Near-Normalized Maxillomandibular Relationship and Upper Airway in Infants with Robin Sequence Treated with Stanford Orthodontic Airway Plate: Computed Tomography Study
Restricted accessResearch articleFirst published online April, 2026
Near-Normalized Maxillomandibular Relationship and Upper Airway in Infants with Robin Sequence Treated with Stanford Orthodontic Airway Plate: Computed Tomography Study
To assess craniofacial and upper airway growth in infants with Robin sequence (RS) during the 1st year of life when their severe upper airway obstruction was treated non-surgically with the Stanford orthodontic airway plate treatment program (SOAP).
Design
Retrospective longitudinal cohort study comparing SOAP-treated infants with RS (treatment group) with age-matched healthy controls (HC) using computed tomography (CT).
Setting
Single tertiary referral hospital.
Patients
Twelve SOAP-treated infants with RS.
Interventions
SOAP.
Main Outcome Measures
Craniofacial skeletal cephalometric parameters and three-dimensional airway metrics.
Results
No infants required mandibular distraction or tracheostomy surgery after SOAP. The pre-treatment CT was acquired at the mean age (±SD) of 1.3 months (±0.7). The treatment lasted for 4.8 months (±0.9). Post-treatment CT was acquired at 12.9 months (±2.3) of age. The pre-treatment obstructive apnea hypopnea index decreased from 29.21 events/hour (±14.80) to 4.11 events/hour (±2.21) at post-treatment. The total mandibular length increased from 40.58 mm (±2.98) to 62.15 mm (±2.77) at post-treatment (p < 0.001) resulting in the growth velocity of 51.02% (±11.20) or 20.52 mm (±3.95) per year. The maxillary and mandibular lengths of the treatment group at post-treatment were shorter than those of HC although the maxillomandibular relationship was not different (p = 0.618). The upper airway volume and minimal cross-sectional area were also not different (p = 0.083, p = 0.254, respectively).
Conclusions
The maxillomandibular relationship and upper airway of the SOAP-treated infants with RS were near-normalized at post-treatment, comparable to age-matched healthy infants.
GiudiceABaroneSBelhousK, et al.Pierre Robin sequence: A comprehensive narrative review of the literature over time. J Stomatol Oral Maxillofac Surg. 2018;119(5):419–428. doi:https://doi.org/10.1016/j.jormas.2018.05.002
VatlachSMaasCPoetsCF.Birth prevalence and initial treatment of Robin sequence in Germany: A prospective epidemiologic study. Orphanet J Rare Dis. 2014;9:9. doi:https://doi.org/10.1186/1750-1172-9-9
5.
StollCAlembickYRothMP. Associated anomalies in pierre Robin sequence. Am J Med Genet A. 2023;191(9):2312–2323. doi:https://doi.org/10.1002/ajmg.a.63344
6.
BreugemCCEvansKNPoetsCF, et al.Best practices for the diagnosis and evaluation of infants with robin sequence: A clinical consensus report. JAMA Pediatr. 2016;170(9):894–902. doi:https://doi.org/10.1001/jamapediatrics.2016.0796
7.
DiepGKEisemannBSFloresRL. Neonatal mandibular distraction osteogenesis in infants with pierre Robin sequence. J Craniofac Surg. 2020;31(4):1137–1141. doi:https://doi.org/10.1097/SCS.0000000000006343
8.
ZaballaKSinghJWatersK. The management of upper airway obstruction in pierre Robin sequence. Paediatr Respir Rev. 2023;45:11–15. doi:https://doi.org/10.1016/j.prrv.2022.07.001
9.
GómezOJBarónOIPeñarredondaML. Pierre Robin sequence: An evidence-based treatment proposal. J Craniofac Surg. 2018;29(2):332–338. doi:https://doi.org/10.1097/SCS.0000000000004178
HebbarKBKasiASVielkindM, et al.Mortality and outcomes of pediatric tracheostomy dependent patients. Front Pediatr. 2021;9:661512. doi:https://doi.org/10.3389/fped.2021.661512
12.
WiechersCBuchenauWArandJ, et al.Mandibular growth in infants with Robin sequence treated with the Tübingen palatal plate. Head Face Med. 2019;15(1):17. doi:https://doi.org/10.1186/s13005-019-0200-1
13.
CôtéAFanousAAlmajedALacroixY. Pierre Robin sequence: Review of diagnostic and treatment challenges. Int J Pediatr Otorhinolaryngol. 2015;79(4):451–464. doi:https://doi.org/10.1016/j.ijporl.2015.01.035
BacherMSautermeisterJUrschitzMSBuchenauWArandJPoetsCF. An oral appliance with velar extension for treatment of obstructive sleep apnea in infants with Pierre Robin sequence. Cleft Palate Craniofac J. 2011;48(3):331–336. doi:https://doi.org/10.1597/09-091
16.
BuchenauWUrschitzMSSautermeisterJ, et al.A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence. J Pediatr. 2007;151(2):145–149. doi:https://doi.org/10.1016/j.jpeds.2007.02.063
17.
SchmidtGHirschfelderAHeilandMMatuschekC. Customized Pre-epiglottic baton plate-A practical guide for successful, patient-specific, noninvasive treatment of neonates with Robin sequence. Cleft Palate Craniofac J. 2021;58(8):1063–1069. doi:https://doi.org/10.1177/1055665620972288
18.
HotzMGnoinskiW. Clefts of the secondary palate associated with the “Pierre Robin syndrome”. Management by early maxillary orthopaedics. Swed Dent J Suppl. 1982;15:89–98.
19.
EffertJUhligSWiechersC, et al.Prospective evaluation of children with Robin sequence following Tübingen palatal plate therapy. J Clin Med. 2023;12(2):448. doi:https://doi.org/10.3390/jcm12020448
20.
PoetsCFKoosBReinertSWiechersC. The Tübingen palatal plate approach to Robin sequence: Summary of current evidence. J Craniomaxillofac Surg. 2019;47(11):1699–1705. doi:https://doi.org/10.1016/j.jcms.2019.08.002
ChooHKimSHAhnHWPoetsCFChungKR. Split orthodontic airway plate: An innovation to the utilization method of conventional orthodontic airway plate for neonates with Robin sequence. Korean J Orthod. 2022;52(4):308–312. doi:10.4041/kjod21.238
23.
ChooHGaleraRIBalakrishnanK, et al.Disruptive therapy using a nonsurgical orthodontic airway plate for the management of neonatal Robin sequence: 1-year follow-up. Cleft Palate Craniofac J. 2023;60(6):758–767. doi:https://doi.org/10.1177/10556656221076980
24.
ChooHKimSHAhnHWPoetsCFChungKR. Split orthodontic airway plate: An innovation to the utilization method of conventional orthodontic airway plate for neonates with Robin sequence. Korean J Orthod. 2022;52(4):308–312. doi:https://doi.org/10.4041/kjod21.238
25.
ChooHDavisASBainLCAhnH. Weight gain of infants with Robin sequence treated nonsurgically using the Stanford orthodontic airway plate (SOAP): 1-Year follow-up. Cleft Palate Craniofac J. 2024. doi:https://doi.org/10.1177/10556656241233239
26.
GuilleminaultCHuangYS. From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Med Rev. 2018;40:203–214. doi:https://doi.org/10.1016/j.smrv.2017.06.008
27.
GuilleminaultCSullivanSSHuangYS. Sleep-Disordered breathing, orofacial growth, and prevention of obstructive sleep apnea. Sleep Med Clin. 2019;14(1):13–20. doi:https://doi.org/10.1016/j.jsmc.2018.11.002
28.
PurnellCAJanesLEKlosowiakJLGosainAK. Mandibular catch-up growth in pierre Robin sequence: A systematic review. Cleft Palate Craniofac J. 2019;56(2):168–176. doi:https://doi.org/10.1177/1055665618774025
29.
DaskalogiannakisJRossRBTompsonBD. The mandibular catch-up growth controversy in pierre Robin sequence. Am J Orthod Dentofacial Orthop. 2001;120(3):280–285. doi:https://doi.org/10.1067/mod.2001.115038
30.
ShenYFVargervikKOberoiSChigurupatiR. Facial skeletal morphology in growing children with Pierre Robin sequence. Cleft Palate Craniofac J. 2012;49(5):553–560. doi:https://doi.org/10.1597/09-154
HermannNVKreiborgSDarvannTAJensenBLDahlEBolundS. Craniofacial morphology and growth comparisons in children with Robin sequence, isolated cleft palate, and unilateral complete cleft lip and palate. Cleft Palate Craniofac J. 2003;40(4):373–396. doi:https://doi.org/10.1597/1545-1569_2003_040_0373_cmagci_2.0.co_2
34.
EriksenJHermannNVDarvannTAKreiborgS. Early postnatal development of the mandible in children with isolated cleft palate and children with nonsyndromic Robin sequence. Cleft Palate Craniofac J. 2006;43(2):160–167. doi:https://doi.org/10.1597/04-113.1
35.
LaitinenSHRantaRE. Cephalometric measurements in patients with Pierre Robin syndrome and isolated cleft palate. Scand J Plast Reconstr Surg Hand Surg. 1992;26(2):177–183. doi:https://doi.org/10.3109/02844319209016010
36.
SuriSRossRBTompsonBD. Craniofacial morphology and adolescent facial growth in Pierre Robin sequence. Am J Orthod Dentofacial Orthop. 2010;137(6):763–774. doi:https://doi.org/10.1016/j.ajodo.2008.07.020
37.
BaekSHHongHYangIH. Growth patterns of the maxillomandibular Complex in preadolescent patients with Pierre-Robin sequence using cluster analysis and longitudinal follow-up cephalometric data. J Craniofac Surg. 2024;35(6):1637–1641. doi:https://doi.org/10.1097/SCS.0000000000010187
38.
WiechersCSowulaJKreutzerK, et al.Prospective cohort study on facial profile changes in infants with Robin sequence and healthy controls. World J Pediatr. 2024;20(6):581–589. doi:https://doi.org/10.1007/s12519-024-00797-z
39.
PourtaheriNChandlerLSinghA, et al.Spatial analysis of the temporomandibular joint and condyle following mandibular distraction in Robin sequence. J Craniofac Surg. 2021;32(6):2163–2166. doi:https://doi.org/10.1097/SCS.0000000000007569
40.
SusarlaSMMercanEEvansKEgbertMAHopperRA. Short-term condylar and glenoid fossa changes in infants with Pierre Robin sequence undergoing mandibular distraction osteogenesis. Int J Oral Maxillofac Surg. 2021;50(2):171–178. doi:https://doi.org/10.1016/j.ijom.2020.07.012
41.
BrodieAG. On the growth pattern of the human head. From the third month to the eighth year of life. Am J Anat. 1941;68:209–262.
42.
SiqueiraGLCTonelloCPeixotoAP, et al.Robin sequence facial profile after conservative treatment: A long-term follow-up. J Craniofac Surg. 2024;35(1):163–167. doi:https://doi.org/10.1097/SCS.0000000000009749
43.
LiuYPBehrentsRGBuschangPH. Mandibular growth, remodeling, and maturation during infancy and early childhood. Angle Orthod. 2010;80(1):97–105. doi:https://doi.org/10.2319/020309-67.1
44.
SchipperJAMvan LieshoutMJSBöhringerS, et al.Modelling growth curves of the normal infant's mandible: 3D measurements using computed tomography. Clin Oral Investig. 2021;25(11):6365–6375. doi:https://doi.org/10.1007/s00784-021-03937-1
MoriceASoupreVMitanchezD, et al.Severity of retrognathia and glossoptosis does not predict respiratory and feeding disorders in Pierre Robin sequence. Front Pediatr. 2018;6:351. doi:https://doi.org/10.3389/fped.2018.00351
HutchinsonEFKieserJAKramerB. Morphometric growth relationships of the immature human mandible and tongue. Eur J Oral Sci. 2014;122(3):181–189. doi:https://doi.org/10.1111/eos.12126
