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Adverse Events Following Palatoplasty in Patients With Robin Sequence: The Impact of Prior Airway Treatment

Liara S Ortiz-Ocasio1, Esperanza Mantilla-Rivas1, Joseph M Escandón1

  • 1Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|August 4, 2025
PubMed

Insights

Prior management of upper airway obstruction (UAO) in Robin Sequence (RS) patients undergoing palatoplasty does not significantly impact postoperative complications. Early UAO intervention leads to comparable safety outcomes, suggesting cost-saving opportunities by utilizing surgical floor care over pediatric intensive care unit (PICU) admissions for stable patients.

Area of Science:

  • Pediatric Surgery
  • Craniofacial Anomalies
  • Airway Management

Background:

  • Robin Sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction (UAO).
  • Palatoplasty is a common surgical intervention for RS patients to address feeding and speech difficulties.
  • The impact of prior UAO management strategies on postoperative outcomes and resource utilization following palatoplasty remains unclear.

Purpose of the Study:

  • To investigate the influence of different upper airway obstruction (UAO) management approaches on postoperative complications after palatoplasty in patients with Robin Sequence (RS).
  • To compare the healthcare costs associated with pediatric intensive care unit (PICU) versus surgical floor care for these patients.

Main Methods:

  • A prospective cohort study involving 58 RS patients undergoing palatoplasty between 2006 and 2020.
  • Patients were categorized based on prior UAO management: conservative, tongue-lip adhesion (TLA), or mandibular distraction osteogenesis (MDO).
  • Postoperative airway and non-airway complications, complication severity, and PICU versus floor care costs were analyzed.

Main Results:

  • Overall complication rates were 31% for airway and 22.4% for non-airway issues, with most being minor.
  • No statistically significant differences in complication rates were found based on prior UAO management (conservative, TLA, MDO).
  • PICU admission rates were significantly higher for TLA (85.7%) and MDO (85.7%) groups compared to the conservative group (33.3%), with PICU care increasing total costs by 72.1%.

Conclusions:

  • Post-palatoplasty complications in Robin Sequence patients are common but generally minor.
  • Appropriate infant UAO management ensures comparable safety regarding postoperative complications.
  • Admitting medically stable patients to the surgical floor instead of the PICU can reduce costs and conserve resources without compromising patient care.

Keywords:
Pierre Robin Syndromeairway obstructioncleft palatepostoperative complicationsrisk assessment

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