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Management of intermittent upper airway obstruction in infants with Pierre Robin sequence using a new intraoral orthodontic appliance

Presented at the Neonatal Society 2006 Summer Meeting (programme).

Sautermeister J1, Buchenau W1, Urschitz MS1, Bacher M2, Herberts T3, Arand J1, Poets CF1

1 Department of Neonatology, University Hospital of Tübingen, Tuebingen, Germany
2 Departments of Orthodontics, University Hospital of Tübingen, Tuebingen, Germany
3 Department of Medical Biometry, University Hospital of Tübingen, Tuebingen, Germany

Background: The Pierre Robin sequence (PRS), characterized by mandibular micrognathia, retrogenia and glossoptosis, presents clinically with intermittent upper airway obstruction (UAO). Current treatment options for UAO in infants with PRS are either not effective, inconvenient, or considerably invasive. We recently developed a preepiglottic baton plate (PEBP) with a velar extension that shifts the dorsum of the tongue forward and widens the hypopharynx. In this study, we evaluated the effect of PEBP on UAO in infants with PRS.

Patients and Methods: Fifteen infants (4 boys; median age 5 days) with isolated PRS and a mixed obstructive apnea index (MOAI) >3 documented by sleep studies upon admission were enrolled. PEBP was applied to all infants and the MOAI determined at discharge and 3 months later. In 11 infants, short-term effects of PEBP on MOAI were compared to a conventional palatal plate without a velar extension (CPP), using a randomized cross-over study design.

Results: Compared to baseline (geometric mean MOAI: 17.2), there was a significant decrease in MOAI with the PEBP to discharge (geometric mean MOAI: 3.8) and the 3-month follow-up (geometric mean: 1.2; p-value: <0.0001; n=15). Compared to CPP (geometric mean MOAI: 14.8), PEBP showed a significantly stronger effect on MOAI (geometric mean MOAI: 3.9; p-value: 0.004; n=11).

Conclusion: In this sample of infants with PRS and UAO, we found a newly developed orthodontic appliance effective in reducing the frequency of mixed and obstructive apneas during sleep. In addition, this new appliance was more effective than an often-used conventional one. We conclude that this new appliance may be a desirable and effective alternative to other treatments for UAO in infants with PRS.

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