Transmandibular K-Wire in the Management of Airway Obstruction in Pierre Robin Sequence

Abstract

The Pierre Robin sequence was first described by Pierre Robin in 1923 as a triad of micrognathia, U-shaped cleft palate, and glossoptosis. Although the problems associated with Pierre Robin sequence may be numerous, the most acute problem in affected newborns is upper airway obstruction. The causes of upper airway obstruction are heterogeneous, and treatment is controversial and may include a long stay in an intensive care setting. Most patients could be treated conservatively with prone/lateral positioning and close clinical observation. A more aggressive approach is to hold the tongue forward surgically by a lip-tongue adhesion (glossopexy) technique, and if all else fails, it might be necessary to perform a tracheostomy. The purpose of this article is to report an unconventional technique for the management of airway obstruction in Pierre Robin sequence. A transmandibular K-wire was used in two patients with Pierre Robin sequence to prevent airway obstruction. The author was not the surgeon who placed the K-wire, and in one of the patients, the K-wire was retained for 4 years before being removed by the author. Both patients had surgical intervention to manage the airway problem in the form of lip-tongue adhesion in addition to the transmandibular K-wire. In conclusion, the value of using a transmandibular K-wire in the two cases presented here could not be determined and was questionable.