures fail, the study recommends mandibular distraction as the preferable technique for stable airway improvement. If the infant is unsuitable for distraction, tongue-lip adhesion may serve as an alternative, while tracheostomy should be reserved for cases of severe multi-level obstruction. The authors propose that large-scale, multicentre trials comparing long-term outcomes are required to establish definitive guidelines. [ABSTRACT FROM AUTHOR] more...
- Published
- 2024
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- View/download PDF
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3. Long-term persistence in obstructive sleep apnea following tongue-lip adhesion in infants with Pierre Robin sequence and a cleft palate.
- Author
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Sahrmann, Julie and Haberman, Brent
- Abstract
Obstructive sleep apnea (OSA) and airway compromise are common in infants with Pierre Robin syndrome (PRS) due to tongue-based airway obstruction. Tongue-lip adhesion (TLA) is an effective procedure that can alleviate the symptoms of OSA by preventing posterior prolapse of the tongue. Although OSA consistently improved following TLA, it did not fully resolve. Ongoing management of OSA was required in all patients. These results identify the need for OSA to be reevaluated and managed for several years in PRS patients who have had a TLA. [ABSTRACT FROM AUTHOR] more...
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- 2024
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4. Airway and Feeding Outcomes in Pierre Robin Sequence: A Comparison of Three Management Strategies.
- Author
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Khansa, Ibrahim, Aldabbeh, Summer, Pearson, Gregory D., Baylis, Adriane, Madhoun, Lauren L., Schoenbrunner, Anna, Splaingard, Mark, and Kirschner, Richard E.
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BONE lengthening (Orthopedics) ,CONSERVATIVE treatment ,TRACHEOTOMY ,KRUSKAL-Wallis Test ,STATISTICS ,ARTIFICIAL feeding ,ACADEMIC medical centers ,MANDIBLE ,NEONATAL diseases ,AIRWAY (Anatomy) ,RETROSPECTIVE studies ,TONGUE ,POLYSOMNOGRAPHY ,MANN Whitney U Test ,RESPIRATORY obstructions ,TREATMENT effectiveness ,SLEEP apnea syndromes ,PIERRE Robin Syndrome ,DATA analysis ,DISEASE management ,LIPS - Abstract
Background: Controversy remains regarding optimal management of Pierre Robin sequence (PRS). The goal of this study was to compare airway and feeding outcomes in infants with PRS who underwent surgical intervention, specifically mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA), or who had conservative management (CM) without surgery. Methods: All consecutive patients treated for PRS at a pediatric academic medical center, with at least one year follow-up, were included. Patients who underwent tracheostomy as an index procedure were excluded. Patients were divided into those who underwent MDO, TLA or CM. Feeding status and data from initial and follow-up polysomnograms were collected. Comparisons between groups were made using the Kruskal-Wallis test, followed by Mann-Whitney pairwise comparison with a Bonferroni correction, when appropriate. Results: 67 neonates were included. 19 underwent TLA, 29 underwent MDO and 19 underwent CM. The proportions of syndromic patients were similar between groups. Patients undergoing CM had the lowest baseline AHI (9.1), but there were no significant differences between TLA (20.1) and MDO (25.4). At follow-up, the three groups had similar mean AHI (MDO 1.3, TLA 4.2, CM 4.5). A similar proportion of patients achieved AHI 5 or less (TLA 89.5%, MDO 96.6%, CM 84.2%). At one year, there were no significant differences in weight percentiles or in risk of failure-to-thrive between groups. One patient from the TLA group required a tracheostomy. Conclusion: The three treatment modalities achieved high airway and feeding success rates. All three modalities should have a place in the armamentarium of the craniofacial surgeon. [ABSTRACT FROM AUTHOR] more...
- Published
- 2023
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5. Long-term speech outcome in patients with Robin sequence after cleft palate repair and tongue-lip adhesion: A 21-year retrospective analysis.
- Author
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Logjes, Robrecht J.H., Mermans, Joline F., Coerts, Marieke J., Lissenberg-Witte, Birgit I., Breugem, Corstiaan C., and Don Griot, J. Peter W.
- Subjects
CLEFT palate ,PALATE surgery ,SPEECH ,VELOPHARYNGEAL insufficiency ,SPEECH therapists ,ARTICULATION (Speech) - Abstract
The purpose of this study was to assess the effect of tongue−lip adhesion (TLA) on the long-term speech and articulation outcomes of patients with Robin sequence (RS) after cleft palate repair. Outcomes were compared to those in patients with RS who required positioning alone and to patients with isolated cleft palate (ICP). All consecutive patients with RS (with or without TLA) versus isolated cleft palate (ICP) who underwent cleft palate repair were retrospectively reviewed. Speech and articulation included all assessments between the age of 3–6 years. Secondary speech operations, velopharyngeal insufficiency (VPI), hypernasality, and articulation errors by cleft-type characteristics (CTC), including 4 categories (passive), non-oral, anterior-oral, and posterior-oral. A total of 41 RS patients and 61 ICP patients underwent repair with sufficient follow-up. Of them, 23 patients underwent a TLA at median age of 12 days. Rates of hypernasality (p = 0.004), secondary speech operations (p = 0.004), and posterior oral CTC (p = 0.042) were higher in RS compared to ICP. Isolated RS had speech outcomes similar to those of ICP; however, syndromic RS patients needed more secondary speech operations compared to isolated RS (p = 0.043). TLA-RS patients did not demonstrate differences in speech outcomes or any CTCs (all p > 0.05) compared to non−TLA-RS patients, except for the anterior oral CTC (74% TLA-RS vs 28% non−TLA-RS, p = 0.005). Within the limitations of the study, it seem that TLA does not affect long-term velopharyngeal function in patients with RS. However, TLA-RS patients demonstrated higher rates of anterior-oral CTC, which might be related to a different positioning of the tongue after TLA. Every effort should be taken to treat patients with RS conservatively instead of with TLA because of this demonstrated a negative effect on one type of articulation error. However, if conservative therapy fails, a TLA is still a valuable adjunct in the treatment of RS, and cleft speech pathologists who treat such patients should be more aware of this phenomenon in order to improve long-term articulation outcomes. [ABSTRACT FROM AUTHOR] more...
- Published
- 2023
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6. Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion.
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Kosyk, Mychajlo S., Carlson, Anna R., Zapatero, Zachary D., Kalmar, Christopher L., Swanson, Jordan W., Bartlett, Scott P., and Taylor, Jesse A.
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LIP surgery ,MANDIBLE surgery ,TONGUE surgery ,BONE lengthening (Orthopedics) ,TISSUE adhesions ,CHILDREN'S hospitals ,CLEFT palate ,TONGUE ,RETROSPECTIVE studies ,ACQUISITION of data ,TERTIARY care ,SURGERY ,PATIENTS ,SURGICAL complications ,POLYSOMNOGRAPHY ,OXYGEN saturation ,TREATMENT effectiveness ,RESPIRATORY obstructions ,ORAL surgery ,MEDICAL records ,LIPS ,PATIENT safety ,LONGITUDINAL method ,EVALUATION - Abstract
Objective: To evaluate the timing and safety of cleft palate (CP) repair in patients with Robin sequence (RS) treated with mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA) for airway obstruction. Design: Retrospective cohort study. Setting: Tertiary Pediatric Hospital during 2004-2020. Patients: 148 patients with RS underwent MDO, 66 met inclusion by having MDO and followed by palatoplasty. 26 patients with RS underwent TLA, 14 met inclusion by having TLA and followed by palatoplasty. Main Outcome Measures: Patient characteristics, hospital/operative details, postoperative complications, and polysomnographic (PSG) data were compared. Results: Groups were well-matched except more patients with syndromes underwent MDO (N = 27, 41%, P ≤.002). In the MDO and TLA cohorts, mean CP repair age was 12.8 ± 1.9 months and 14.6 ± 1.6 months, respectively (P ≤.002). Despite the earlier CP repair in the MDO group, there were no differences in peri-operative complication rates after palatoplasty in either group. All sleep respiratory parameters improved after MDO/TLA prior to palatoplasty P ≤.050. All PSG parameters remained significantly improved after palatoplasty compared to preoperative values, P ≤.043. Obstructive apnea hypopnea index and Oxygen saturation nadir further improved after palatoplasty within the MDO group, P ≤.050, while no changes in the TLA group, P ≥.500. Conclusions: MDO was associated with earlier age at palatoplasty than TLA with a similar perioperative risk profile. In those patients with pre- and post-palatoplasty PSG data, palatoplasty was not associated with a deterioration in PSG parameters, and in fact in the MDO group, PSG data improved. [ABSTRACT FROM AUTHOR] more...
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- 2023
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7. A comparison of airway interventions and gastrostomy tube placement in infants with Robin sequence.
- Author
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El Ghoul, K., Calabrese, C.E., Koudstaal, M.J., and Resnick, C.M.
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TRACHEOTOMY ,INFANTS ,CHILDREN'S hospitals ,ODDS ratio - Abstract
The purpose of this study was to evaluate feeding impairment following non-operative or operative management of airway obstruction in a large series of infants with Robin sequence (RS) by rate of G-tube placement. A retrospective study was conducted at Boston Children's Hospital including 225 patients (47.1% female) with RS treated between 1976 and 2018. Subjects were grouped by intervention required for successful management of airway obstruction: non-operative only (n = 120), tongue–lip adhesion (TLA, n = 75), mandibular distraction osteogenesis (MDO, n = 21), or tracheostomy (n = 9). The operative group had a higher rate of G-tube placement (58.1%) than the non-operative group (28.3%, P < 0.0001). Subjects in the TLA and tracheostomy groups had higher odds of G-tube placement than subjects in the MDO group: odds ratio (OR) 5.5 (95% confidence interval (CI) 1.8–17.3, P = 0.004) and OR 27.0 (95% CI 3.2–293.4, P = 0.007), respectively. Syndromic patients and those with gastrointestinal anomalies also had higher odds of G-tube placement: OR 3.5 (95% CI 1.7–7.2, P = 0.001) and OR 5.9 (95% CI 1.6–21.0, P = 0.007), respectively. Infants with RS who require an airway operation and those with a syndromic diagnosis or gastrointestinal anomalies are more likely to require placement of a G-tube. Of the operative groups, MDO was associated with the lowest G-tube rate, compared to TLA and tracheostomy. [ABSTRACT FROM AUTHOR] more...
- Published
- 2020
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8. Spectrum of Disease in Hospitalized Newborns with Congenital Micrognathia: A Cohort of 3,236 Infants at North American Tertiary-Care Intensive Care Units.
- Author
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Padula, Michael A., Naing, Khatija, Wenger, Tara L., Ahmad, Irfan, Coghill III, Carl H., Wild, K. Taylor, Rottgers, S. Alex, Resnick, Cory M., Goldstein, Jeffrey, Ehsan, Zarmina, Watkins, Donna, Deptula, Nicole, Lai, Kuan-Chi, Lioy, Janet, Gogcu, Semsa, and Cielo, Christopher M. more...
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- 2024
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9. Impact of Micro- and Retrognathia on the Neonatal Airway
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Goldstein, Jesse A., Taylor, Jesse A., Lioy, Janet, editor, and Sobol, Steven E., editor
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- 2015
- Full Text
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10. Tongue–lip adhesion in Pierre-Robin sequence: Role redefined.
- Author
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Singh, Veena, Sinha, Chandni, Sahay, Nishant, Haq, Ansarul, Sharma, Sarsij, and Payal, Shilpa
- Abstract
The triad of retrognathia, glossoptosis, and airway obstruction characterizes the Robin sequence along with the detrimental effects of mandibular hypoplasia on feeding, swallowing, and growth, which are very well described. Most of the babies are managed successfully on nonsurgical measures, but selected patients require surgical intervention in the neonatal period for survival. Conventionally, tracheostomy was done, which still remains a first-line surgical procedure for some surgeons. However, presently, most of the craniofacial centers have switched over to mandibular distraction procedures at an early stage and only sometimes tongue–lip adhesion (TLA). The literature is unclear as to which surgical procedure for securing the airway is more effective for these patients, and hence, the choice of procedure depends on the resources and surgical expertise. This article tells the tale of a neonate who survived by just placing a simple U-stitch between the tongue and lip, retracting the tongue outside, which is the basic concept of all TLA procedures. It also reemphasizes the importance of TLA in Robin patients to improve the airway obstruction and helps buy the time in which the mandible and associated structures grow. [ABSTRACT FROM AUTHOR] more...
- Published
- 2020
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11. Evaluation of the efficacy of tongue-lip adhesion in Pierre Robin sequence.
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Broucqsault, H., Lamblin, M.-D., Hosana, G., and Fayoux, P.
- Abstract
Objective Tongue-lip adhesion may be used to relieve obstructive sleep apnoea in infants with Pierre Robin sequence (PRS), but only a few studies have objectively evaluated its efficacy. The purpose of this study was to evaluate the results of tongue-lip adhesion by polysomnography. Materiel and methods A single-centre retrospective study was conducted in infants with PRS treated by tongue-lip adhesion from 2004 to 2015, in whom at least laryngotracheal endoscopy and polysomnography were performed. The variables collected were the syndromic diagnosis, demographic data, respiratory management before tongue-lip adhesion, symptoms, and additional airway interventions. Obstructive sleep apnoea was classified into 3 groups according to severity. Polysomnography was performed one month after tongue-lip adhesion. Statistical analysis was performed with Wilcoxon signed-rank test with a limit of statistical significance of P < 0.005. Results Thirty-seven subjects in whom tongue-lip adhesion was performed at a mean age of 45 days (8 to 210 days) were included. Thirty-one patients had isolated PRS and 6 patients had associated anomalies. All patients had confirmed severe obstructive sleep apnoea. All patients required respiratory support prior to surgery: 8 intubated patients, 15 patients with noninvasive ventilation and 14 patients with nasopharyngeal airways. Eight patients had bradycardia before tongue-lip adhesion. All parameters were improved on postoperative polysomnography: oxygen saturation, hypercapnia, apnoea-hypopnoea index, bradycardia ( P < 0.005). Only 8 patients had persistent severe obstructive sleep apnoea and required tracheostomy ( n = 5) or noninvasive ventilation ( n = 3). No significant correlation was observed between treatment success and any predictive variables. Conclusion Tongue-lip adhesion improved airway obstruction in all infants with PRS and resolved obstructive sleep apnoea in 29 patients. However, 8 patients required additional airway interventions. [ABSTRACT FROM AUTHOR] more...
- Published
- 2018
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12. Outcome Following Surgical Interventions for Micrognathia in Infants With Pierre Robin Sequence: A Systematic Review of the Literature.
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Almajed, Athari, Viezel-Mathieu, Alex, Gilardino, Mirko S., Flores, Roberto L., Tholpady, Sunil S., and Côt, Aurore
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INFANTS ,MEDLINE ,MICROGNATHIA ,ONLINE information services ,SYSTEMATIC reviews ,PIERRE Robin Syndrome - Abstract
The article discusses research which examined the rate of failure of each type of surgical interventions for airway obstruction in infants born with Pierre Robin sequence. Topics discussed include the indication for the need for tracheostomy, the proportion of infants that have signficant airway obstruction postoperatively as determined by polysomnography, and mandibular distraction osteogenesis (MDO) as the most effective technique. more...
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- 2017
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13. Successful Weaning of a Laryngeal Mask Airway After a Tongue-lip Adhesion Operation in a Case With Cerebro-costo-mandibular Syndrome
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Chi-Yung So, Yan-Yan Ng, Chih-Yu Peng, Jui-Ming Hu, Suh-Jen Chen, Jia-Yuh Chen, and Pen-Hua Su
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airway obstruction ,cerebro-costo-mandibular syndrome ,tongue-lip adhesion ,Pediatrics ,RJ1-570 - Abstract
Cerebro-costo-mandibular syndrome (CCMS) consists of severe micrognathia, glossoptosis, posterior rib-gap defects and developmental delay. It may cause upper airway obstruction and flail chest, resulting in neonatal hypoxia, and possibly death. Early airway management or surgical intervention to maintain a patent airway is critical to avoid hypoxia in CCMS patients. We report a newborn with CCMS who was successfully weaned from a laryngeal mask after undergoing a tongue–lip adhesion operation at 164 days of age. more...
- Published
- 2010
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14. Airway and Feeding Outcomes in Pierre Robin Sequence: A Comparison of Three Management Strategies.
- Author
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Khansa I, Aldabbeh S, Pearson GD, Baylis A, Madhoun LL, Schoenbrunner A, Splaingard M, and Kirschner RE
- Subjects
- Infant, Newborn, Infant, Humans, Child, Treatment Outcome, Retrospective Studies, Mandible surgery, Pierre Robin Syndrome surgery, Osteogenesis, Distraction methods, Airway Obstruction surgery
- Abstract
Background: Controversy remains regarding optimal management of Pierre Robin sequence (PRS). The goal of this study was to compare airway and feeding outcomes in infants with PRS who underwent surgical intervention, specifically mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA), or who had conservative management (CM) without surgery., Methods: All consecutive patients treated for PRS at a pediatric academic medical center, with at least one year follow-up, were included. Patients who underwent tracheostomy as an index procedure were excluded. Patients were divided into those who underwent MDO, TLA or CM. Feeding status and data from initial and follow-up polysomnograms were collected. Comparisons between groups were made using the Kruskal-Wallis test, followed by Mann-Whitney pairwise comparison with a Bonferroni correction, when appropriate., Results: 67 neonates were included. 19 underwent TLA, 29 underwent MDO and 19 underwent CM. The proportions of syndromic patients were similar between groups. Patients undergoing CM had the lowest baseline AHI (9.1), but there were no significant differences between TLA (20.1) and MDO (25.4). At follow-up, the three groups had similar mean AHI (MDO 1.3, TLA 4.2, CM 4.5). A similar proportion of patients achieved AHI 5 or less (TLA 89.5%, MDO 96.6%, CM 84.2%). At one year, there were no significant differences in weight percentiles or in risk of failure-to-thrive between groups. One patient from the TLA group required a tracheostomy., Conclusion: The three treatment modalities achieved high airway and feeding success rates. All three modalities should have a place in the armamentarium of the craniofacial surgeon. more...
- Published
- 2023
- Full Text
- View/download PDF
15. Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion.
- Author
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Kosyk MS, Carlson AR, Zapatero ZD, Kalmar CL, Swanson JW, Bartlett SP, and Taylor JA
- Subjects
- Humans, Child, Infant, Retrospective Studies, Treatment Outcome, Tongue surgery, Mandible surgery, Cleft Palate surgery, Cleft Palate complications, Pierre Robin Syndrome surgery, Pierre Robin Syndrome complications, Osteogenesis, Distraction, Airway Obstruction etiology, Airway Obstruction surgery
- Abstract
Objective: To evaluate the timing and safety of cleft palate (CP) repair in patients with Robin sequence (RS) treated with mandibular distraction osteogenesis (MDO) or tongue-lip adhesion (TLA) for airway obstruction., Design: Retrospective cohort study., Setting: Tertiary Pediatric Hospital during 2004-2020., Patients: 148 patients with RS underwent MDO, 66 met inclusion by having MDO and followed by palatoplasty. 26 patients with RS underwent TLA, 14 met inclusion by having TLA and followed by palatoplasty., Main Outcome Measures: Patient characteristics, hospital/operative details, postoperative complications, and polysomnographic (PSG) data were compared., Results: Groups were well-matched except more patients with syndromes underwent MDO (N = 27, 41%, P ≤ .002). In the MDO and TLA cohorts, mean CP repair age was 12.8 ± 1.9 months and 14.6 ± 1.6 months, respectively ( P ≤ .002). Despite the earlier CP repair in the MDO group, there were no differences in peri-operative complication rates after palatoplasty in either group. All sleep respiratory parameters improved after MDO/TLA prior to palatoplasty P ≤ .050. All PSG parameters remained significantly improved after palatoplasty compared to preoperative values, P ≤ .043. Obstructive apnea hypopnea index and Oxygen saturation nadir further improved after palatoplasty within the MDO group, P ≤ .050, while no changes in the TLA group, P ≥ .500., Conclusions: MDO was associated with earlier age at palatoplasty than TLA with a similar perioperative risk profile. In those patients with pre- and post-palatoplasty PSG data, palatoplasty was not associated with a deterioration in PSG parameters, and in fact in the MDO group, PSG data improved. more...
- Published
- 2023
- Full Text
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16. A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm.
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Paes, Emma, Nunen, Daan, Speleman, Lucienne, Muradin, Marvick, Smarius, Bram, Kon, Moshe, Molen, Aebele, Niers, Titia, Veldhoen, Esther, and Breugem, Corstiaan
- Subjects
- *
PIERRE Robin Syndrome , *MEDICAL specialties & specialists , *TRACHEOTOMY , *DENTAL adhesives , *RETROSPECTIVE studies , *THERAPEUTICS - Abstract
Objectives: Initial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution's approach and a review of the current literature. Material and methods: A retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996-2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS. Results: Forty-four infants (59 %) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25 %, p = .014). A mandibular distraction was conducted in 24 % ( n = 18) of cases, a tracheotomy in 9 % ( n = 7), and a tongue-lip adhesion in 8 % ( n = 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described. Conclusions: RS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended. Clinical Relevance: We provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics. [ABSTRACT FROM AUTHOR] more...
- Published
- 2015
- Full Text
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17. Pierre Robin sequence: Review of diagnostic and treatment challenges.
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Côté, Aurore, Fanous, Amanda, Almajed, Athari, and Lacroix, Yolène
- Subjects
- *
PIERRE Robin Syndrome , *NUCLEOTIDE sequence , *RARE diseases , *RESPIRATORY obstructions , *AIRWAY (Anatomy) , *PEDIATRIC otolaryngology , *THERAPEUTICS , *DISEASES - Abstract
Pierre Robin sequence is not a rare condition and paediatric specialists caring for respiratory related issues are likely to encounter cases in their practice. There have been a few recent reviews on the topic, mostly focusing on the surgical interventions performed for cases with severe airway obstruction. In the present review, we will highlight the different challenges that remain today in the global evaluation of infants afflicted with this condition through a thorough review of the medical literature, giving the clinician a full scope of the disease and of the various management options. The need for an improved objective evaluation of airway obstruction and for a better classification will be emphasized. We are therefore proposing a novel classification scheme that will better account for respiratory and feeding difficulties in these infants. Finally, many knowledge gaps persist regarding this condition, underlining the necessity for further research both in the genetic field and regarding the outcome of therapy. [ABSTRACT FROM AUTHOR] more...
- Published
- 2015
- Full Text
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18. A comparison of airway interventions and gastrostomy tube placement in infants with Robin sequence
- Author
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El Ghoul, K. (K.), Calabrese, C.E. (C. E.), Koudstaal, M.J. (Maarten), Resnick, C.M. (C. M.), El Ghoul, K. (K.), Calabrese, C.E. (C. E.), Koudstaal, M.J. (Maarten), and Resnick, C.M. (C. M.)
- Abstract
The purpose of this study was to evaluate feeding impairment following non-operative or operative management of airway obstruction in a large series of infants with Robin sequence (RS) by rate of G-tube placement. A retrospective study was conducted at Boston Children's Hospital including 225 patients (47.1% female) with RS treated between 1976 and 2018. Subjects were grouped by intervention required for successful management of airway obstruction: non-operative only (n = 120), tongue–lip adhesion (TLA, n = 75), mandibular distraction osteogenesis (MDO, n = 21), or tracheostomy (n = 9). The operative group had a higher rate of G-tube placement (58.1%) than the non-operative group (28.3%, P < 0.0001). Subjects in the TLA and tracheostomy groups had higher odds of G-tube placement than subjects in the MDO group: odds ratio (OR) 5.5 (95% confidence interval (CI) 1.8–17.3, P = 0.004) and OR 27.0 (95% CI 3.2–293.4, P = 0.007), respectively. Syndromic patients and those with gastrointestinal anomalies also had higher odds of G-tube placement: OR 3.5 (95% CI 1.7–7.2, P = 0.001) and OR 5.9 (95% CI 1.6–21.0, P = 0.007), respectively. Infants with RS who require an airway operation and those with a syndromic diagnosis or gastrointestinal anomalies are more likely to require placement of a G-tube. Of the operative groups, MDO was associated with the lowest G-tube rate, compared to TLA and tracheostomy. more...
- Published
- 2020
- Full Text
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19. Regional variations in the presentation and surgical management of Pierre Robin sequence.
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Scott, Andrew R. and Mader, Nicholas S.
- Abstract
Objectives/Hypothesis To estimate the current birth prevalence of isolated and syndromic Pierre Robin sequence (iPRS and sPRS), including demographic variations. To assess for regional variations in surgical airway interventions for PRS, and to determine the mean length of stay (LOS), cost of admission, complication rate, and rate of associated procedures related to tongue-lip adhesion (TLA), neonatal mandibular distraction osteogenesis (MDO), and tracheotomy. Study Design Retrospective cross-sectional study. Methods The 2006 and 2009 Kids Inpatient Databases were used to identify newborns and infants with PRS; analysis using cross tabulations and linear regression modeling was performed. Results In 2006 and 2009, the estimated birth prevalence of iPRS was 1.8:10,000 live births and sPRS 1.4:10,000 live births. The highest rate was in whites and the lowest in non-Hispanic blacks. There were 145 TLAs (36%), 176 MDOs (43%), and 85 tracheotomies (21%). The Northeast favored a TLA strategy; the Midwest favored MDO. The mean LOS for TLA was 24.5 days, MDO 36.7 days, tracheotomy (iPRS) 44.9 days, and tracheotomy (sPRS) 53.0 days. Conclusions The birth prevalence of PRS may be higher than previously described, especially in whites. Surgical management strategies vary between regions. The overall cost of a TLA admission is lower than an MDO or tracheotomy admission, owing primarily to shorter LOS. This study was limited by not taking into account outpatient expenses (nursing care, monitoring) or need for further airway/feeding intervention over subsequent admissions. Level of Evidence 2c Laryngoscope, 124:2818-2825, 2014 [ABSTRACT FROM AUTHOR] more...
- Published
- 2014
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20. Tongue-lip adhesion.
- Author
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Morrow, Brad T. and Samson, Thomas D.
- Abstract
The management of Pierre Robin sequence is challenging and requires a multidisciplinary approach. A thorough workup must be done to exclude sites of airway obstruction other than the base of the tongue and to exclude central sleep apnea. Airway security is critical and can be managed nonoperatively in most children. When surgical management is necessary, the tongue-lip adhesion is the first step in many institutional algorithms. Multiple modifications have been described, but the basic premise is an anterior advancement of the tongue base and suture fixation of the tongue to the lip. This increases the diameter of the airway and results in safe and successful management in the overwhelming majority of patients. There are few sequelae with the most common being dehiscence. This can be prevented by intermuscular sutures, a circummandibular stitch, and release of the genioglossus muscle. Once mandibular “catch-up” growth has been achieved, the tongue-lip adhesion may be reversed. [ABSTRACT FROM AUTHOR] more...
- Published
- 2015
- Full Text
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21. Outcomes after tongue–lip adhesion or mandibular distraction osteogenesis in infants with Pierre Robin sequence and severe airway obstruction.
- Author
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Papoff, P., Guelfi, G., Cicchetti, R., Caresta, E., Cozzi, D.A., Moretti, C., Midulla, F., Miano, S., Cerasaro, C., and Cascone, P.
- Subjects
BONE growth ,PIERRE Robin Syndrome ,RESPIRATORY obstructions ,AIRWAY (Anatomy) ,INFANT diseases ,HEALTH outcome assessment ,DISEASES - Abstract
Abstract: The objective was to review and compare outcomes after tongue–lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) in infants with severe breathing difficulties related to Pierre Robin sequence (PRS). A single-centre retrospective (2002–2012) study was carried out; 18 infants with severe breathing difficulties related to PRS resistant to conservative treatment, who underwent TLA or MDO to correct airway obstruction, were enrolled. The primary outcome measures were successful weaning from respiratory support and resumption of full oral feeding. Nine underwent TLA and nine MDO. Eight of the nine infants who underwent MDO and all those treated with TLA were successfully weaned from respiratory support. After discharge, residual respiratory distress was diagnosed more commonly after TLA than after MDO (6/9 vs 1/9, P =0.050). Infants resumed oral feeding sooner after MDO than after TLA (mean days after surgery to full oral feeds 44±24 vs 217±134, P <0.003). The length of hospital stay was longer for infants treated with MDO than for those treated with TLA. The rate of complications was similar. Infants with severe airway obstruction related to PRS can benefit safely from either TLA or MDO. Although MDO lengthens the time to discharge, this option stabilizes airway patency of infants with PRS more efficiently and achieves full oral feeding more rapidly than TLA. [Copyright &y& Elsevier] more...
- Published
- 2013
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22. Tongue-lip adhesion.
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Fayoux, P., Hosana, G., Bonne, N.X., and Nicollas, R.
- Published
- 2013
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23. A Novel Technique for Performing a Tongue-Lip Adhesion-The Tongue Suspension Technique.
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Mann, Robert J, Neaman, Keith C, Hill, Brian, Bajnrauh, Robert, and Martin, Matthew D
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PALATE surgery ,PLASTIC surgery ,BRONCHOSCOPY ,SURGICAL complications ,EQUIPMENT & supplies ,PIERRE Robin Syndrome - Abstract
The article presents a study on the tongue suspension technique for performing tongue-lip adhesion. It notes that tongue-lip adhesion with suspension entails several advantages including the prevention of button aspiration and potential interference in early bottle-feeding and developmental oral motor function. It mentions that the technique expands the armamentarium of craniofacial surgeons in managing difficult airways in Pierre Robin sequence. more...
- Published
- 2012
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24. Characterization of Obstructive Sleep Apnea Before and After Tongue-Lip Adhesion in Children With Micrognathia.
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Sedaghat, Ahmad R, Anderson, Iee Ching W, McGinley, Brian M, Rossberg, Mark I, Redett, Richard J, and Ishman, Stacey L
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TONGUE surgery ,ACTIVE oxygen in the body ,MICROGNATHIA ,SLEEP apnea syndromes ,T-test (Statistics) ,POLYSOMNOGRAPHY ,PILOT projects ,RETROSPECTIVE studies ,PIERRE Robin Syndrome ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
The article presents a study which characterizes obstructive sleep apnea before and after tongue-lip adhesion in children with micrognathia utilizing polysomnography. It notes that the findings reveal that tongue-lip adhesion is performed to alleviate airway obstruction in micrognathic infants. It was also found out that polysomnographic evaluation of tongue-lip adhesion before and after surgery reveals that only 38% had complete resolution. more...
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- 2012
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25. Successful Weaning of a Laryngeal Mask Airway After a Tongue-lip Adhesion Operation in a Case With Cerebro-costo-mandibular Syndrome.
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So, Chi-Yung, Ng, Yan-Yan, Peng, Chih-Yu, Hu, Jui-Ming, Chen, Suh-Jen, Chen, Jia-Yuh, and Su, Pen-Hua
- Subjects
BRAIN diseases ,MANDIBLE ,RESPIRATORY obstructions ,LARYNX ,AIRWAY (Anatomy) ,OPERATIVE surgery ,DISEASES - Abstract
Cerebro-costo-mandibular syndrome (CCMS) consists of severe micrognathia, glossoptosis, posterior rib-gap defects and developmental delay. It may cause upper airway obstruction and flail chest, resulting in neonatal hypoxia, and possibly death. Early airway management or surgical intervention to maintain a patent airway is critical to avoid hypoxia in CCMS patients. We report a newborn with CCMS who was successfully weaned from a laryngeal mask after undergoing a tongue–lip adhesion operation at 164 days of age. [Copyright &y& Elsevier] more...
- Published
- 2010
- Full Text
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26. Labioglossopexe u pacienta s Pierre Robinovou sekvencí.
- Author
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Hybášková, J., Vítečková, T., Poláčková, R., Zeleník, K., and Komínek, P.
- Subjects
- *
PIERRE Robin Syndrome , *MICROGNATHIA , *TREATMENT of respiratory obstructions , *TRACHEOTOMY , *OTOLARYNGOLOGY , *THERAPEUTICS - Abstract
Pierre Robin sequence is a congenital malformation. One of its typical sign is micrognathia, which often causes retroposition of the tongue with possible significant airway obstruction and feeding difficulties. If conservative treatment is not sufficient, a surgical procedure can be performed. Labio-glossopexy in patients with PRS should be balanced against the other operations, namely tracheostomy and mandibular distraction. Labio-glossopexy is less invasive method then tracheostomy, simplifies nursing care, shortens hospital stay and makes homecare less demanding. [ABSTRACT FROM AUTHOR] more...
- Published
- 2015
27. Pierre Robin Sequence: Secondary Respiratory Difficulties and Intrinsic Feeding Abnormalities.
- Author
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Cruz, Michael J., Kerschner, Joseph E., Beste, David J., and Conley, Stephen F.
- Abstract
Objective: There is considerable variation in opinion regarding the optimal management of patients with Pierre Robin sequence (PRS). No single method of airway intervention or feeding strategy is universally appropriate and effective. This study was performed to examine methods used for airway and feeding management and to identify specific problems encountered. Study Design: A retrospective study of 252 patient charts between 1989 and 1997 at Children's Hospital of Wisconsin. Methods: Patient information was collected regarding perinatal history, genetics evaluation, and airway and feeding evaluations and intervention. A group of 47 patients was determined as having PRS. Results: Secondary respiratory difficulties, defined as respiratory abnormalities in addition to the expected PRS obstruction, were identified in 23% of patients. Also, intrinsic feeding abnormalities not associated with airway obstruction were identified in 11% of patients. Analysis by Fisher's Exact Test revealed patients with a syndromic diagnosis to have a significantly higher rate for tracheotomies and gastrostomy tube placement ( P = .041, and P = .0004, respectively). Syndromic patients were also found to have significantly lower Apgar scores and longer hospital stays. Positioning techniques, tongue-lip adhesion, and tracheotomy were also employed effectively with specific indications and specific difficulties that need to be considered. Conclusion: Patients with PRS require thorough airway and feeding evaluation. Those with additional syndromic diagnoses demonstrate higher rates of more invasive interventions. Patients with PRS must undergo individualized approaches with consideration of multiple factors for successful management. [ABSTRACT FROM AUTHOR] more...
- Published
- 1999
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28. Tongue–lip adhesion in Pierre-Robin sequence: Role redefined
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Nishant Sahay, Veena Singh, Ansarul Haq, Sarsij Sharma, Shilpa Payal, and Chandni Sinha
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micrognathia ,medicine.medical_specialty ,business.industry ,Glossoptosis ,Mandible ,Case Report ,tongue–lip adhesion ,Airway obstruction ,medicine.disease ,Hypoplasia ,Surgery ,Airway ,medicine.anatomical_structure ,Tongue ,Retrognathia ,Medicine ,Pierre-Robin sequence ,Oral Surgery ,Craniofacial ,medicine.symptom ,business - Abstract
The triad of retrognathia, glossoptosis, and airway obstruction characterizes the Robin sequence along with the detrimental effects of mandibular hypoplasia on feeding, swallowing, and growth, which are very well described. Most of the babies are managed successfully on nonsurgical measures, but selected patients require surgical intervention in the neonatal period for survival. Conventionally, tracheostomy was done, which still remains a first-line surgical procedure for some surgeons. However, presently, most of the craniofacial centers have switched over to mandibular distraction procedures at an early stage and only sometimes tongue–lip adhesion (TLA). The literature is unclear as to which surgical procedure for securing the airway is more effective for these patients, and hence, the choice of procedure depends on the resources and surgical expertise. This article tells the tale of a neonate who survived by just placing a simple U-stitch between the tongue and lip, retracting the tongue outside, which is the basic concept of all TLA procedures. It also reemphasizes the importance of TLA in Robin patients to improve the airway obstruction and helps buy the time in which the mandible and associated structures grow. more...
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- 2020
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29. The tongue-lip adhesion
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Qaqish, Clement and Caccamese, John F.
- Abstract
The tongue-lip adhesion (TLA) has long been a part of the management algorithm for glossoptosis associated with the Pierre Robin sequence (PRS). Advancement of the base of the tongue has been shown to relieve airway obstruction in some infants. TLA has few complications or long-term sequelae. The procedure has also been shown to ameliorate the feeding difficulties associated with PRS and therefore, reduces hospital stay, simplifies nursing care, and makes home care less demanding. [Copyright &y& Elsevier] more...
- Published
- 2009
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30. Resolution of obstructive sleep apnea after mandibular distraction osteogenesis in setting of delayed tongue–lip adhesion takedown
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Brooke French, Aaron Kian, Katherine Chin, and Robyn S. Randall
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Male ,Osteogenesis, Distraction ,Adhesion (medicine) ,Mandible ,Adenoidectomy ,03 medical and health sciences ,0302 clinical medicine ,stomatognathic system ,Tongue ,030225 pediatrics ,Medicine ,Humans ,In patient ,Clinical Case Report ,obstructive sleep apnea ,Tonsillectomy ,Orthodontics ,Robin Sequence ,Sleep Apnea, Obstructive ,Pierre Robin Syndrome ,business.industry ,Pierre Robin ,tongue–lip adhesion ,030206 dentistry ,General Medicine ,medicine.disease ,Lip ,respiratory tract diseases ,Obstructive sleep apnea ,stomatognathic diseases ,Treatment Outcome ,Mandibular distraction ,Tongue lip adhesion ,Child, Preschool ,business ,Tomography, X-Ray Computed ,Research Article - Abstract
Rationale: There is a high prevalence of obstructive sleep apnea (OSA) in patients with Pierre Robin sequence (PRS), and treatment approaches are highly variable. One approach is a temporary tongue-lip adhesion (TLA) that acts as a temporizing measure while the mandible continues to grow and is usually taken down at 1 year of age. Patient concerns: Side effects of prolonged tongue-lip adhesion and optimal workup and treatment of persistent OSA in the setting of a tongue-lip adhesion. Diagnoses: Pierre Robin sequence (PRS), persistent obstructive sleep apnea (OSA), and tongue-lip adhesion (TLA). Interventions: Mandibular distraction osteogenesis (MDO), adenotonsillectomy, and tongue-lip adhesion takedown. Outcomes: Resolution of OSA. Lessons: This case puts into question the efficacy of isolated TLA in infants with Pierre Robin sequence and OSA, and places emphasis on the importance of considering an earlier workup of other potential causes of obstruction and the potential need for MDO as a primary or adjunctive approach to treatment. more...
- Published
- 2018
31. The effect of glossopexy on weight velocity in infants with Pierre Robin syndrome.
- Author
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Cozzi, Francesco, Totonelli, Giorgia, Frediani, Simone, Zani, Augusto, Spagnol, Lorna, and Cozzi, Denis A.
- Subjects
PEDIATRIC surgery ,PEDIATRICS ,DEGLUTITION disorders ,ESOPHAGUS diseases - Abstract
Abstract: Aim: In infants with Pierre Robin syndrome (PRS), mandibular distraction may be more advantageous than glossopexy as it not only relieves oropharyngeal airway obstruction but also reverses body growth retardation. Because no data are available on body weight velocity after glossopexy, we assessed longitudinally the body weight velocity in a cohort of children undergoing glossopexy. Methods: The records of 48 infants with PRS undergoing glossopexy after unsuccessful nonoperative treatment between 1981 and 2005 were reviewed. Weight measurements were analyzed at 4 time-points: at birth, on admission for glossopexy, on admission for lysis of lip-tongue adhesion (TLA), and at follow-up. Weight velocity was assessed using Tanner''s tables. Main Results: Adhesion dehiscence occurred in 9 patients (18.7%). Lip-tongue adhesion resolved airway compromise in 36 infants (75%). Release of TLA was accomplished in 34 patients. Data on weight velocity from birth to follow-up (mean, 5.57 ± 0.59 years) were available for 31 patients. After glossopexy, mean body weight increased from the 9.7 ± 2.6th to the 17.5 ± 4.6th percentile (P > .05), whereas mean weight velocity increased from the 19.1 ± 4.9th to the 74.2 ± 4.7th percentile (P < .001). No temporal correlation was found between glossopexy and oropharyngeal dysphagia. Conclusion: In infants with PRS, glossopexy is a valid alternative to mandibular distraction because it does not cause decline in body growth. [Copyright &y& Elsevier] more...
- Published
- 2008
- Full Text
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32. Tongue-lip adhesion
- Author
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P. Fayoux, R. Nicollas, G. Hosana, and N.-X. Bonne
- Subjects
medicine.medical_specialty ,MEDLINE ,Dentistry ,Tongue Diseases ,Tongue-lip adhesion ,Tongue ,medicine ,Humans ,Child ,Head and neck ,Postoperative Care ,business.industry ,Suture Techniques ,Glossoptosis ,Surgical technique ,Pharyngeal Diseases ,medicine.disease ,Pierre Robin syndrome ,Lip ,Airway Obstruction ,Otorhinolaryngology ,Tongue lip adhesion ,Surgery ,medicine.symptom ,business - Abstract
European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 130 - N° 2 - p. 99-102
- Published
- 2013
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33. Successful Weaning of a Laryngeal Mask Airway After a Tongue-lip Adhesion Operation in a Case With Cerebro-costo-mandibular Syndrome
- Author
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Suh-Jen Chen, Chi-Yung So, Yan-Yan Ng, Chih-Yu Peng, Jia-Yuh Chen, Pen-Hua Su, and Jui-Ming Hu
- Subjects
Larynx ,Male ,Flail chest ,medicine.medical_specialty ,medicine.medical_treatment ,Micrognathism ,Ribs ,Laryngeal Masks ,Laryngeal mask airway ,Tongue ,medicine ,Flail Chest ,Humans ,Abnormalities, Multiple ,Pediatrics, Perinatology, and Child Health ,airway obstruction ,business.industry ,Glossoptosis ,lcsh:RJ1-570 ,Infant, Newborn ,lcsh:Pediatrics ,Syndrome ,Airway obstruction ,medicine.disease ,cerebro-costo-mandibular syndrome ,Lip ,Surgery ,Cleft Palate ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Airway management ,medicine.symptom ,business ,tongue-lip adhesion - Abstract
Cerebro-costo-mandibular syndrome (CCMS) consists of severe micrognathia, glossoptosis, posterior rib-gap defects and developmental delay. It may cause upper airway obstruction and flail chest, resulting in neonatal hypoxia, and possibly death. Early airway management or surgical intervention to maintain a patent airway is critical to avoid hypoxia in CCMS patients. We report a newborn with CCMS who was successfully weaned from a laryngeal mask after undergoing a tongue–lip adhesion operation at 164 days of age. more...
- Published
- 2010
- Full Text
- View/download PDF
34. Outcomes after tongue-lip adhesion or mandibular distraction osteogenesis in infants with Pierre Robin sequence and severe airway obstruction
- Author
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Paola Papoff, Piero Cascone, Fabio Midulla, Silvia Miano, Roberto Cicchetti, G. Guelfi, Denis A. Cozzi, Corrado Moretti, Elena Caresta, and Carla Cerasaro
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Osteogenesis, Distraction ,Mandible ,Intensive Care Units, Pediatric ,Tongue ,medicine ,Humans ,Weaning ,Retrospective Studies ,Pierre Robin Syndrome ,Respiratory distress ,business.industry ,Infant ,Retrospective cohort study ,Length of Stay ,Airway obstruction ,medicine.disease ,Respiration, Artificial ,Lip ,Surgery ,Airway Obstruction ,Treatment Outcome ,medicine.anatomical_structure ,Otorhinolaryngology ,Pierre Robin syndrome ,Breathing ,Distraction osteogenesis ,mandibular distraction ,airway obstruction ,tongue-lip adhesion ,pierre robin sequence ,Female ,Oral Surgery ,Respiratory Insufficiency ,business - Abstract
The objective was to review and compare outcomes after tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) in infants with severe breathing difficulties related to Pierre Robin sequence (PRS). A single-centre retrospective (2002-2012) study was carried out; 18 infants with severe breathing difficulties related to PRS resistant to conservative treatment, who underwent TLA or MDO to correct airway obstruction, were enrolled. The primary outcome measures were successful weaning from respiratory support and resumption of full oral feeding. Nine underwent TLA and nine MDO. Eight of the nine infants who underwent MDO and all those treated with TLA were successfully weaned from respiratory support. After discharge, residual respiratory distress was diagnosed more commonly after TLA than after MDO (6/9 vs 1/9, P=0.050). Infants resumed oral feeding sooner after MDO than after TLA (mean days after surgery to full oral feeds 44±24 vs 217±134, P more...
- Published
- 2013
35. Tongue-lip adhesion in Pierre Robin sequence
- Author
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Krishna Kumar, K. S., Vylopilli, Suresh, Sivadasan, Anand, Pati, Ajit Kumar, Narayanan, Saju, and Nair, Santhy Mohanachandran
- Subjects
medicine.medical_specialty ,Robin Sequence ,business.industry ,Patent airway ,Adhesion (medicine) ,Case Report ,respiratory system ,Airway obstruction ,medicine.disease ,Pierre Robin syndrome ,respiratory tract diseases ,Surgery ,Feeding difficulty ,Tongue-lip adhesion ,Tongue lip adhesion ,medicine ,Oral Surgery ,business - Abstract
Patients with Pierre Robin sequence exhibit varying degrees of airway obstruction and feeding difficulty. In some patients, airway obstruction may be profound, warranting surgical intervention to maintain a patent airway. The purpose of this article is to highlight the advantages of the tongue-lip adhesion procedure for the management of airway obstruction in such patients compared to the currently available options. more...
- Published
- 2016
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36. Airway Management in Pierre Robin Sequence: The Vancouver Classification.
- Author
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Li WY, Poon A, Courtemanche D, Verchere C, Robertson S, Bucevska M, Malic C, and Arneja JS
- Abstract
Background: Pierre Robin sequence (PRS) is a triad of micrognathia, glossoptosis, and respiratory distress. There is no standard clinical classification used in the management of neonatal airway in patients with PRS. The goal of our study was to review the presentation and management of patients with PRS and formulate a clinical grading system and treatment algorithm., Methods: A 10-year retrospective review of all neonates diagnosed with PRS was performed after obtaining institutional ethics approval. Patients were identified using our cleft lip and palate program database. Inclusion criteria were 2 of the following 3 clinical features-glossoptosis, retrognathia, or airway obstruction. We collected demographic data, clinical information (coexisting airway morbidity, maxillary-mandibular discrepancy, type of intervention used, complications, and outcomes (feeding, length of stay, and airway status) during the first year of life., Results: Sixty-three patients met our inclusion criteria. Of these, 55 (87%) had cleft palate and 17 (27%) were syndromic. Forty-eight (76%) patients were managed by prone positioning. Of the 15 surgically managed patients, the initial procedure was floor of mouth release in 7, mandibular distraction osteogenesis (MDO) in 4, and tongue-lip adhesion in 4. Five patients with coexisting airway morbidity needed a second surgery; 2 had MDO and 3 tracheostomies (one patient was later decannulated). Seven (47%) of the surgically managed patients required a gastrostomy tube., Conclusion: At present, there is no consensus on neonatal airway management in infants with PRS. From our review of 63 patients with PRS, we hereby propose a simple 4-point classification system and treatment algorithm, based on clinical features., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. more...
- Published
- 2017
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37. Outcome Following Surgical Interventions for Micrognathia in Infants With Pierre Robin Sequence: A Systematic Review of the Literature.
- Author
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Almajed A, Viezel-Mathieu A, Gilardino MS, Flores RL, Tholpady SS, and Côté A
- Subjects
- Airway Obstruction surgery, Humans, Infant, Micrognathism mortality, Osteogenesis, Distraction, Pierre Robin Syndrome mortality, Polysomnography, Tracheostomy, Treatment Outcome, Micrognathism surgery, Pierre Robin Syndrome surgery
- Abstract
Background: Tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and subperiosteal release of the floor of the mouth (SPRFM) are the most commonly performed surgical procedures to treat severe airway obstruction in infants born with Pierre Robin sequence (PRS)., Objectives: To determine the rate of failure of each type of procedure, in terms of mortality and the need for tracheostomy, and to determine what proportion of infants have significant airway obstruction postoperatively as determined by polysomnography (PSG) and compare the data by procedure type., Method: A comprehensive literature search (1981 through June 2015) was done of the National Library of Medicine database using PubMed. Extracted data included diagnosis, type of surgery, and outcome including mortality, need for postoperative tracheostomy and details of PSG. Persistence of significant airway obstruction was defined as an apnea-hypopnea index >15 events/h on PSG., Results: Both mortality rate and need for tracheostomy were low for all procedures. Many studies lacked sufficient detail to identify significant airway obstruction postoperatively. In studies with sufficient data, MDO was associated with the lowest percentage of significant airway obstruction postprocedure (3.6%) compared to 50% for infants who underwent TLA. Insufficient PSG data was available for patients who were treated with SPRFM., Conclusions: There is a paucity of objective PSG data to definitively assess postoperative airway outcomes for PRS. MDO appears to be the most effective technique based on the available PSG data. Standardized use of PSG may lead to better identification and treatment of patients at risk for suboptimal airway outcomes postoperatively. more...
- Published
- 2017
- Full Text
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38. A pragmatic approach to infants with Robin sequence: a retrospective cohort study and presence of a treatment algorithm
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Bram Smarius, Titia L. E. M. Niers, Emma C. Paes, Esther S. Veldhoen, Aebele B. Mink van der Molen, Marvick S. M. Muradin, Moshe Kon, Daan P. F. van Nunen, Corstiaan C. Breugem, Lucienne Speleman, and Amsterdam Reproduction & Development (AR&D) more...
- Subjects
Robin Sequence ,Pediatrics ,medicine.medical_specialty ,Approach ,business.industry ,Critically ill ,Dentistry(all) ,Pierre Robin ,Retrospective cohort study ,Mandibular distraction ,Multidisciplinary team ,Treatment ,Tongue lip adhesion ,Journal Article ,Medicine ,Original Article ,Decision process ,Tracheotomy ,business ,General Dentistry ,Tongue–lip adhesion - Abstract
Objectives: Initial approaches to and treatments of infants with Robin sequence (RS) is diverse and inconsistent. The care of these sometimes critically ill infants involves many different medical specialties, which can make the decision process complex and difficult. To optimize the care of infants with RS, we present our institution’s approach and a review of the current literature. Material and methods: A retrospective cohort study was conducted among 75 infants diagnosed with RS and managed at our institution in the 1996–2012 period. Additionally, the conducted treatment regimen in this paper was discussed with recent literature describing the approach of infants with RS. Results: Forty-four infants (59 %) were found to have been treated conservatively. A significant larger proportion of nonisolated RS infants than isolated RS infants needed surgical intervention (53 vs. 25 %, p =.014). A mandibular distraction was conducted in 24 % (n = 18) of cases, a tracheotomy in 9 % (n = 7), and a tongue–lip adhesion in 8 % (n = 6). Seventy-seven percent of all infants had received temporary nasogastric tube feeding. The literature review of 31 studies showed that initial examinations and the indications to perform a surgical intervention varied and were often not clearly described. Conclusions: RS is a heterogenic group with a wide spectrum of associated anomalies. As a result, the decisional process is challenging, and a multidisciplinary approach to treatment is desirable. Current treatment options in literature vary, and a more uniform approach is recommended. Clinical Relevance: We provide a comprehensive and pragmatic approach to the analysis and treatment of infants with RS, which could serve as useful guidance in other clinics. more...
- Full Text
- View/download PDF
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