Resolving feeding difficulties with early airway intervention in Pierre Robin Sequence

Laryngoscope. 2008 Jan;118(1):120-3. doi: 10.1097/MLG.0b013e31815667f3.


Objectives/hypothesis: To observe rates of gastrostomy tube (g-tube) placement in Pierre Robin Sequence (PRS) and to determine whether relieving airway obstruction solves feeding difficulties.

Study design: All PRS referrals to a multidisciplinary cleft team for children at a tertiary pediatric hospital from January 1988 to June 2006 were retrospectively reviewed.

Methods: Patients were analyzed for occurrence of g-tube placement, neurologic disorders, and airway intervention including tracheotomy and mandibular distraction osteogenesis.

Results: Sixty-seven PRS patients were divided into two categories: 51 (76.1%) isolated PRS (iPRS) and 16 (23.9%) with additional disorders and syndromes (sPRS). Patients were then placed into two subgroups: those who received early airway intervention and those who received late or no airway intervention. Of the 51 iPRS children, 12 (23.5%) received early airway intervention, none of whom required a g-tube. There were 39 (76.5%) children who received late or no airway intervention, and 5 (12.8%) of these required g-tube placement. Of the 16 sPRS children, 8 (50%) received early airway intervention, and 7 (87.5%) of these still required a g-tube. Of the remaining 8 (50%) sPRS patients who received late or no airway intervention, 5 (62.5%) required a g-tube.

Conclusion: In children with iPRS, feeding difficulties can be resolved with early airway intervention. Delaying airway intervention may necessitate feeding assistance because all of the iPRS children who required a g-tube fell into this category. The presence of additional disorders and syndromes further complicates treatment because most of the sPRS children required g-tubes regardless of airway intervention.

Publication types

  • Comparative Study

MeSH terms

  • Airway Obstruction / prevention & control*
  • Child
  • Enteral Nutrition / instrumentation
  • Feeding and Eating Disorders / prevention & control*
  • Follow-Up Studies
  • Gastrostomy / instrumentation
  • Humans
  • Infant
  • Intubation, Gastrointestinal / instrumentation
  • Mandible / surgery
  • Osteogenesis, Distraction / methods
  • Pierre Robin Syndrome / complications*
  • Retrospective Studies
  • Time Factors
  • Tracheotomy