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Gastroesophageal reflux in Pierre Robin sequence--early surgical treatment
Z Dudkiewicz1, E Sekuła, A Nielepiec-Jałosińska
1Department of Pediatric Surgery and Centre for Craniofacial Disorders, National Research Institute for Mother and Child, Warsaw, Poland. Zofia.Dudkiewicz@imid.med.pl
Insights
Early palatoplasty with subperiosteal release of the floor of the mouth effectively treated gastroesophageal reflux (GER) and upper respiratory tract infections in infants with Pierre Robin sequence, reducing the need for further surgeries.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Gastroenterology
Background:
- Pierre Robin sequence is associated with a high prevalence of gastroesophageal reflux (GER).
- GER can lead to complications such as upper respiratory tract infections.
- Traditional management may involve multiple surgical interventions.
Purpose of the Study:
- To determine the prevalence of GER in patients with Pierre Robin sequence.
- To evaluate the efficacy of early palatoplasty combined with subperiosteal release of the floor of the mouth (SRFM) in resolving GER and upper respiratory tract infections.
Main Methods:
- A cohort of 24 children with Pierre Robin sequence treated between 1993 and 1997 was retrospectively reviewed.
- GER screening was performed in children undergoing early palatoplasty (at 3 months of age).
- Palatoplasty combined with SRFM was implemented in the last two years of the study period.
Main Results:
- Gastroesophageal reflux (GER) was confirmed in 21 out of 24 patients.
- Early palatoplasty with SRFM resulted in prompt clinical improvement and shorter hospital stays.
- Post-operative follow-up showed no evidence of GER in patients who underwent the combined procedure.
Conclusions:
- Early surgical closure of the palatopharyngeal ring and addressing tongue-base issues can effectively manage GER in Pierre Robin sequence.
- This approach may reduce the necessity for additional surgeries like glossopexy, gastrostomy, tracheostomy, and Nissen's fundoplication.
Objective:
To assess the prevalence of gastroesophageal reflux (GER) in patients with Pierre Robin sequence and to assess whether early palatoplasty with subperiosteal release of the floor of the mouth eliminates upper respiratory tract infections and gastroesophageal reflux.
Methods:
In the period from 1993 to 1997, 24 children with Pierre Robin sequence were treated. Because GER is known to occur in patients with this syndrome, we screened for GER in each child for whom an early palatoplasty was to be performed at 3 months of age. In 21 cases, the presence of GER was confirmed. Within the past 2 years, palatoplasty has been combined with subperiosteal release of the floor of the mouth (SRFM). Prompt clinical improvement and shortened hospital stays have resulted.
Results And Conclusions:
Follow-up studies performed several months after the surgery showed no evidence of GER. The authors conclude that an early closure of the impaired palatopharyngeal ring and the elimination of the mechanism that causes the posterior rotation of the tongue can reduce the need for such surgical procedures as glossopexy, gastrostomy, tracheostomy, and Nissen's fundoplication.