Tongue-lip adhesion in Pierre Robin sequence

Patients with Pierre Robin sequence exhibit varying degrees of airway obstruction and feeding difficulty. In some patients, airway obstruction may be profound, warranting surgical intervention to maintain a patent airway. The purpose of this article is to highlight the advantages of the tongue-lip adhesion procedure for the management of airway obstruction in such patients compared to the currently available options.

Sequential Management of Pierre Robin Sequence: Case Report

Tongue-Lip Adhesion Using an Alveolar Protector Appliance for Management of Pierre Robin Sequence

PURPOSE: Pierre Robin sequence is a congenital malformation in which micrognathia causes glossoptosis and airway obstruction. If conservative treatment fails, surgical procedures such as tongue-lip adhesion can be performed. However, this procedure remains a subject of debate, with favorable results being countered by reports of complications. To overcome the above limitations, we revised the traditional method of tongue-lip adhesion using an alveolar protector. METHODS: Between 1992 and 2011, a total of eight patients were identified with Pierre Robin sequence and were treated with tongue-lip adhesion. Two of these eight tongue-lip adhesion procedures were performed with an alveolar protector. The operative technique for tongue-lip adhesion was similar to that described in other published reports. The alveolar protector was inserted between the ventral surface of the tip of the tongue and the lower labial sulcus. RESULTS: Tongue-lip adhesion failed in two patients because of wound dehiscence. The primary surgical success rate was 66.7%. In the two tongue-lip adhesion procedures performed with the alveolar protector, we observed no postoperative complications. CONCLUSION: Resistance to traction of the tongue can be encountered with nonunionized symphysis menti, causing loosening of the traction suture through the symphysis menti. This can lead to backward positioning of tongue, resulting in dehiscence of tongue lip adhesion. The alveolar protector is a good adjunct to tongue-lip adhesion because this method avoids postoperative loosening of the traction suture and wound dehiscence. It is a simple and effective auxiliary method that yields functional improvement.

Unilateral Complete Cleft Lip and Palate Repair Using Lip Adhesion and Passive Alveolar Molding Appliance: Effect on the Maxillary Alveolar Arch

To manage a unilateral complete cleft lip and palate, lip adhesion along with the positioning of a passive alveolar molding appliance was performed in infants at 4 to 6 weeks of age. The lip adhesion creats a force acting on the cleft alveolus. Thereafter, the greater segment of the alveolus is guided by the appliance, while the lesser segment of the alveolus is prevented from collapsing. Definite cheiloplasty was then performed at 4 to 5 months of age and palatoplasty at 12 months of age. Twenty-five patients with a unilateral complete cleft lip and palate were treated using this protocol from 1994 to 2002. Fifteen were male and ten were female. The mean follow-up period was one to nine years. Dental cast measurements were performed at lip adhesion, definite cheiloplasty and palatoplasty in 18 patients, 3 to 9 years in 19 patients. The alveolar gap, length of maxillary alveolar cleft, width of maxillary alveolar cleft and palatal gap were 10.1 +/-4.2mm, 6.1+/-0.9mm, 10.2+/-4.8mm, 13.4+/-2.9mm at lip adhesion, 3.1+/-1.4mm, 2.6+/-0.8mm, 2.7+/-1.6mm, 9.6+/-1.5mm at definite cheiloplasty, and 0.2+/-0.1mm, 1.5+/-0.7mm, 0.2+/-0.1mm, 8.3+/-1.1mm at palatoplasty respectively. Measurements at palatoplasty were decreased with statistical significance(p<0.05). Twenty- three patients developed good symmetrically aligned alveolar segments plus a symmetric platform for the nose. However, two patients developed poor maxillary orthopedics because of the displacement of the appliance by the patient. On the following maxillary dental cast from 8 to 9 years, intercanine width and canine arch length were within the normal value. However, intermolar width and molar arch length was decreased slightly compared to the normal with a statistical significance (p<0.005). In conclusion, lip adhesion and passive alveolar molding appliance achieve a normal position and stabilizing the arch, a symmetrical platform. However, longer follow- up is necessary until 15 years old for permanent dental arch establishment.

The effect of lip adhesion on rotation-advancement repair in unilateral complete cleft lip

The present study was carried out to evaluate the postoperative results of Millard rotation-advancement repair (MR) and lip adhesion followed by Millard rotation-advancement repair (LAMR) in unilateral complete cleft lip. Twenty patients with unilateral complete cleft lip underwent MR or LAMR at the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital over a period of 6 years (January 1994 to December 1999) were analyzed. The surgical results following the operation were assessed on the basis of scoring, vertical lip length, and scar hypertrophy. The mean score was better in LAMR group (74.74+/-1.09, n=13) than in MR group (66.50+/-1.14, n=7) for both lip and nose segments. Scar hypertrophy developed in MR group with 28.6% and in LAMR group with 23.1%. No significant difference was noted in the ratio of lip length between LAMR and MR groups (0.84+/-0.08 and 0.73+/-0.10). These results suggest that LAMR is better than MR in repairing the unilateral complete cleft lip.

Effect of Presurgical Orthopedics and Lip Adhesion on Maxillary Alveolar Arch in Complete Unilateral Cleft of Primary and Secondary Palate

The ultimate goal of the treatment of cleft lip and palate is the obliteration of the entire cleft early without disturbing facial bone growth. Presurgical orthopedics attempts to correct the characteristic skeletal deformities that occur in cleft lip and palate, and lip adhesion reduces the tension of the definite lip repair and allows gentle molding until the solidification of the arch occurs. Additionally lip adhesion gives a psychologic benefit to the patient's parents because of the improvement in appearance. The authors performed presurgical orthopedics and lip adhesion for 26 cases of complete unilateral cleft of primary and secondary palate between 1997 and 2001. Postoperatively, the patients are evaluated by the analysis using preoperative and postoperative dental casts. Dental cast analyses evaluate width, length, height of maxillary alveolar cleft, alveolar gap, palatal gap, and angle of arch. Results include improvement of alignment of maxillary alveolar arch and reducement of cleft gap. Also, this study of serial dental cast is the objective method to explain the corrective effect on maxillary alveolar arch in cleft lip and palate. In conclusion, presurgical orthodontics and lip adhesion achieve the main goal of moving the palate into a normal position and stabilizing the arch with a bony bridge that attracts teeth. It avoids the difficult anterior fistulae and presents a more symmetrical platform upon which the lip can be united and the nose can be corrected early. Additionally, there is a psychologic benefit to the patient's parents because of the improvement in appearance

Two Cases of Pierre Robin Syndrome Managed with Tongue-Lip Adhesion and Tracheostomy

Pierre Robin syndrome presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress and feeding difficulties. This is potentially fatal and surgical intervention in these cases is necessary. We experienced two newborns with pronounced micrognathia who were managed with tongue-lip adhesion and tracheostomy. Herein, we report these two cases with literature reviews.