Pierre Robin sequence from orthodontic and surgical perspective

Pierre Robin sequence(PRS)is a triad of micrognathia,glossoptosis,and cleft palate that results in an obstruction of the airway on inspiration and impeding feeding.The tongue of infants with PRS fall back toward the posterior pharyngeal wall(glossoptosis)due to receding chin produced by mandibular micrognathia(small jaw)or retrognathia.This causes a serious condition with potentially severe,life-threatening airway obstruction.If untreated,this problem can lead to exhaustion,cardiac failure,and ultimately death,especially during the early months of life.Actually,in the majority of PRS infants,these symptoms can be managed by placing the infant in the prone position until adequate growth of the jaw occurs.If this type of treatment fails,the infant then should be considered for other conservative therapies or surgical interventions.This paper reviews surgical interventions such as tongue-lip adhesion,mandibular traction,mandibular distraction,tracheotomy and conservative orthodontic approaches,and presents a baby treated successfully with an orthodontic appliance.

Prospective cohort study on facial profile changes in infants with Robin sequence and healthy controls

Background Various conservative and surgical approaches exist to treat Robin sequence(RS),but their effects on facial profile and mandibular catch-up growth are unclear.A functional treatment concept,used in our centre for 25 years,includes an individualized palatal plate with a velo-pharyngeal extension and intensive feeding training.Methods We performed a prospective study to objectively describe facial profiles in infants with RS treated with the above concept.Infants with isolated RS were admitted to our tertiary perinatal and national referral centre for craniofacial malformations between May 2018 and Nov 2019.Infants with RS received 3D-photographs during clinically indicated visits.Healthy controls were recruited from Dec 2018 to Sep 2019 and received 3D-photographs every 3 months.The digitally measured jaw index(JI),defined as alveolar overjet(O)x maxillary arch(U)/mandibular arch(L),and the soft tissue reference points A’-point,Nasion’,B’-point angle(ANB’),describing the relative position of maxilla to mandible,were evaluated.Linear mixed models were used to examine time trajectories in JI and ANB’.Results A total of 2073D images,obtained in 19 infants with RS and 32 controls,were analysed.JI and ANB’decreased over time in both groups[for JI−0.18(95%CI−0.25 to−0.10);for ANB’:−0.40°per month[(95%CI−0.48 to−0.32)]]but remained lower in controls[for JI−2.5(95%CI−3.2 to−1.8);for ANB’-1.7°(95%CI−2.4 to−1.0)].Also,the ANB’model showed a significant effect of the interaction term diagnosis x age.Conclusions Based on longitudinal 3D images,we describe changes in objective parameters of facial profile in infants with and without RS during the first year of life.Our findings indicate catch-up growth in infants treated for RS.