Polysomnographic indications for surgical intervention in Pierre Robin sequence: acute airway management and follow-up studies after repair and take-down of tongue-lip adhesion.

The major concern for neonates with Pierre Robin sequence is the stability of the airways. The accepted management has been close clinical observation followed by surgical intervention if the airway was felt to be unstable. Six newborns with this diagnosis were admitted for evaluation in a 7-month period. Each underwent transcutaneous oxygen and carbon dioxide monitoring in a resting state. Each infant then was evaluated with infant polysomnography to ascertain the presence of obstructive apnea. Pulse-oximetry was utilized to document the oxygen saturation of each child during the polysomnography. On the basis of these studies, four of the neonates required a tongue-lip adhesion to stabilize the airway. These four infants were reassessed with polysomnography postoperatively, prior to cleft palate repair, following palatoplasty, and after their tongue-lip adhesion was released. This method of evaluation allows early testing of the stability of the airway in a way that augments and confirms the clinical assessment of the infant, allowing appropriate surgical intervention when necessary. This method of evaluation also allows the safe prediction of airway stability following palatoplasty and release of the tongue-lip adhesion.