Descriptive Summary and Experience Introducing the Orthodontic Airway Plate to Treat Upper Airway Obstruction for Infants with Robin Sequence: Lessons Learned

Abstract

Objectives Share our experience, summarize our protocol and describe initial outcomes implementing an orthodontic airway plate (OAP) care pathway for infants with Robin sequence (RS) and upper airway obstruction (UAO).

Design Narrative experience of a care pathway for neonates with RS and UAO with retrospective review of initial series of patients with RS treated with this pathway.

Setting The neonatal intensive care and acute care units of a tertiary Children's Hospital, with transition to 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 Creation of an orthodontic airway plate clinical pathway

Main Outcome Measure(s) Lessons learned, clinical course, respiratory and sleep metrics

Results In August 2023 our institution launched an OAP treatment pathway. Critical lessons learned highlight the importance of multidisciplinary communication, patient selection, and patience. Nine of eleven patients completed OAP therapy. oAHI values before OAP were median 71 (range 16-189, StDev 55.1). After OAP treatment, oAHI improved to median oAHI 7.9 (range 1.1-12.7, StDev 3.8). Pre-treatment, seven patients were on high-flow nasal cannula, one on low-flow nasal cannula, and one on CPAP. All OAP graduates advanced to room air.

Conclusions The OAP can be a safe and effective nonsurgical intervention for UAO in RS. Interdisciplinary collaboration is key to OAP program success. Infants undergoing OAP treatment can safely transition from hospital to home and experience sustained respiratory improvements.

Keywords: Robin Sequence, Upper airway obstruction, Orthodontic airway plate