Caring for Infants with Robin Sequence Treated with the Tübingen Palatal Plate: A Review of Personal Practice
Abstract
:1. Introduction
2. Materials and Methods
3. Results and Practice
3.1. Admission
3.2. Manufacturing of the TPP
- Two adhesive tapes (e.g., Steri-Strip, 3M Health Care, MN, USA) or special tapes for infants with hypersensitive skin, with their width depending on the required traction.
- Two orthodontic elastic bands, stretched over two nails hammered into a wooden board, with the end of one tape being poked through an elastic band, then bent back and fixed.
- Adhesive enhancer, e.g., benzoin tincture 90% 1:5 (Caelo, Hilden, Germany).
- Adhesive cream (Procter & Gamble, Schwalbach, Germany).
- Gauze swabs for oral care.
- Dexpanthenol solution (at home, sage tea may be used instead).
- Adhesive releaser, e.g., Convatec Inc., Deeside, UK.
- Toothbrush and toothpaste.
- Small flashlight.
3.3. Inserting the TPP
3.4. Positioning the Baby
3.5. Daily Oral Care and Plate Hygiene
4. Problems Potentially Necessitating Modifications of the TPP
4.1. Persisting Upper Airway Obstruction
4.2. Swallowing Problems
- If the mouth opening is not yet sufficient, milk cannot be swallowed properly; this is mostly the case in infants with a cleft palate who were used to positioning their tongue inside the cleft during the fetal period, which is not possible anymore once the plate is inserted. In these infants, the tongue will push against the plate, the child’s swallow is empty, and milk remains in the oral cavity until infants become accustomed to the plate.
- If the angle of the extension is too steep, the child will also not swallow. When feeding is attempted, the tongue does not have enough space to perform the swallowing act and is just being pushed towards the plate. Therefore, swallowing would consequently leverage the plate off.
- If the airway becomes obstructed during swallowing, the angle of the extension is generally too flat, or the extension is not steep enough in its lower third.
- If the extension is too narrow, the tongue is pushing around the extension and/or the velum extends behind the extension.
4.3. Pressure Marks, Dents, and Malpositioning of the Plate
4.4. Problems with Too Much or Too Little Saliva
4.5. Nursing Problems with the TPP
- Improper insertion of the plate is an issue. If the fixation or width of the aforementioned strips are not appropriate, they provide too little traction and the plate slips off, or dents on the frontal alveolar ridge develop; if too much traction is used, pressure marks may occur on the alveolar ridge or palate.
- If too little adhesive cream has been applied, the plate wobbles on the maxilla; if too much has been used, cream may ooze into the cleft and hinder nasal breathing, or the plate cannot stick in the first place if too much cream has been applied. If the oversupply oozes through the gap in the holding rim, it must be removed, which causes unnecessary stress for the baby.
- Skin problems can be caused by the improper removal of the strips, creating redness, possibly blisters, or even skin lesions.
4.6. Feeding
4.6.1. Feeding before Plate Fitting
4.6.2. Advanced Feeding Training—TPP and Finger Feeding
4.6.3. Feeding Training with the Playtex™ System
4.6.4. Course of Feeding Progress
5. Discussion and Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Caouette-Laberge, L.; Bayet, B.; Larocque, Y. The Pierre Robin sequence: Review of 125 cases andevolution of treatment modalities. Plast. Reconstr. Surg. 1994, 93, 934–942. [Google Scholar] [CrossRef] [PubMed]
- Breugem, C.; Courtemanche, D. Robin Sequence: Clearing Nosologic Confusion. Cleft Palate-Craniofacial J. 2010, 47, 197–200. [Google Scholar] [CrossRef]
- Breugem, C.C.; Mink van der Molen, A.B. What is ‘Pierre Robin sequence’? J. Plast. Reconstr. Aesthet. Surg. 2009, 62, 1555–1558. [Google Scholar] [CrossRef] [PubMed]
- Evans, K.N.; Sie, K.C.; Hopper, R.A.; Glass, R.P.; Hing, A.V.; Cunningham, M.L. Robin Sequence: From Diagnosis to Development of an Effective Management Plan. Pediatrics 2011, 127, 936–948. [Google Scholar] [CrossRef] [PubMed]
- Karempelis, P.; Hagen, M.; Morrell, N.; Roby, B.B. Associated syndromes in patients with Pierre Robin Sequence. Int. J. Pediatr. Otorhinolaryngol. 2020, 131, 109842. [Google Scholar] [CrossRef] [PubMed]
- Wright, M.F.; Knowles, R.L.; Cortina-Borja, M.; Javadpour, S.; Mehendale, F.V.; Urquhart, D.S. Epidemiology of Robin sequence in the UK and Ireland: An active surveillance study. Arch. Dis. Child. 2023, 108, 748–753. [Google Scholar] [CrossRef] [PubMed]
- Printzlau, A.; Andersen, M. Pierre Robin sequence in Denmark: A retrospective population-based epidemiological study. Cleft Palate-Craniofacial J. 2004, 41, 47–52. [Google Scholar] [CrossRef] [PubMed]
- Flores, R.L.; Tholpady, S.S.; Sati, S.; Fairbanks, G.; Socas, J.; Choi, M.; Havlik, R.J. The Surgical Correction of Pierre Robin Sequence. Plast. Reconstr. Surg. 2014, 133, 1433–1439. [Google Scholar] [CrossRef] [PubMed]
- van Lieshout, M.J.; Joosten, K.F.; Mathijssen, I.M.; Koudstaal, M.J.; Hoeve, H.L.; van der Schroeff, M.P.; Wolvius, E.B. Robin sequence: A European survey on current practice patterns. J. Cranio-Maxillofac. Surg. 2015, 43, 1626–1631. [Google Scholar] [CrossRef]
- Poets, C.F.; Bacher, M. Treatment of Upper Airway Obstruction and Feeding Problems in Robin-Like Phenotype. J. Pediatr. 2011, 159, 887–892. [Google Scholar] [CrossRef]
- Abel, F.; Bajaj, Y.; Wyatt, M.; Wallis, C. The successful use of the nasopharyngeal airway in Pierre Robin sequence: An 11-year experience. Arch. Dis. Child. 2012, 97, 331–334. [Google Scholar] [CrossRef] [PubMed]
- Paradowska-Stolarz, A.; Mikulewicz, M.; Duś-Ilnicka, I. Current Concepts and Challenges in the Treatment of Cleft Lip and Palate Patients—A Comprehensive Review. J. Pers. Med. 2022, 12, 2089. [Google Scholar] [CrossRef] [PubMed]
- Buchenau, W.; Urschitz, M.S.; Sautermeister, J.; Bacher, M.; Herberts, T.; Arand, J.; Poets, C.F. A Randomized Clinical Trial of a New Orthodontic Appliance to Improve Upper Airway Obstruction in Infants with Pierre Robin Sequence. J. Pediatr. 2007, 151, 145–149. [Google Scholar] [CrossRef]
- Poets, C.F.; Koos, B.; Reinert, S.; Wiechers, C. The Tübingen palatal plate approach to Robin sequence: Summary of current evidence. J. Cranio-Maxillofac. Surg. 2019, 47, 1699–1705. [Google Scholar] [CrossRef]
- Dalessandri, D.; Tonni, I.; Laffranchi, L.; Migliorati, M.; Isola, G.; Bonetti, S.; Visconti, L.; Paganelli, C. Evaluation of a Digital Protocol for Pre-Surgical Orthopedic Treatment of Cleft Lip and Palate in Newborn Patients: A Pilot Study. Dent. J. 2019, 7, 111. [Google Scholar] [CrossRef]
- Müller-Hagedorn, S.; Buchenau, W.; Arand, J.; Bacher, M.; Poets, C.F. Treatment of infants with Syndromic Robin sequence with modified palatal plates: A minimally invasive treatment option. Head. Face Med. 2017, 13, 4. [Google Scholar] [CrossRef]
- Wiechers, C.; Buchenau, W.; Arand, J.; Oertel, A.-F.; Peters, K.; Müller-Hagedorn, S.; Koos, B.; Poets, C.F. Mandibular growth in infants with Robin sequence treated with the Tübingen palatal plate. Head. Face Med. 2019, 15, 17. [Google Scholar] [CrossRef] [PubMed]
- Effert, J.; Uhlig, S.; Wiechers, C.; Quante, M.; Poets, C.F.; Schulz, M.C.; Reinert, S.; Krimmel, M.; Koos, B.; Weise, C. Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy. J. Clin. Med. 2023, 12, 448. [Google Scholar] [CrossRef]
- Abbas, D.B.; Lavin, C.; Fahy, E.J.; Choo, H.; Truong, M.T.; Bruckman, K.C.; Khosla, R.K.; Lorenz, H.P.; Momeni, A.; Wan, D.C. A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence. Cleft Palate-Craniofacial J. 2021, 59, 365–376. [Google Scholar] [CrossRef]
- Xepapadeas, A.B.; Weise, C.; Frank, K.; Spintzyk, S.; Poets, C.F.; Wiechers, C.; Arand, J.; Koos, B. Technical note on introducing a digital workflow for newborns with craniofacial anomalies based on intraoral scans—Part II: 3D printed Tübingen palatal plate prototype for newborns with Robin sequence. BMC Oral. Health 2020, 20, 171. [Google Scholar] [CrossRef]
- Weise, C.; Frank, K.; Wiechers, C.; Weise, H.; Reinert, S.; Koos, B.; Xepapadeas, A.B. Intraoral scanning of neonates and infants with craniofacial disorders: Feasibility, scanning duration, and clinical experience. Eur. J. Orthod. 2021, 44, 279–286. [Google Scholar] [CrossRef]
- Aretxabaleta, M.; Xepapadeas, A.B.; Poets, C.F.; Koos, B.; Spintzyk, S. Fracture Load of an Orthodontic Appliance for Robin Sequence Treatment in a Digital Workflow. Materials 2021, 14, 344. [Google Scholar] [CrossRef]
- Aretxabaleta, M.; Roehler, A.; Poets, C.F.; Xepapadeas, A.B.; Koos, B.; Weise, C. Automation of Measurements for Personalized Medical Appliances by Means of CAD Software—Application in Robin Sequence Orthodontic Appliances. Bioengineering 2022, 9, 773. [Google Scholar] [CrossRef] [PubMed]
- Thurzo, A.; Šufliarsky, B.; Urbanová, W.; Čverha, M.; Strunga, M.; Varga, I. Pierre Robin Sequence and 3D Printed Personalized Composite Appliances in Interdisciplinary Approach. Polymers 2022, 14, 3858. [Google Scholar] [CrossRef]
- Schmidt, G.; Hirschfelder, A.; Heiland, M.; Matuschek, C. Customized Pre-Epiglottic Baton Plate—A Practical Guide for Successful, Patient-Specific, Noninvasive Treatment of Neonates With Robin Sequence. Cleft Palate-Craniofacial J. 2020, 58, 1063–1069. [Google Scholar] [CrossRef]
- Choo, H.; Galera, R.I.; Balakrishnan, K.; Lin, H.-F.C.; Ahn, H.; Lorenz, P.; Khosla, R.K.; Profit, J.; Poets, C.F.; Lee, J.S. Disruptive Therapy Using a Nonsurgical Orthodontic Airway Plate for the Management of Neonatal Robin Sequence: 1-Year Follow-up. Cleft Palate-Craniofacial J. 2022, 60, 758–767. [Google Scholar] [CrossRef] [PubMed]
- Ho, A.C.; Wong, R.W.; Cheung, T.; Ng, D.K.; Siu, K.; Fung, S. Orthodontic plate for management of obstructive sleep apnoea in infants with Pierre Robin sequence: Experience and protocol in Hong Kong. J. Orthod. 2019, 46, 367–373. [Google Scholar] [CrossRef] [PubMed]
- Galluccio, G.; Mazzoli, V.; Vernucci, R.; Silvestri, A.; Barbato, E. Neonatal Functional Treatment for Pierre Robin Sequence. Turk. J. Orthod. 2019, 32, 151–159. [Google Scholar] [CrossRef]
- Bütow, K.-W.; Hoogendijk, C.F.; Zwahlen, R.A. Pierre Robin sequence: Appearances and 25 years of experience with an innovative treatment protocol. J. Pediatr. Surg. 2009, 44, 2112–2118. [Google Scholar] [CrossRef]
- Gerzanic, L.; Feichtinger, M.; Kärcher, H. The influence of the Tübingen soft palate plate and early cleft closure on the nasopharyngeal airway for the management of airway obstruction in an infant with Pierre Robin sequence: A case report. Int. J. Surg. Case Rep. 2012, 3, 608–610. [Google Scholar] [CrossRef]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Knechtel, P.; Weismann, C.; Poets, C.F. Caring for Infants with Robin Sequence Treated with the Tübingen Palatal Plate: A Review of Personal Practice. Children 2023, 10, 1628. https://doi.org/10.3390/children10101628
Knechtel P, Weismann C, Poets CF. Caring for Infants with Robin Sequence Treated with the Tübingen Palatal Plate: A Review of Personal Practice. Children. 2023; 10(10):1628. https://doi.org/10.3390/children10101628
Chicago/Turabian StyleKnechtel, Petra, Christina Weismann, and Christian F. Poets. 2023. "Caring for Infants with Robin Sequence Treated with the Tübingen Palatal Plate: A Review of Personal Practice" Children 10, no. 10: 1628. https://doi.org/10.3390/children10101628
APA StyleKnechtel, P., Weismann, C., & Poets, C. F. (2023). Caring for Infants with Robin Sequence Treated with the Tübingen Palatal Plate: A Review of Personal Practice. Children, 10(10), 1628. https://doi.org/10.3390/children10101628