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Multidisciplinary approach to airway management in Pierre Robin sequence: beyond tracheostomy
Thirunavukkarasu Saravanamuthu1, Pravilika Parachur2, M D Sofitha3
1Kanchi Kamakoti Childs Trust Hospital, India.
Insights
Pierre Robin Sequence (PRS) management for airway issues can often avoid tracheostomy. A multidisciplinary approach focusing on feeding and airway interventions improves quality of life for affected children.
Area of Science:
- Pediatric Otolaryngology
- Aerodigestive Medicine
- Neonatal Care
Background:
- Pierre Robin Sequence (PRS) presents with micrognathia, glossoptosis, and cleft palate, frequently causing upper airway obstruction and feeding difficulties.
- Airway compromise in PRS is a significant concern, often leading to interventions like tracheostomy.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary approach in managing airway problems in infants with Pierre Robin Sequence (PRS).
- To demonstrate that airway issues in PRS can be managed without resorting to tracheostomy in most cases.
Main Methods:
- Retrospective review of 33 infants diagnosed with PRS admitted to the NICU between April 2014 and December 2022.
- Data collected included patient demographics, clinical features, interventions (surgical and non-surgical), and outcomes.
- Statistical analysis was performed on collected data.
Main Results:
- Out of 33 patients, 31 (94%) were managed without tracheostomy.
- Non-surgical interventions included feeding support and obturator placement.
- Surgical interventions were performed in 16 patients, including glossopexy and supraglottoplasty; only 2 required tracheostomy, with one successfully decannulated.
Conclusions:
- A multidisciplinary evaluation and management strategy, incorporating conservative and airway interventions, is effective in managing upper airway obstruction in PRS patients.
- This approach can significantly improve the quality of life for children with PRS by avoiding tracheostomy.
- Aerodigestive medicine plays a crucial role in addressing both feeding and respiratory challenges in PRS.
Objective:
Pierre robin sequence (PRS) is characterized by a triad of cleft palate, micrognathia and glossoptosis leading to upper airway obstruction with feeding difficulties. Objective of our study is to share our experience on how children with Airway problems in PRS can be managed without the need for tracheostomy by Multidisciplinary approach for evaluation and management.
Methods:
A retrospective review of 33 patients between April 2014-Dec 2022 diagnosed with PRS who were admitted to the NICU with feeding or breathing difficulties were taken into the study. Electronic data was collected and analyzed. Statistical analysis of age, gender, clinical features,intervention required and outcome were made.
Results:
In our review of 33 patients, mean age was 2.5 months. 17 (51 %) were males and sixteen (48 %) were females. Non surgical interventions included feed establishment and placement of obturator. Surgical intervention was required in sixteen (48 %) of patients, of which 8 (24 %) underwent glossopexy, 6 (18 %)underwent supraglottoplasty and 2 (6 %) underwent tracheostomy. Of the 2 tracheostomised children one was decannulated and the other child was lost to follow up. Thirty one patients were managed without the need for tracheostomy.
Conclusion:
Prior to considering tracheostomy as a bypass to upper airway obstruction commonly seen in PRS children, a multidisciplinary approach for evaluation providing combined conservative and airway intervention can be beneficial and thereby improving the QoL. Significance to aerodigestive medicineAerodigestive medicine has a significant role in addressing the two major problems in management of PR sequence - feeding and respiratory difficulties. Prompt evaluation and effective intervention can ensure optimal function of the aerodigestive tract.
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