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Subperiosteal release of the floor of the mouth in Pierre Robin sequence: experience with 12 cases
L Caouette-Laberge1, C Plamondon, Y Larocque
1Division of Plastic Surgery, Hôpital Sainte-Justine, Université de Montreal, Quebec, Canada.
Insights
Subperiosteal release of the floor of the mouth (SRFM) effectively treats airway obstruction and feeding issues in infants with Pierre Robin sequence. This surgical intervention improved breathing and oxygen levels, leading to positive outcomes for most patients.
Area of Science:
- Craniofacial Surgery
- Pediatric Otolaryngology
- Pediatric Airway Management
Background:
- Pierre Robin sequence presents significant challenges including severe upper-airway obstruction and feeding difficulties.
- Current management strategies for Pierre Robin sequence require effective interventions to improve patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of subperiosteal release of the floor of the mouth (SRFM) in managing infants with Pierre Robin sequence.
- To assess the impact of SRFM on upper-airway obstruction and feeding difficulties.
Main Methods:
- A retrospective review of 12 children with Pierre Robin sequence treated with SRFM between 1983 and 1995.
- Patients were divided into two groups: group 1 (n=10) for airway obstruction and group 2 (n=2) for feeding difficulties.
- Postoperative outcomes including intubation duration, polysomnography results, and feeding status were analyzed.
Main Results:
- SRFM significantly improved obstructive phenomena and oxygen saturation levels in infants with airway obstruction.
- Most children were decanulated or discharged with oral feeding, indicating successful management.
- One case of wound infection was the only complication, successfully treated with antibiotics.
Conclusions:
- Subperiosteal release of the floor of the mouth is an effective surgical option for Pierre Robin sequence.
- SRFM addresses both severe upper-airway obstruction and feeding challenges in affected infants.
- The procedure demonstrates a favorable safety profile with minimal complications.
Abstract:
Between 1983 and 1995, 12 children with Pierre Robin sequence were treated with a subperiosteal release of the floor of the mouth (SRFM) to correct severe upper-airway obstruction (group 1: n = 10) and prolonged feeding difficulties (group 2: n = 2). Eight children had isolated Pierre Robin sequence, while four had associated anomalies. The age at surgery was 2 to 13 weeks (mean, 5.2 wk) in group 1, and 8.5 months to 5 years in group 2. Postoperative endotracheal intubation was maintained for 1 to 14 days, and nasopharyngeal intubation for 3 to 13 days. One child with a tracheostomy prior to SRFM was decanulated 11 weeks postoperatively. Postoperative course was uneventful and control polysomnograms (group 1) showed a marked improvement of the obstructive phenomenons and O2 saturation levels. Children were discharged 2 to 6 weeks postoperatively (mean, 4 wk) except for the child with a tracheostomy (19 wk). The only complication was a wound infection treated with systemic antibiotics. Oral feedings were initiated shortly after extubation: six children were discharged with oral feedings only, one child required supplemental gavages for 6 weeks at home, and three children had persistent inadequate oral intake. We have found SRFM to be an effective surgical procedure for the management of infants with Pierre Robin sequence.