Paradigm Shift in Airway Management for Pierre Robin Sequence: Tongue Base Suspension

Abstract Surgical management of the airway in children with Pierre Robin Sequence (PRS) includes tongue lip adhesion and mandibular distraction. Herein, the authors report the first case of an alternative surgical approach, the tongue base suspension (TBS). A full-term 5-week-old male with PRS with difficulty managing his airway through noninvasive mechanisms. A polysomnogram revealed severe obstructive sleep apnea (OSA) despite support. Parents desired the least invasive surgical approach, and therefore TBS was offered. Child underwent TBS without complications and weaned from 15L high flow to room air over 48 hours. Post-procedure polysomnogram revealed complete resolution of OSA. The child was discharged home without any supplemental support. The standard of surgical care for children with PRS has been either tongue lip adhesion or mandibular distraction. While their success is well-established, no alternatives have been considered. The authors demonstrate TBS can provide a less invasive, equally viable, and improved alternative in children with PRS.