Hanneke Basart1, Frea H Kruisinga2, Corstiaan C Breugem3, J Peter W Don Griot4, Raoul C Hennekam2, Chantal M A M Van der Horst5. 1. Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: h.basart@amc.nl. 2. Department of Pediatrics, Emma Children's Hospital, Amsterdam, The Netherlands. 3. Department of Plastic, Reconstructive and Hand Surgery, Utrecht Medical Centre/Wilhelmina Children's Hospital, Utrecht, The Netherlands. 4. Department of Plastic, Reconstructive and Hand Surgery, VU Medical Centre, Amsterdam, The Netherlands. 5. Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Robin Sequence (RS) is characterized by micrognathia and upper airway obstruction (UAO), with or without cleft palate, causing respiratory and feeding problems. Management options are: positioning; nasopharyngeal airway (NPA); tongue-lip adhesion (TLA); mandibular distraction (MDO); and tracheostomy. Controversy exists in literature regarding RS definition and management. Here we describe definitions, management strategies and criteria in opting for management strategies, used by Dutch and Belgian cleft teams. METHODS: A specifically designed questionnaire was sent to members of all 16 Dutch and Belgian cleft teams. RESULTS: 14 cleft teams returned 35 questionnaires. All used micrognathia as definition criterion, 93.4% cleft palate, 51.5%glossoptosis and 45.7% UAO. Six different RS definitions were used; even within a single team >1 definition was used. All teams used different management strategies: all used positioning, 10 NPA, 6 TLA, 7 MDO, 8 tracheostomy, 5 refer patients with invasive treatment indication. Criteria in opting management modalities were: O2-saturation (89.3%), clinical presentation (86.2%), growth and feeding problems (69.0%), polysomnography (62.1%), and differed within teams. CONCLUSION: The Dutch and Belgian cleft teams use variable RS definitions, different management modalities and criteria in choosing management strategies. A single, strict definition and evidence-based management guidelines should be formulated for optimal patient care.
BACKGROUND:Robin Sequence (RS) is characterized by micrognathia and upper airway obstruction (UAO), with or without cleft palate, causing respiratory and feeding problems. Management options are: positioning; nasopharyngeal airway (NPA); tongue-lip adhesion (TLA); mandibular distraction (MDO); and tracheostomy. Controversy exists in literature regarding RS definition and management. Here we describe definitions, management strategies and criteria in opting for management strategies, used by Dutch and Belgian cleft teams. METHODS: A specifically designed questionnaire was sent to members of all 16 Dutch and Belgian cleft teams. RESULTS: 14 cleft teams returned 35 questionnaires. All used micrognathia as definition criterion, 93.4% cleft palate, 51.5%glossoptosis and 45.7% UAO. Six different RS definitions were used; even within a single team >1 definition was used. All teams used different management strategies: all used positioning, 10 NPA, 6 TLA, 7 MDO, 8 tracheostomy, 5 refer patients with invasive treatment indication. Criteria in opting management modalities were: O2-saturation (89.3%), clinical presentation (86.2%), growth and feeding problems (69.0%), polysomnography (62.1%), and differed within teams. CONCLUSION: The Dutch and Belgian cleft teams use variable RS definitions, different management modalities and criteria in choosing management strategies. A single, strict definition and evidence-based management guidelines should be formulated for optimal patient care.
Authors: Zarmina Ehsan; Christopher Kurian; K Nicole Weaver; Brian S Pan; Guixia Huang; Md M Hossain; Narong Simakajornboon Journal: J Clin Sleep Med Date: 2019-03-15 Impact factor: 4.062
Authors: Emma C Paes; Daan P F van Nunen; Lucienne Speleman; Marvick S M Muradin; Bram Smarius; Moshe Kon; Aebele B Mink van der Molen; Aebele B Mink van der Molen; Titia L E M Niers; Esther S Veldhoen; Corstiaan C Breugem Journal: Clin Oral Investig Date: 2015-02-15 Impact factor: 3.573