Non-surgical management of Pierre Robin syndrome.

A review of relevant published reports seems to indicate that in the case of babies suffering from intermittent airway obstruction due to a combination of micrognathia, glossoptosis, and often cleft of hard and soft palate (the Pierre Robin syndrome), successful treatment usually includes surgery of one kind or another. However, some non-surgical methods have been advocated. Pierre Robin (1934) recommended 'orthostatic' feeding, where the baby is forced to suck at the mother's breast with the thorax held up straight, to lift the neck and propel the chin forward. Davis and Dunn (1933) devised an attachment to the feeding bottle of a curved plate which rested on the upper lip and forced the baby to extend the lower jaw. Eley and Farber (1930) used a head cap supporting a strong copper wire which passed down behind the ramus on each side and under the chin. This wire was adjusted so as to keep the mandible in a forward position. Dennison (1965), in his paper reviewing 44 case histories, states that a cleft palate is a common but not constant feature of the syndrome. He lists the different types of management required for his patients and suggests that surgery has little to offer in the treatment of the syndrome. Of the surgical treatments, the Douglas (1946) technique, whereby the mucous membrane was removed from the anterior tongue and inner margin of the lower lip and these parts then sutured together, appears to work well providing the surgical union heals without complications. Other surgical methods included wires through and round the anterior mandible to hold it forward by cords or springs attached to external framework or weights. Hadley and Johnson (1963) described a successfully treated case using a Kirschner wire which was passed in through one ramus, and out through the other. The wire was inserted low enough so as to pass through the posterior body of the tongue, thus fixing it in the forward position. With regard to tracheostomies, Moyson (1961) calls this type of treatment for the Pierre Robin