Restricted accessResearch articleFirst published online 2026
Weight Gain in Infants With Pierre Robin Sequence: A Comparison of Nonsurgical Orthodontic Airway Plate Versus Surgical Mandibular Distraction Osteogenesis
To compare weight gain in infants with PRS treated with nonsurgical orthodontic airway plate (OAP) or surgical mandibular distraction osteogenesis (MDO).
Design
Retrospective cohort study.
Setting
Single tertiary-care pediatric center.
Patients
Neonates and infants with PRS at a single institution from 2016 to 2023.
Interventions
Nonsurgical OAP or surgical MDO, with or without gastrostomy tube (GT) placement.
Main Outcome Measures
Weight, weight-for-age (WFA) percentile, and WFA Z-score were analyzed at four timepoints: at birth (T0), start of treatment (T1), end of treatment (T2), and end of observation (T3, approximately 12 months of age). Fisher’s exact, two-tailed paired t-test, and mixed effect models were used to compare groups.
Results
Twenty OAP-treated and sixteen MDO-treated infants with two MDO-Subgroups based on oral feeds status at T3. There were no differences in comorbidities between groups. GT was inserted in no infants in OAP and nine infants in MDO. The hospital stay and total treatment duration were 13.1 days (± 4.8) and 4.3 months (± 0.98) in OAP and 20.8 days (± 11.2) and 4.6 months (± 0.99) in MDO, respectively. There was no difference in weight parameters between OAP and MDO at any time point. All infants in OAP achieved full oral feeds significantly earlier than MDO (p < .001).
Conclusions
Weight gain in infants with PRS treated with either OAP alone or MDO ± GT at a single institution was similar during the first year of life.
BushPWilliamsA. Incidence of the Robin Anomalad (Pierre Robin syndrome). Br J Plast Surg. 1983;36(4):434‐437.
2.
ShprintzenRJ. The implications of the diagnosis of Robin sequence. Cleft Palate Craniofac J. 1992;29(3):205‐209.
3.
LidskyMELanderTASidmanJD. Resolving feeding difficulties with early airway intervention in Pierre Robin sequence. Laryngoscope.2008;118(1):120‐123.
4.
CruzMJKerschnerJEBesteDJConleySF. Pierre Robin sequence: Secondary respiratory difficulties and intrinsic feeding abnormalities. Laryngoscope.1999;109(10):1632‐1636.
5.
PaesECde VriesIACPenrisWM, HannyK, Karlijn HS, van LeerdamE, RademakerM, VeldhoenE, EijkemansR, KonM, et al.Growth and prevalence of feeding difficulties in children with Robin sequence: A retrospective cohort study. Clin Oral Investig. 2017;21(6):2063-2076.
6.
BaudonJJRenaultFGoutetJM, Flores-GuevaraR, SoupreV, GoldF, VazquezMP. Motor dysfunction of the upper digestive tract in Pierre Robin sequence as assessed by sucking-swallowing electromyography and esophageal manometry. J Pediatr. 2002;140(6):719-723.
7.
GangopadhyayNMendoncaDAWooAS.Pierre Robin sequence. Vol. 26. New York, NY, USA: Thieme Medical Publishers; 2012.
8.
ScottARMaderNS. Regional variations in the presentation and surgical management of Pierre Robin sequence. Laryngoscope.2014;124(12):2818‐2825.
9.
VerlindenCvan de VijfeijkenSJansmaEBeckingASwennenG. Complications of mandibular distraction osteogenesis for congenital deformities: A systematic review of the literature and proposal of a new classification for complications. Int J Oral Maxillofac Surg. 2015;44(1):37‐43.
10.
PielouW. Non-surgical management of Pierre Robin syndrome. Arch Dis Child. 1967;42(221):20.
11.
PielouWAllenA. The use of an obturator in the management of the Pierre Robin syndrome. Dent Pract Dent Rec. 1968;18(5):169‐172.
12.
PoetsCFMaasCBuchenauW, ArandJ, VierzigA, BraumannB, Müller-HagedornS. Multicenter study on the effectiveness of the pre-epiglottic baton plate for airway obstruction and feeding problems in Robin sequence. Orphanet J Rare Dis. 2017;12(6):1-6.
13.
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.
14.
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.
15.
ChooHGaleraRIBalakrishnanK, LinHF, AhnH, LorenzP, KhoslaR, ProfitJ, PoetsCF, LeeJS. Disruptive therapy using a nonsurgical orthodontic airway plate for the management of neonatal Robin sequence: 1-year follow-up. Cleft Palate Craniofacial J. 2023;60(6):758-767.
16.
KimJWWanAKimJYChooH. Presurgical reduction of the cleft palate: Serendipitous benefit of the Stanford Orthodontic Airway Plate Treatment (SOAP) for infants with Robin sequence. Cleft Palate Craniofacial J. 2024;62(9):1469-1477.
17.
ChooHSidellDRKimJWAhnHWDayHSSullivanSS.Nonsurgical improvement of severe upper airway obstruction in infants with Robin sequence and cleft palate using Stanford Orthodontic Airway Plate treatment. J Clin Sleep Med. 2024;20(11):1807‐1811. Published online 2024:jcsm-11282.
18.
ChooH. Stanford Orthodontic airway plate treatment program for neonates with Pierre Robin sequence in the United States: Nonsurgical alternative to neonatal mandibular distraction osteogenesis. J Clin Sleep Med. 2025;21(4):737‐738.
19.
HotzMGnoinskiW. Comprehensive care of cleft lip and palate children at Zürich University: A preliminary report. Am J Orthod. 1976;70(5):481‐504.
20.
ChooHDavisASBainLCAhnH. Weight gain of infants with Robin sequence treated nonsurgically using the Stanford Orthodontic Airway Plate (SOAP): 1-year follow-up. Cleft Palate Craniofacial J. 2025;62(6):1053‐1060. Published online. 2024:10556656241233239.
21.
ChooHKhoslaRKMeisterKD, WanD, LinHF, FeczkoR, BruckmanK, HopkinsE, TruongM, LorenzP. Nonsurgical orthodontic airway plate treatment for newborns with Robin sequence. Cleft Palate Craniofac J. 2022;59(3):403-410.
22.
GeorgeAJagannathPJoshiSSJagadeeshA. Weight-for-age standard score-distribution and effect on in-hospital mortality: A retrospective analysis in pediatric cardiac surgery. Ann Card Anaesth. 2015;18(3):367‐372.
23.
BorghiEde OnisMGarzaC, den BroeckJ, FrongilloE, Grummer‑StrawnL, Van BuurenS, PanH, MolinariL, MolinariR, et al.Construction of the World Health Organization child growth standards: Selection of methods for attained growth curves. Stat Med. 2006;25(2):247-265.
24.
De OnisM.World health organization reference curves. ECOG’s EBook Child Adolesc Obes. 2015;19.
25.
McHoneyMEatonSPierroA. Metabolic response to surgery in infants and children. Eur J Pediatr Surg. 2009;19(05):275‐285.
26.
ColeSZLanhamJS. Failure to thrive: An update. Am Fam Physician. 2011;83(7):829‐834.
27.
PandyaANBoormanJG. Failure to thrive in babies with cleft lip and palate. Br J Plast Surg. 2001;54(6):471‐475.
28.
MarquesILBettiolHDe SouzaLBarbieriMABachegaMI. Longitudinal study of the growth of infants with isolated Robin sequence considered being severe cases. Acta Paediatr. 2008;97(3):371‐375.
29.
AlbinoFPWoodBCHanKD, YiS, SeruyaM, RogersG, OhA. Clinical factors associated with the non-operative airway management of patients with Robin sequence. Arch Plast Surg. 2016;43(06):506-511.
30.
CozziFTotonelliGFredianiSZaniASpagnolLCozziDA. The effect of glossopexy on weight velocity in infants with Pierre Robin syndrome. J Pediatr Surg. 2008;43(2):296‐298.
31.
GaryCSMarczewskiSVitaglianoPMSawh-MartinezRWuRSteinbacherDM. A quantitative analysis of weight gain following mandibular distraction osteogenesis in Robin sequence. J Craniofac Surg. 2018;29(3):676‐682.
32.
HarrisJACaprioRMResnickCM. Do infants with Robin sequence have improved feeding and weight gain after mandibular distraction?J Oral Maxillofac Surg.2021;79(6):1331‐1338.
33.
SusarlaSMMundingerGSChangCC, SwansonE, LoughD, RottgersSA, RedettR, KumarA. Gastrostomy placement rates in infants with Pierre Robin sequence: A comparison of tongue-lip adhesion and mandibular distraction osteogenesis. Plast Reconstr Surg. 2017;139(1):149-154.
34.
El GhoulKCalabreseCEKoudstaalMJResnickCM. A comparison of airway interventions and gastrostomy tube placement in infants with Robin sequence. Int J Oral Maxillofac Surg. 2020;49(6):734‐738.
35.
GalluccioGMazzoliVVernucciRSilvestriABarbatoE. Neonatal functional treatment for Pierre Robin sequence. Turk J Orthod. 2019;32(3):151.
36.
MasterDLHansonPRGosainAK. Complications of mandibular distraction osteogenesis. J Craniofac Surg. 2010;21(5):1565‐1570.
37.
ChocronYBaroneNZammitDGilardinoMS. Efficacy and complications of mandibular distraction osteogenesis for airway obstruction in the Robin sequence population: A comprehensive literature review. J Craniofac Surg. 2022;33(6):1739‐1744.
38.
TomicJMetzlerPAlconA, JakseN, ZemannW, SchanbacherM, ZrncT. Weight gain in infants with Pierre Robin sequence. J Cranio-Maxillofac Surg. 2020;48(6):555-559.
39.
WiechersCIffländerRGerdesR, CiuffolottiM, ArandJ, WeiseC, PetersK, GrandkeB, ReinertS, KoosB, et al.Retrospective study on growth in infants with isolated Robin sequence treated with the Tuebingen Palate Plate. Orphanet J Rare Dis. 2021;16(1):338.
40.
AbbasDBLavinCFahyEJ, ChooH, TruongM, BruckmanK, KhoslaRK, LorenzHP, MomeniA, WanD. A systematic review of mandibular distraction osteogenesis versus orthodontic airway plate for airway obstruction treatment in Pierre Robin sequence. Cleft Palate Craniofac J. 2022;59(3):365-376.
41.
ResnickCMde GijselJJindalS, QuanteM, WiechersC, PoetsC, KatzE. Comparative effectiveness of preepiglottic baton plates and mandibular distraction in infants with Robin sequence. Plast Reconstr Surg. 2025;156(2):267e.
42.
ChwalsWJLallyKPWoolleyMMMahourGH. Measured energy expenditure in critically III infants and young children. J Surg Res. 1988;44(5):467‐472.
43.
ChwalsWJ. Energy expenditure in critically ill infants. Pediatr Crit Care Med. 2008;9(1):121‐122.
44.
PierroA. Metabolic response to neonatal surgery. Curr Opin Pediatr. 1999;11(3):230‐236.
45.
CladisFKumarAGrunwaldtLOttesonTFordMLoseeJE. Pierre Robin sequence: A perioperative review. Anesth Analg. 2014;119(2):400‐412.
46.
LiLScottAR. Weight gain in infants with Pierre Robin sequence in the first year of life. Otolaryngol Head Neck Surg. 2020;163(5):1032‐1037.
47.
MartinVGreatrex-WhiteS. An evaluation of factors influencing feeding in babies with a cleft palate with and without a cleft lip. J Child Health Care. 2014;18(1):72‐83.
48.
MossMLSalentijnL. The primary role of functional matrices in facial growth. Am J Orthod. 1969;55(6):566‐577. doi:10.1016/0002-9416(69)90034-7. PMID: 5253955.
49.
AhnHChoiYJBaekWKimHYChangPEChooH. Near-normalized maxillomandibular relationship and upper airway in infants with Robin sequence treated with Stanford Orthodontic Airway Plate: Computed tomography study. Cleft Palate Craniofacial J. 2024. Published online. 2024:10556656241306531.
50.
ChooH. Functional matrix theory and Stanford orthodontic airway plate treatment program for infants with Pierre Robin Sequence (SOAP for PRS). Cleft Palate Craniofacial J. Published online. 2025:10556656251318114.
51.
MarstonAPPatelTPechaPPNguyenSADiscoloCM.Impact of hospital characteristics on mandibular distraction osteogenesis outcomes among patients with Pierre Robin sequence utilizing a national inpatient database. Cleft Palate Craniofac J. 2022;59(5):622‐628.
52.
LeeKCEisigSBCarraoVChuangSKPerrinoMA.Which factors affect length of stay and readmission rate in mandibular distraction osteogenesis?J Oral Maxillofac Surg. 2019;77(8):1681‐1686.
53.
HotzM, GnoinskiW. Clefts of the secondary palate associated with the “Pierre-Robin syndrome”. Swed Dent J Suppl. 1982;15(15):89-98.
54.
SkolnickGBKellerMRBaughmanEJ, NickelK, NaidooS, OlsenM, PatelK. Timing of cleft palate repair in patients with and without Robin sequence. J Craniofac Surg. 2021;32(3):931-935.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
