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Perioperative complications in cleft palate repair with Robin sequence following Tuebingen palatal plate treatment
Andreas Naros1, Michael Krimmel1, Franziska Zengerle2
1Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Germany; Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Germany.
Insights
The Tuebingen palatal plate (TPP) effectively manages upper airway obstruction in Robin sequence (RS) patients, minimizing perioperative complications during cleft palate repair. This approach ensures normal airway function and adequate weight gain before surgery.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Anesthesiology
Background:
- Robin sequence (RS) presents significant challenges in cleft palate repair due to associated airway obstruction.
- Effective perioperative management is crucial for improving outcomes in RS patients.
Purpose of the Study:
- To evaluate perioperative complications in cleft palate repair for Robin sequence (RS) patients.
- To assess the impact of the Tuebingen palatal plate (TPP) and anesthesiology protocol refinement on patient outcomes.
Main Methods:
- Retrospective analysis of 143 RS patients undergoing cleft palate repair (2000-2020).
- Inclusion of patients treated with the Tuebingen palatal plate (TPP).
- Comparison of outcomes before and after anesthesiology protocol adjustment in 2014.
Main Results:
- TPP treatment normalized the mixed-obstructive apnea index (MOAI) and promoted adequate weight gain.
- Postoperative course was uneventful in 93% of cases.
- Anesthesiology protocol refinement reduced perioperative events from 10.7% to 2.9%.
Conclusions:
- Early TPP treatment is recommended for Robin sequence (RS) children.
- TPP effectively corrects upper airway obstruction, minimizing perioperative complications in cleft palate repair.
- Refined anesthesiology protocols further enhance perioperative safety.
Abstract:
Our study aimed to evaluate perioperative complications following our institutional pre- and intraoperative management in cleft palate repair with Robin sequence (RS). RS patients who underwent cleft palate repair between 2000 and 2020 were retrospectively analysed. RS children with complete documentation and whose initial treatment involved the Tuebingen palatal plate (TPP) were included. Clinical records and operative charts were reviewed with regard to clinical characteristics as well as the neonatal and perioperative course. Results before and after adjustment of the anesthesiology protocol in 2014 were compared. 143 RS patients (41% male, 59% female) were included. Median pretherapeutic mixed-obstructive apnea index (MOAI) after birth was 9.4/hour (IQR 20.0). TPP treatment was associated with normalisation of the MOAI and adequate weight gain until surgery. At surgery, median age was 10 months (IQR 3), MOAI 0.1/h (IQR 0.5), and weight 8.7 kg (IQR 1.7). In 93% of cases (n = 133), the postoperative course was uneventful. Refinement of the anesthesiology protocol showed positive effects on the perioperative course and led to a reduction in perioperative events (10.7% vs. 2.9%). No severe perioperative complications occurred. We recommend the adoption of TPP treatment in the therapy of RS children. Our favourable results show that early TPP treatment minimizes perioperative complications in cleft palate repair by effectively and sustainably correcting upper airway obstruction.
