Airway Management in Pierre Robin Sequence: The Vancouver Classification

Area of Science:

• Pediatric Otolaryngology
• Craniofacial Surgery
• Neonatal Intensive Care

Background:

• Pierre Robin sequence (PRS) is characterized by micrognathia, glossoptosis, and respiratory distress.
• Current management of neonatal airway in PRS lacks a standardized clinical classification system.
• This study aimed to review PRS presentation and management to develop a clinical grading system and treatment algorithm.

Purpose of the Study:

• To review the clinical presentation and management strategies for neonates diagnosed with Pierre Robin sequence (PRS).
• To develop and propose a novel 4-point clinical classification system for PRS.
• To create a treatment algorithm to guide the management of neonatal airway in PRS patients.

Main Methods:

• A 10-year retrospective review of neonates diagnosed with PRS was conducted.
• Inclusion criteria required at least two features: glossoptosis, retrognathia, or airway obstruction.
• Data collected included demographics, clinical information, interventions, complications, and outcomes.

Main Results:

• Sixty-three PRS patients were analyzed; 55% had cleft palate and 27% were syndromic.
• Prone positioning was used in 76% of patients; surgical interventions included floor of mouth release, mandibular distraction osteogenesis (MDO), and tongue-lip adhesion.
• Seven surgically managed patients required gastrostomy tubes, and some needed secondary surgeries for airway management.

Conclusions:

• There is a lack of consensus regarding neonatal airway management in infants with Pierre Robin sequence.
• A proposed 4-point classification system and treatment algorithm based on clinical features is presented.
• This system aims to standardize and improve the clinical approach to PRS airway management.