Tongue-Lip Adhesion in the Treatment of Pierre Robin Sequence

Objective: Pierre Robin sequence (PRS) is a congenital malformation in which micrognathia causes retroposition of the tongue. This results in feeding and breathing difficulties that can lead to severe complications. If conservative treatment is not sufficient, a surgical procedure such as a tongue-lip adhesion can be performed. The objective of this study was to evaluate our benefits and complications with this operation. Setting: All patients under the care of the Department of Plastic and Reconstructive Surgery of the VU University Medical Center, Amsterdam, the Netherlands, in the period 1993 to 2002. Patients: A consecutive series of 22 patients who needed operative intervention for PRS. All underwent a tongue-lip adhesion. Methods: Retrospective analysis of the patient charts. Follow-up has been performed for a minimum of 1 year. Results: In 16 (73%) of the patients operated on, feeding and breathing have improved. In 6 children, the results were limited because of concomitant congenital anomalies. Complications, all without lasting effect, were observed in 12 (55%) of the patients: 4 of 5 children with dehiscence of the adhesion needed reoperation, 6 developed small chin abscess that resolved after removal of the supporting suture, and 1 patient was reintubated for bronchospasm. Conclusions: Tongue-lip adhesion is a good surgical treatment for most children with PRS who have an isolated tongue-base airway obstruction. More invasive procedures such as mandibular distraction can be reserved for patients where a tongue-lip adhesion has not been successful.