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Mandibular growth in infants with Robin sequence treated with the Tübingen palatal plate

Cornelia Wiechers1,2, Wolfgang Buchenau1,2, Jörg Arand1,2

  • 1Department of Neonatology, Tübingen University Hospital, Calwerstr. 7, D-72076, Tübingen, Germany.

Head & Face Medicine
|June 24, 2019
PubMed

Insights

The Tübingen Palatal Plate (TPP) may improve mandibular growth and reduce airway obstruction in infants with Robin sequence (RS). This functional treatment shows promising results for infants with RS, potentially reducing the need for invasive interventions.

Area of Science:

  • Craniofacial surgery
  • Pediatric surgery
  • Otolaryngology

Background:

  • Robin sequence (RS) is a congenital condition characterized by a small jaw (mandibular retrognathia), a tongue falling back into the throat (glossoptosis), and breathing difficulties (upper airway obstruction).
  • The potential for mandibular catch-up growth in infants with RS is a subject of ongoing debate.
  • Nonsurgical interventions, including the Tübingen Palatal Plate (TPP), early oral feeding, and orofacial stimulation, are being explored to promote mandibular growth and improve outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of the Tübingen Palatal Plate (TPP) in promoting mandibular growth in infants with Robin sequence (RS).
  • To assess the impact of TPP treatment on objective measures of upper airway obstruction (sleep study results) and nutritional status (weight gain).

Main Methods:

  • A retrospective analysis was conducted on the electronic patient database of infants diagnosed with isolated or syndromic Robin sequence.
  • Data collected included measurements of the jaw index, results from sleep studies (Mixed-Obstructive Apnea Index - MOAI), and weight gain (Z-scores).
  • Measurements were taken at admission, discharge, and a 3-month follow-up to track changes over time.

Main Results:

  • Significant improvement in the jaw index was observed from admission to the 3-month follow-up (p < 0.0001).
  • The Mixed-Obstructive Apnea Index (MOAI) significantly decreased, indicating reduced airway obstruction (p < 0.002).
  • While no direct correlation was found between MOAI and jaw index, MOAI correlated with the Maxillary/Mandibular arch ratio (r=0.58; p < 0.001). Weight gain Z-scores remained stable, but the need for nasogastric tube feeding decreased from 84% to 8%.

Conclusions:

  • Longitudinal data suggest that the Tübingen Palatal Plate, when used in conjunction with other supportive therapies, may effectively alleviate upper airway obstruction in infants with Robin sequence.
  • The treatment appears to promote mandibular growth, offering a less invasive alternative to surgical interventions for managing RS.
  • Further research can explore the long-term impact and optimal application of TPP in diverse RS populations.
Abstract

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