Tongue-lip adhesion in the treatment of Pierre Robin sequence.

OBJECTIVE

Pierre Robin sequence (PRS) is a congenital malformation in which micrognathia causes retroposition of the tongue. This results in feeding and breathing difficulties that can lead to severe complications. If conservative treatment is not sufficient, a surgical procedure such as a tongue-lip adhesion can be performed. The objective of this study was to evaluate our benefits and complications with this operation.

SETTING

All patients under the care of the Department of Plastic and Reconstructive Surgery of the VU University Medical Center, Amsterdam, The Netherlands, in the period 1993 to 2002.

PATIENTS: A consecutive series of 22 patients who needed operative intervention for PRS. All underwent a tongue-lip adhesion.

METHODS

Retrospective analysis of the patient charts. Follow-up has been performed for a minimum of 1 year.

RESULTS

In 16 (73%) of the patients operated on, feeding and breathing have improved. In 6 children, the results were limited because of concomitant congenital anomalies. Complications, all without lasting effect, were observed in 12 (55%) of the patients: 4 of 5 children with dehiscence of the adhesion needed reoperation, 6 developed small chin abscess that resolved after removal of the supporting suture, and 1 patient was reintubated for bronchospasm.

CONCLUSIONS

Tongue-lip adhesion is a good surgical treatment for most children with PRS who have an isolated tongue-base airway obstruction. More invasive procedures such as mandibular distraction can be reserved for patients where a tongue-lip adhesion has not been successful.