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Airway management in Pierre Robin sequence
C M Myer1, J M Reed, R T Cotton
1Department of Otolaryngology and Maxillofacial Surgery, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Insights
Management of airway obstruction in children with Pierre Robin sequence lacks consensus. Pediatric otolaryngology programs show varied practices, with tracheotomy often favored despite limited data, highlighting the need for evidence-based guidelines.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pediatric Surgery
Background:
- Pierre Robin sequence frequently causes airway obstruction in infants.
- Current long-term management strategies for this condition are controversial and lack standardized protocols.
- Existing literature reflects a lack of consensus among specialists.
Purpose of the Study:
- To survey current practice patterns in pediatric otolaryngology fellowship programs regarding airway obstruction in Pierre Robin sequence.
- To identify methods for evaluating airway obstruction, home care choices, and treatment complications.
- To highlight the discrepancies between clinical practice and scientific evidence.
Main Methods:
- A survey was distributed to all 23 pediatric otolaryngology fellowship programs.
- The survey addressed evaluation methods (e.g., polysomnography), home care after failed conservative treatment, and treatment modality complications.
- Responses were analyzed to identify trends and variations in management approaches.
Main Results:
- Significant variation in practice patterns was observed among the surveyed programs.
- Tracheotomy was frequently reported as the preferred method for long-term airway management.
- Decision-making often appeared influenced by emotional factors rather than solely by scientific data.
Conclusions:
- There is a notable lack of consensus in the long-term management of airway obstruction in Pierre Robin sequence.
- Clinical practice is not consistently guided by robust scientific evidence.
- Recommendations are provided to guide clinicians in evidence-based management of these complex pediatric cases.
Abstract:
There is a great deal of controversy regarding the long-term management of airway obstruction in children with Pierre Robin sequence. All 23 pediatric otolaryngology fellowship programs were surveyed to determine their current practice patterns. Issues that were addressed included methods of evaluation of airway obstruction, including polysomnography, choices for home care in children in whom observation and positioning treatment failed, and complications of the various treatment modalities. The lack of unanimity among the respondents mirrors the controversy found in the literature. Though tracheotomy appears to be favored as the method of long-term management, responses from those surveyed often were based on emotions as much as on scientific data. This report details those findings and offers suggestions to clinicians involved with the management of patients with Pierre Robin sequence with airway compromise.