Descriptive Summary and Experience Introducing the Orthodontic Airway Plate to Treat Upper Airway Obstruction for Infants With Robin Sequence

Abstract

Objectives

(1) Provide our narrative experience treating patients with Robin Sequence (RS) with our orthodontic airway plate (OAP) protocol and (2) report initial patient outcomes. A secondary objective is to share OAP clinician survey results.

Design

(1) Narrative experience of a care pathway for neonates with RS and upper airway obstruction (UAO). (2) Retrospective review of initial series of patients with RS treated with this pathway. A clinician survey was also administered.

Setting

Neonatal intensive care unit and acute care units of a tertiary children's hospital, with continuity outpatient multidisciplinary craniofacial clinic care.

Patients and Participants

Neonates with RS and severe base of tongue UAO not stabilized with positioning, and without mechanical ventilation, profound dysphagia, or microstomia.

Interventions

Adapt an OAP clinical pathway

Main Outcome Measure(s)

Lessons learned, clinical course, and respiratory metrics.

Results

In August 2023, our institution launched an OAP treatment pathway. Lessons learned highlight the importance of multidisciplinary communication, patient selection, and patience. Nine patients completed OAP therapy. oAHI values improved from mean 71/h (range 16-189, SD 55.1) to mean oAHI 7.9/h (range 1.1-12.7, SD 3.8). Pretreatment, 7 patients were on high-flow nasal cannula, one each on low-flow nasal cannula and continuous positive airway pressure. All OAP graduates advanced to room air. Clinician survey results suggested high OAP care preparedness and satisfaction.

Conclusions

The OAP can be introduced in new setting and delivered as a safe and effective nonsurgical intervention for UAO in RS. Interdisciplinary collaboration is key to treatment success. Infants undergoing OAP treatment can safely discharge home and experience sustained respiratory improvements.