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Minimally-invasive airway management and early cleft palate repair in infants born with Robin sequence

Catherine de Blacam1, Daryl Butler2, Laura Duggan3

  • 1Dept of Plastic Surgery, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Royal College of Surgeons in Ireland, Dublin 2, Ireland.

Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
|March 6, 2024
PubMed

Insights

Early cleft palate repair in infants with Robin sequence (RS) using non-surgical airway management improved oxygen saturation and reduced obstructive apnoea-hypopnea index (OAHI). This approach is effective for managing RS airway issues.

Area of Science:

  • Pediatric Surgery
  • Craniofacial Surgery
  • Neonatology

Background:

  • Robin sequence (RS) presents significant airway challenges in infants.
  • Cleft palate repair timing is critical for managing RS-related respiratory distress.

Purpose of the Study:

  • To evaluate outcomes of early cleft palate repair in infants with RS.
  • To assess the efficacy of non-surgical airway management in this population.

Main Methods:

  • Retrospective case series of 69 infants with RS and cleft palate.
  • Utilized nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) guided by sleep studies.
  • Performed cleft palate repair using a modified Malek technique between 6-9 months.

Main Results:

  • NPA was the most common airway adjunct (59.4%), with a median use of 5.6 months.
  • Cleft palate repair occurred at a median age of 7 months.
  • Significantly lower obstructive apnoea-hypopnea index (OAHI) postoperatively (5.9 vs 2.8, P=0.028).

Conclusions:

  • Non-surgical airway strategies combined with early cleft palate repair are beneficial for infants with RS.
  • This combined approach effectively manages airway obstruction and improves respiratory outcomes.

Keywords:
Early cleft palate repairIsolated cleft palateNasopharyngeal airwayNon-invasive ventilationRobin sequence

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