Multidisciplinary approach to airway management in Pierre Robin sequence: beyond tracheostomy

Abstract

Objective

Pierre robin sequence (PRS) is characterized by a triad of cleft palate, micrognathia and glossoptosis leading to upper airway obstruction with feeding difficulties. Objective of our study is to share our experience on how children with Airway problems in PRS can be managed without the need for tracheostomy by Multidisciplinary approach for evaluation and management.

Methods

A retrospective review of 33 patients between April 2014–Dec 2022 diagnosed with PRS who were admitted to the NICU with feeding or breathing difficulties were taken into the study. Electronic data was collected and analyzed. Statistical analysis of age, gender, clinical features,intervention required and outcome were made.

Results

In our review of 33 patients, mean age was 2.5 months. 17 (51 %) were males and sixteen (48 %) were females. Non surgical interventions included feed establishment and placement of obturator. Surgical intervention was required in sixteen (48 %) of patients, of which 8 (24 %) underwent glossopexy, 6 (18 %)underwent supraglottoplasty and 2 (6 %) underwent tracheostomy. Of the 2 tracheostomised children one was decannulated and the other child was lost to follow up. Thirty one patients were managed without the need for tracheostomy.

Conclusion

Prior to considering tracheostomy as a bypass to upper airway obstruction commonly seen in PRS children, a multidisciplinary approach for evaluation providing combined conservative and airway intervention can be beneficial and thereby improving the QoL.

Significance to aerodigestive medicineAerodigestive medicine has a significant role in addressing the two major problems in management of PR sequence - feeding and respiratory difficulties. Prompt evaluation and effective intervention can ensure optimal function of the aerodigestive tract.