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Current Trends in Surgical Airway Management of Neonates with Robin Sequence

Fan, Kenneth L., MD*; Mandelbaum, Max; Buro, Justin; Rokni, Alex; Rogers, Gary F., MD, JD, MBA, MPH; Chao, Jerry W., MD; Oh, Albert K., MD

Plastic and Reconstructive Surgery – Global Open: November 7, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001973
Latest Articles: PDF Only

Background: Robin sequence is defined by the clinical triad of micrognathia, glossoptosis, and upper airway obstruction, and is frequently associated with cleft palate and failure to thrive. Though the efficacy of certain surgical interventions to relieve airway obstruction has been well established, algorithms dictating decision making and perioperative protocols are poorly defined.

Methods: A 22-question survey was sent via e-mail to members of the American Cleft Palate-Craniofacial Association and International Society of Craniofacial Surgeons. Questions were related to surgeon experience in treating neonates with Robin sequence, and specific perioperative protocols.

Results: One hundred fifty-one responses were collected. Most respondents were surgeons practicing in North America(82.8%), in a university hospital setting (81.5%) and had completed a fellowship in pediatric plastic surgery or craniofacial surgery (76.2%). Preoperative protocols varied widely by years in training and location of practice. Although 78.8% of respondents always performed direct laryngoscopy, only 49.7% of respondents routinely obtained preoperative polysomnography. Mandibular distraction osteogenesis was the most common primary surgical airway intervention reported by 74.2%, with only 12.6% primarily utilizing tongue-lip adhesion. Slightly less than half of respondents ever performed tongue-lip adhesion. Operative selection was influenced by surgeon experience, with 80% of those in practice 0–5 years primarily utilizing mandibular distraction, compared with 56% of respondents in practice >15 years.

Conclusions: This study documents wide variations in preoperative, operative, and postoperative protocols for the surgical airway management of neonates with severe Robin sequence. These results underscore the need to acquire more objective data, to compare different protocols and outcome measures.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, D.C.

Division of Plastic and Reconstructive Surgery, The George Washington University School of Medicine and Health Sciences, Washington, D.C.

Division of Plastic and Reconstructive Surgery, Children’s National Medical Center, Washington, D.C.

Published online 7 November 2018.

Received for publication July 5, 2018; accepted August 15, 2018.

Presented at the ACPA 2018 Annual Meeting, Pittsburgh, Pa.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

Albert K. Oh, MD, Division of Plastic & Reconstructive Surgery, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.