Article Text

other Versions

PDF
The successful use of the nasopharyngeal airway in Pierre Robin sequence: an 11-year experience
  1. Francois Abel1,
  2. Yogesh Bajaj2,
  3. Michelle Wyatt2,
  4. Colin Wallis1
  1. 1Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, UK
  2. 2Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
  1. Correspondence to Yogesh Bajaj, Department of Paediatric Otolaryngology, Great Ormond Street Hospital, 13 Abbotsford Gardens, Woodford Green, Essex IG8 9HN, UK; ybajaj{at}hotmail.co.uk

Abstract

Introduction Pierre Robin sequence (PRS) is a congenital anomaly presenting with micrognathia, glossoptosis and a cleft palate. This study describes a decade's experience of the management of upper airway obstruction (UAO) in PRS patients with a nasopharyngeal airway (NPA).

Methods This study was conducted by paediatric respiratory and otolaryngology departments. Children with PRS referred with UAO were evaluated according to a standard protocol. Data collected included the degree of airway obstruction, method of airway management, polysomnography data before and after intervention, and longer term follow-up.

Results Data were collected on 104 PRS patients referred to us for airway assessment in 2000–2010. 64/104 were aged <4 weeks at referral. Airway symptoms were managed conservatively in 27 patients (25.9%), with an NPA in 63 (60.6%) and a tracheostomy in 14 (13.4%). The average duration of NPA use was 8 months (3 weeks to 27 months). Polysomnography results improved in all 63 patients with an NPA. Fourteen severely obstructed patients underwent a tracheostomy. 86.5% (90/104) of PRS patients were managed conservatively or with the help of an NPA. There were no NPA related complications.

Conclusion There is a spectrum of UAO in PRS. This study reports on long-term outcomes in 104 children with PRS and airway obstruction. In most children (86.5%), airway obstruction was managed by conservative measures or with an NPA for a few months. The natural history shows that with normal growth, airway compromise resolves without immediate surgical intervention as advocated by some practitioners. Few PRS children require a tracheostomy.

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.