Clinical Pathway for Evaluation/Treatment of the Neonate/Infant with Micrognathia/Retrognathia and Concern for Airway Obstruction
- Related Pathways
Team Assessment
- History and Physical
- Note positioning (e.g., supine, prone, side-lying) when assessing vital signs
- Subspecialty Consults
- Imaging recommended by Plastic Surgery
- If extubated, obtain 2 View Skull X-ray
- If intubated, obtain Facial 3D CT Scan
No Airway Support
Non-Invasive Airway Support
Successful Extubation
Airway Considerations
Airway Considerations
Trial Off Non-Invasive Airway Support
Successful
Unsuccessful
- Sleep Study to assess for OSA
- OSA severity should be considered in the context of other clinical factors to determine respiratory support and surgical candidacy
Review with Plastic Surgery, Pulmonary, and/or ENT
Non-Surgical Management
Tracheostomy Candidate
- Lower severity apnea
- Adequate PO feeding
Favorable anatomy based
on exam, imaging
on exam, imaging
- Multi-level airway obstruction
- Neurologic impairment
- Severe genetic syndromes
Pulmonary assessment for initiation of respiratory support as indicated
Drug-Induced Sleep Endoscopy (DISE) and MDO as indicated
- Discuss continued respiratory support (e.g., nasal cannula)
- Discuss sleep study titration
if on CPAP
Repeat Sleep Study
Tracheostomy as indicated
Posted: February 2017
Last Revised: November 2024
Last Revised: November 2024
Evidence
- Surgical Management and Outcomes of Pierre Robin Sequence: A Comparison of Mandibular Distraction Osteogenesis and Tongue-Lip Adhesion
- Multimodal Treatment of Robin Sequence Utilizing Mandibular Distraction Osteogenesis and Continuous Positive Airway Pressure
- Pharyngeal Airway Changes Following Mandibular Distraction Osteogenesis as Evaluated with Laryngoscopy
- Mandibular Distraction Osteogenesis for Tongue-Based Airway Obstruction Without Micrognathia
- Risk Factors for Perioperative Respiratory Failure Following Mandibular Distraction Osteogenesis for Micrognathia: A Retrospective Cohort Study
- Glossoptosis-Apnea Syndrome in Infancy
- The Surgical Correction of Pierre Robin Sequence: Mandibular Distraction Osteogenesis Versus Tongue-Lip Adhesion
- Disorders of the Neonatal Airway - Fundamentals for Practice
- Evolution of Obstructive Sleep Apnea in Infants with Cleft Palate and Micrognathia
- Craniofacial Disorders Associated with Airway Obstruction in the Neonate
- Surgical Outcome and Treatment Trends in 1289 Infants with Micrognathia: A Multicenter Cohort
- Spectrum of Disease in Hospitalized Newborns with Congenital Micrognathia: A Cohort of 3,236 Infants at North American Tertiary-Care Intensive Care Units
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