Both clinical manifestations and CT images of this neonate showed prominent features and met the diagnostic criteria of PRS. CT examination showed distance between the base of tongue and posterior pharynx wall was narrowed significantly (about 1.4 mm) with narrowing of the upper airway at the corresponding level (the second cervical vertebra to the fourth cervical vertebra), shortened and retracted mandible ( Figure 2). Respiratory rate was 64 breaths/min, and arterial oxygen saturation was 80%. Physical examination revealed a wide cleft palate, micrognathia, retrognathia, glossoptosis and cyanosis ( Figure 1A). The neonate was full-term, delivered by cesarean section, and with low birth weight was 2,450 g. Case reportĪ 51-hour-old male neonate was admitted to the Neonatal Intensive Care Unit because of respiratory distress and feeding difficulties on June 30, 2020. We recorded treatment process and follow-up in detail, expecting to provide more references for the surgical treatment of neonatal PRS. The modified mandible traction with wires successfully and safely treated the neonate. Computed Tomography (CT) examination showed distance between the base of tongue and posterior pharynx wall was narrowed significantly about 1.4 mm. In this report, a 51-hour-old PRS neonate was admitted because of respiratory distress, and physical examination revealed a wide cleft palate, micrognathia, retrognathia, glossoptosis, and cyanosis. Existing researches lack a consensus on optimal surgery for neonatal PRS. Although each surgical method has been applied in the neonatal period, they have different limitations and risks ( 4, 7– 11). Surgical therapies include tongue lip adhesion (TLA), mandible traction, and tracheostomy ( 5, 6). Therefore, lengthening mandible to solve mandibular deficiency and restore normal morphology of mandible is the key to treatment ( 4). The combination of the small and receding mandible, tongue falling back, and upper airway obstruction make a cascade reaction of respiratory distress and feeding difficulties at the birth of PRS neonates. About 50% PRS patients overlap with other more complex syndromes, such as Stickler syndrome, Velo-cardio-facial syndrome, Treacher-Collins syndrome and so on ( 2). In addition, PRS also had a wide cleft palate, which is not requisite for the diagnosis but is found in up to 85% ∼ 90% of PRS patients ( 2, 3). Pierre Robin sequence (PRS) is a congenital craniofacial deformity characterized by micrognathia, glossoptosis and airway obstruction ( 1). This report aims to provide more evidence of the successful treatment of neonatal PRS micrognathia by modified mandible traction with wires. At the present follow-up until 2 years old, there were no significant differences in the maxillofacial appearance, teeth growth, breathing, feeding, growth and development between the patient and normal children.Ĭonclusion: The modified mandible traction with wires can safely and effectively resolve micrognathia, the key to treating PRS, which is minimally invasive, simple and provides immediate relief of airway obstruction with no long term complications compared with other surgical methods. No overlap of other more complex syndromes was found, such as ocular abnormalities, hearing loss, other skeletal abnormalities, cardiac abnormalities or other atypical abnormalities. No other complications were observed except for mild local infection. We performed the modified mandible traction with wires at four days old and achieved a satisfactory result in improving airway obstruction. If without timely treatment, it is possible to cause not only organ damage and developmental abnormalities but also early newborn mortality.Ĭase presentation: In this report, a 51-hours-old neonate was diagnosed with PRS, who had severe upper airway obstruction and required surgery. Some affected neonates are born with severe life-threatening upper airway obstruction that requires surgery. 3Graduate College, Tianjin Medical University, Tianjin, Chinaīackground: Pierre Robin sequence (PRS) is a congenital craniofacial deformity characterized by micrognathia, glossoptosis and airway obstruction. 2Department of Neonatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China.1Department of Plastic Surgery, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China.Hailiang Zuo 1,†, Jing Gao 2,3,†, Yu Mu 2,†, Fang Zhang 2 and Yang Liu 2*
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