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Non-operative interventions for Pierre-Robin sequence: A systematic review and meta-analysis.

Justin Haas1, Kimberley Yuen1, Forough Farrokhyar2

  • 1McMaster University, 1280 Main St. W., Hamilton, ON, Canada, L8S 4L8.

Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
|September 10, 2024
PubMed
Summary

Most infants with Pierre-Robin Sequence (PRS) receive non-operative airway interventions. Infant positioning, orthodontic appliances, and nasopharyngeal tubes are the most common methods for managing PRS respiratory distress.

Keywords:
Conservative managementNasopharyngeal tubeNon-operative managementOrthodontic plate therapyPierre-robin sequencePierre-robin syndromePositioning

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Area of Science:

  • Pediatrics
  • Otolaryngology
  • Respiratory Medicine

Background:

  • Pierre-Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and airway obstruction.
  • Management of respiratory distress in PRS infants lacks standardized guidelines, and surgical options carry risks.
  • Non-operative interventions offer an alternative for PRS airway management.

Purpose of the Study:

  • To systematically review all non-operative airway intervention modalities for infants with Pierre-Robin Sequence.
  • To identify the most frequently used non-operative treatments for PRS-related respiratory distress.

Main Methods:

  • Systematic review following PRISMA 2020 guidelines.
  • Searched Embase, Medline, Cochrane, EMCARE, and Web of Science databases (1992-2022).
  • Included studies focused on non-operative management of PRS infants under one year; excluded non-original research, surgical-only focus, case reports, and non-English articles.

Main Results:

  • 88 articles were included from 3280 screened abstracts.
  • Non-operative interventions were used in 65.8% of 4708 PRS infants across 60 studies.
  • Common non-operative interventions included infant positioning (1664), orthodontic appliances (1299), and nasopharyngeal tubes (983).

Conclusions:

  • Non-operative management is the predominant approach for PRS infants.
  • Infant positioning, orthodontic appliances, and nasopharyngeal tubes are the most frequently reported non-operative interventions.
  • Further research may be needed to address the moderate methodological quality of included studies.