The Stanford Orthodontic Airway Plate: Design and Clinical Implementation in 64 Consecutively Treated Infants With...

Mandibular distraction osteogenesis (MDO) is the established standard of care in the United States for severe upper airway obstruction in infants with Pierre Robin Sequence (PRS). While airway plates have been utilized effectively in Europe for decades, this approach was not adopted in the United States until 2020, when an institution-specific protocol was developed to coexist with surgical paradigms. The current study details the design and clinical implementation of the institution's Orthodontic Airway Plate (OAP). By applying orthodontic Visual Treatment Objective principles to maxillofacial computed tomography, infant-specific airway dimensions were preprogrammed into the device design. This methodology ensures immediate airway patency upon device delivery and minimizes bedside modifications associated with traditional methods. An innovative outpatient adjustment regimen was developed to accelerate mandibular growth without hindering maxillary development. In a cohort of 64 consecutively treated infants, 62 (96.9%) were successfully discharged home. Thirty-five infants were transferred from other hospitals specifically for OAP at distances exceeding 350 miles, including 30 from outside the state of California. None required subsequent MDO or tracheostomy. The mean age (± standard deviation) was 1.7 months (±0.9) at the start of treatment. The mean hospital stay from OAP delivery to discharge was 16.2 days (±8.1). The mean treatment duration was 3.6 months (±1.3). The mean Obstructive Apnea Hypopnea Index decreased from 33.9 events/hour (±26.0) to 8.5 events/hour (±5.0) immediately following OAP delivery. This OAP protocol has demonstrated efficacy as a robust and predictable nonsurgical complement to MDO, marking a significant milestone in contemporary management of infants with PRS.