Respiratory distress in Pierre Robin sequence: an experience with mandible traction by wires

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Neonatal Respiratory Medicine

Background:

• Isolated Pierre Robin sequence (iPRS) is characterized by congenital retrognathia and glossoptosis, leading to airway obstruction and feeding difficulties in neonates.
• Glossoptosis, a retracted tongue due to a small mandible, significantly reduces the oropharyngeal airway, causing potential hypoxemia and failure to thrive.
• Existing treatments for iPRS-related respiratory issues include prone positioning, nasopharyngeal tubes, glossopexy, and mandibular distraction.

Purpose of the Study:

• To evaluate the efficacy and safety of mandibular traction using parasymphyseal wires for treating respiratory problems in neonates and infants with iPRS.
• To assess the impact of this specific surgical technique on airway obstruction and apnea associated with glossoptosis.

Main Methods:

• A retrospective review of 118 neonates and infants treated for iPRS over 28 years.
• Mandibular traction was achieved using two parasymphyseal wires placed under local anesthesia.
• Success was defined by the resolution of respiratory problems and apnea.

Main Results:

• All 118 procedures were successful, with no major complications reported.
• Patients experienced a sudden and complete resolution of respiratory problems and apnea immediately following the initiation of mandibular traction.
• The parasymphyseal wire technique proved effective in alleviating airway obstruction caused by glossoptosis.

Conclusions:

• Mandibular traction with parasymphyseal wires is a safe and highly effective treatment for respiratory distress in isolated Pierre Robin sequence.
• This minimally invasive technique offers a rapid solution for airway obstruction and apnea, improving outcomes for affected neonates and infants.