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Caring for Infants with Robin Sequence Treated with the Tübingen Palatal Plate: A Review of Personal Practice
Petra Knechtel1, Christina Weismann2,3, Christian F Poets1,2
1Department of Neonatology, Tübingen University Hospital, 72076 Tübingen, Germany.
Insights
The Tübingen Palatal Plate (TPP) offers effective, minimally invasive treatment for infants with Robin Sequence (RS) by improving upper airway obstruction. This functional orthodontic approach has eliminated the need for tracheostomies in isolated RS cases.
Area of Science:
- Craniofacial Orthodontics
- Pediatric Sleep Medicine
- Neonatal Care
Background:
- Robin Sequence (RS) presents significant upper airway obstruction challenges in infants.
- Current treatments often involve invasive procedures.
- A need exists for effective, minimally invasive interventions.
Purpose of the Study:
- To review practical experience with the Tübingen Palatal Plate (TPP) for treating infants with Robin Sequence.
- To assess the efficacy of TPP in managing upper airway obstruction.
- To highlight the TPP's role in preventing tracheostomy.
Main Methods:
- Utilized 3-D intraoral scans for semi-digital TPP manufacturing.
- Confirmed TPP extension length and angulation via awake laryngoscopy.
- Assessed treatment effectiveness using sleep studies and clinical observation.
Main Results:
- Immediate normalization of breathing observed upon TPP insertion.
- No tracheostomies were required for isolated RS cases treated with TPP.
- TPP facilitated feeding training and daily oral care.
Conclusions:
- The Tübingen Palatal Plate is a highly effective, minimally invasive functional orthodontic treatment for RS-related upper airway obstruction.
- Early parental involvement and dedicated team support are crucial for successful TPP implementation.
- TPP significantly reduces the need for tracheostomy in infants with Robin Sequence.
Abstract:
The Tübingen Palatal Plate (TPP) is a minimally invasive yet highly effective functional orthodontic treatment for upper airway obstruction in infants with Robin Sequence (RS). It consists of a palatal plate to cover the cleft and a velar extension that shifts the root of the tongue forward. We review our practical experience with this approach. First, upon admission, our local orthodontists perform an (3-D) intraoral scan of the maxilla. Based on the scan data, the TPP is manufactured in a semi-digital workflow. The length and angulation of its extension is checked via awake laryngoscopy and the effectiveness confirmed by a sleep study. Plates are kept in place by adhesive cream. When inserting the TPP, the tip of the tongue must be visible. Next, metal fixation bows should be secured to the forehead using tape and elastic bands. Plates are removed daily for cleaning, and the oral mucosa is then checked for pressure marks. Feeding training (initially only via finger feeding) may even start before plate insertion. Breathing often normalizes immediately once the plate is inserted. For isolated RS, we have never had to perform a tracheostomy. This has largely been possible through our highly dedicated and competent team, particularly the nursing staff, and the early involvement of parents.
