90 Tongue-Lip Adhesion in the Management of Pierre Robin Sequence with Airway Obstruction: Technique and Outcome Faye Huang, MD; Lun-Jou Lo 1 , MD; Yu-Ray Chen 1 , MD; Johnson C. Yang, MD; Chen -Kuang Niu 2 ; MD, Mei-Yung Chung 2 , MD Background: Airway obstruction and feeding difficulty can occur in patients born with Pierre Robin sequence. In select patients with pronounced micrognathia, sur- gical intervention to relieve the airway obstruction is necessary. The surgical indications and appropriate surgical procedure continue to have a great deal of controversy. The purpose of this study was to evaluate our experience of tongue-lip adhesion in the management of upper airway obstruction associat- ed with Pierre Robin sequence. Methods: From March 1995 through May 2002, a total of 14 patients with Pierre Robin sequence, who were admitted to the pediatric neonatal intensive care unit either with prolong intubation, poor body weight gain, or repeated airway infection, underwent tongue-lip adhesion (TLA). The operation was per- formed by raising mucosa flaps and approximated the muscles between tongue and lower lip. Retention sutures were used. The patients were evalu- ated for clinical responses. Results: Our successful rate with tongue-lip adhesion was 70%. Ten of the 14 patients showed clinical improvements including extubation of the endotraccheal tube, body weight gain, return for home care, reduced episodes of respiratory infection, and improvement in O2 saturation and blood gas. The surgical pro- cedure was simple to perform without major complications. Conclusions: This retrospective review showed that with a thorough preoperative airway evaluation, TLA could be successfully used to treat select patients with Pierre Robin sequence suffering from severe upper airway obstruction. Thus, TLA should be first considered when surgical relief of airway obstruc- tion is indicated and when obstruction is limited to the classic tongue base obstruction type. (Chang Gung Med J 2005;28:90-6) Key words: tongue-lip adhesion, Pierre Robin sequence, airway obstruction. From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kaohsiung; 1 Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei; 2 Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung. Received: Oct. 27, 2004; Accepted: Dec. 21, 2004 Address for reprints: Dr. Faye Huang, Department of Plastic Surgery, Chang Gung Memorial Hospital. No. 123, Dabi Rd., Niausung Shiang, Kaohsiung, Taiwan 833, R.O.C. Tel: 886-7-7317123 ext. 8002; Fax: 886-7-7317123 ext. 8004; E-mail: spencer- faye@cgmh.org.tw T he triad of glossoptosis, micrognathia, and cleft palate is known as Pierre Robin Sequence (PRS). (1) The concept of “sequence” suggests that one anomaly causes subsequent anomalies, and micrognathia is believed to be the inciting anomaly in patients with PRS. (1,2) Airway obstruction and Original Article