Airway compromise following palatoplasty in Robin sequence: improving safety and predictability

Prior studies report a high incidence of airway complications in patients with Robin sequence following palatoplasty. The authors' institution uses polysomnography to assess risk of airway compromise before palatoplasty in Robin sequence. This study compares airway complications in Robin sequence to cleft palate only using this screening airway protocol and identifies risk factors for airway complications after palatoplasty.

A 12-year retrospective review of patients with Robin sequence undergoing palatoplasty was performed. Robin sequence patients were divided into nonoperative management and mandibular distraction osteogenesis subgroups. Preoperative variables including comorbidities were recorded. The primary outcome was postoperative airway complication, defined as reintubation, emergency room visit, or hospital admission within 3 months of palatoplasty.

One hundred thirteen patients met inclusion criteria: polysomnography, 34.5 percent; Robin sequence, 65.5 percent; and Robin sequence treated with mandibular distraction osteogenesis, 30.1 percent. Screening polysomnography was used to indicate patients for palatoplasty or other airway interventions. The total airway complication rate was 7.1 percent; this was similar in Robin sequence (5.8 percent) and cleft palate only (7.7 percent). In isolated Robin sequence, the reintubation rate was 0 percent. Lower airway anomalies were associated with airway complications (p = 0.03). Significant variables for reintubation were cardiac (p = 0.046), gastrointestinal (p = 0.04), and lower airway anomalies (p = 0.025) and syndromic diagnosis (p = 0.05).

Screening polysomnography can control airway complications following palatoplasty in Robin sequence patients to a rate that is comparable to that of patients with cleft palate only.