The Tübingen palatal plate approach to Robin sequence: Summary of current evidence

Area of Science:

• Craniofacial Surgery
• Pediatric Otolaryngology
• Neonatology

Background:

• Robin sequence (RS) often presents with upper airway obstruction (UAO) requiring intervention.
• Current treatments for RS-associated UAO can be invasive, raising concerns about patient harm.
• The Tübingen palatal plate (TPP) is a device used to manage UAO in infants with RS.

Purpose of the Study:

• To review data on the efficacy and safety of the Tübingen palatal plate (TPP) for managing upper airway obstruction in infants with Robin sequence (RS).
• To compare the TPP treatment with other interventions, including invasive procedures and prone positioning.

Main Methods:

• A narrative review of data from peer-reviewed studies on TPP treatment in infants with RS.
• Inclusion of data from a randomized trial comparing TPP to a sham procedure.
• Analysis of outcomes including UAO alleviation, intellectual development, apnea index, and need for tracheostomy.

Main Results:

• The TPP was superior to sham procedures in alleviating UAO.
• Infants treated with TPP showed normal intellectual development.
• TPP reduced the mixed-obstructive apnea index and the need for tracheostomy (5% overall, 100% in syndromic cases requiring it).
• Prone positioning was ineffective and associated with increased risk of sudden death.
• Emerging data suggest TPP may promote mandibular growth and reduce respiratory complications post-cleft surgery.

Conclusions:

• The TPP is an effective and safe treatment for UAO in infants with RS, offering significant advantages over invasive procedures.
• The TPP supports normal development and may have long-term benefits, including mandibular growth.
• Standardized monitoring with endoscopy and sleep studies is crucial for TPP effectiveness, questioning the adherence to the 'First do no harm' principle with more invasive methods.