Dept of Plastic Surgery, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dublin Cleft Centre, Children's Health Ireland at Crumlin, Dublin 12, Ireland; Dept of Paediatrics, Trinity College Dublin, Dublin 2, Ireland; Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Dept of Paediatric Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin 12, Ireland.
J Craniomaxillofac Surg. 2024 Apr;52(4):514-521. doi: 10.1016/j.jcms.2024.02.006. Epub 2024 Feb 11.
The objective of this study was to report outcomes of early cleft palate repair in infants born with Robin sequence (RS). A retrospective case series in a tertiary referral paediatric hospital was carried out, examining a consecutive series of 69 infants born with RS and cleft palate. A minimally invasive approach was taken to upper airway obstruction, with liberal nasopharyngeal airway (NPA) and non-invasive ventilation (NIV) use, guided by sleep studies. The palate was repaired between 6 and 9 months with a modified Malek technique. The most frequently used airway adjunct (59.4% of patients) was an NPA and the median duration of use was 5.6 months. All patients underwent a modified Malek cleft palate repair at a median of 7 months of age. Overnight oximetry demonstrated higher mean oxygen saturation (SpO) across the group from initial neonatal admission to discharge (median 96.5% (interquartile range [IQR] 95-98%) vs 97.45% (IQR 96.5-98%) (P = 0.2, N = 34). Of those with a cardiorespiratory polysomnogram, the obstructive apnoea-hypopnea index (OAHI) was significantly lower postoperatively (5.9 vs 2.8, P = 0.028). This study supports the use of non-surgical airway strategies and early cleft palate repair in infants born with RS and cleft palate.
本研究旨在报告伴有 Robin 序列（RS）的婴儿早期腭裂修复的结果。在一家三级转诊儿科医院进行了回顾性病例系列研究，检查了连续 69 例伴有 RS 和腭裂的婴儿。采用微创方法治疗上呼吸道阻塞，根据睡眠研究，广泛使用鼻咽气道（NPA）和无创通气（NIV）。腭裂在 6 至 9 个月大时采用改良的 Malek 技术修复。最常使用的气道辅助装置（59.4%的患者）是 NPA，其使用中位数为 5.6 个月。所有患者均在 7 个月龄时接受改良的 Malek 腭裂修复术。整夜血氧仪显示，从新生儿入院到出院，整个组的平均血氧饱和度（SpO）均较高（中位数 96.5%（四分位距 [IQR] 95-98%）与 97.45%（IQR 96.5-98%）（P=0.2，N=34）。在进行心肺多导睡眠图检查的患者中，术后阻塞性呼吸暂停低通气指数（OAHI）显著降低（5.9 比 2.8，P=0.028）。本研究支持在伴有 RS 和腭裂的婴儿中采用非手术气道策略和早期腭裂修复。
