Airway Obstruction Risk in Unique Infant Cleft Phenotype: PSIO Protocol Modification Recommendations

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Cleft Lip and Palate Research

Background:

• Unilateral cleft lip and palate can cause unique nasal airway obstruction.
• Presurgical infant orthopedic (PSIO) therapy and lip taping may exacerbate breathing difficulties in these infants.
• Specific alveolar segment positioning contributes to bilateral nasal obstruction.

Purpose of the Study:

• To describe a unique unilateral cleft phenotype causing nasal airway obstruction.
• To evaluate the efficacy of lip-nose adhesion (LNA) in relieving obstruction.
• To discuss treatment alternatives for infants with this specific cleft anatomy.

Main Methods:

• Case presentation of four patients with a distinct unilateral cleft phenotype.
• Description of bilateral nasal airway obstruction mechanisms.
• Surgical technique and outcomes of lip-nose adhesion (LNA).

Main Results:

• Patients presented with anterior greater alveolar segment projection and posterior lesser segment collapse.
• Bilateral nasal airway obstruction was observed due to cleft ala drape and caudal septum displacement.
• Lip-nose adhesion (LNA) provided immediate relief of airway obstruction.

Conclusions:

• Lip-nose adhesion (LNA) effectively addresses nasal airway obstruction in this specific cleft phenotype.
• Careful consideration of PSIO appliance modification versus LNA is crucial.
• Multidisciplinary consultation involving surgeons, PSIO providers, and caretakers is recommended.