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Nasopharyngoscopy in Robin sequence: clinical and predictive value
Telma Vidotto de Sousa1, Ilza Lazarini Marques, Araken Fernando Carneiro
1Hospital de Reabilitação de Anomalias Craniofaciais, University of São, Bauru, São Paulo, Brazil. telmavidoto@uol.com.br
Insights
Nasopharyngoscopy poorly predicts respiratory obstruction severity in infants with Robin sequence (RS). While glossoptosis severity correlates with age-related respiratory distress, it doesn't reliably predict clinical manifestations in the first month of life.
Area of Science:
- Craniofacial anomalies
- Pediatric respiratory medicine
- Neonatal care
Background:
- Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction.
- Respiratory distress is a common and potentially life-threatening complication in infants with RS, necessitating accurate assessment and management.
- Early identification of the severity of respiratory obstruction is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate the correlation between nasopharyngoscopic findings and clinical manifestations of respiratory obstruction in infants with Robin sequence during the first month of life.
- To assess the longitudinal course of respiratory obstruction over the first year of life in these infants.
- To determine the predictive value of nasopharyngoscopy for the clinical severity of respiratory obstruction in RS.
Main Methods:
- A longitudinal prospective study involving 56 infants diagnosed with Robin sequence.
- Nasopharyngoscopy was used to define the type and severity of respiratory obstruction, specifically glossoptosis.
- Infants were classified based on nasopharyngoscopic findings (mild, moderate, severe glossoptosis) and clinical manifestations.
Main Results:
- Respiratory obstruction due to glossoptosis was observed in 75% of the infants.
- A poor correlation was found between the severity of glossoptosis and clinical manifestations in the first month of life.
- A statistically significant correlation was observed between glossoptosis severity and respiratory distress in relation to age, with 83.3% showing mild or absent glossoptosis by 12 months.
Conclusions:
- Nasopharyngoscopy is not a reliable tool for predicting the clinical severity of respiratory obstruction caused by glossoptosis in the early neonatal period.
- While glossoptosis severity improves with age, its initial assessment via nasopharyngoscopy may not accurately reflect the infant's clinical presentation.
- Further research may be needed to identify more accurate methods for predicting the clinical course of respiratory obstruction in infants with Robin sequence.
Objective:
To correlate nasopharyngoscopic findings with clinical manifestations during the first month of life and study the course of respiratory obstruction during the first year in infants with Robin sequence (RS).
Design:
A longitudinal prospective study of children with RS.
Setting:
Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru-SP, Brazil, 1998 to 2000.
Patients:
Fifty-six children were studied from the age of 1 month to 12 months.
Interventions:
The type of respiratory obstruction was defined by nasopharyngoscopy. Patients for whom glossoptosis was the only mechanism of respiratory obstruction were classified as having mild, moderate, or severe glossoptosis by nasopharyngoscopy and as mild, moderate, or severe cases with respect to the clinical manifestations.
Results:
Forty-two (75%) patients showed respiratory obstruction caused by glossoptosis; seven (43.7%) of these infants with mild clinical manifestations showed moderate glossoptosis during the first month of life and five (31.3%) presented severe glossoptosis; 10 (45.5%) of the infants with severe clinical manifestations showed moderate and 11 (50.0%) severe glossoptosis. At 12 months of age, glossoptosis was mild or absent in 83.3% of the patients, moderate in 14.3% and severe in 2.4%.
Conclusions:
A poor correlation between the severity of glossoptosis and the severity of clinical manifestations was observed for patients with respiratory obstruction caused by glossoptosis during the first month of life, but the correlation between glossoptosis and respiratory distress according to age was statistically significant. Nasopharyngoscopy is not a good method for predicting the severity of the clinical course of respiratory obstruction caused by glossoptosis.
