피에르 로빈 연속증의 치료로써 치조 보호 장치를 이용한 혀-하순 유착술

Tongue-Lip Adhesion Using an Alveolar Protector Appliance for Management of Pierre Robin Sequence

  • 이장원 (연세대학교 원주의과대학 성형외과학교실) ;
  • 박병윤 (연세대학교 의과대학 성형외과학교실)
  • Lee, Jang-Won (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Park, Beyoung-Yun (Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine)
  • 투고 : 2011.03.16
  • 심사 : 2011.04.26
  • 발행 : 2011.07.10

초록

Purpose: Pierre Robin sequence is a congenital malformation in which micrognathia causes glossoptosis and airway obstruction. If conservative treatment fails, surgical procedures such as tongue-lip adhesion can be performed. However, this procedure remains a subject of debate, with favorable results being countered by reports of complications. To overcome the above limitations, we revised the traditional method of tongue-lip adhesion using an alveolar protector. Methods: Between 1992 and 2011, a total of eight patients were identified with Pierre Robin sequence and were treated with tongue-lip adhesion. Two of these eight tongue-lip adhesion procedures were performed with an alveolar protector. The operative technique for tongue-lip adhesion was similar to that described in other published reports. The alveolar protector was inserted between the ventral surface of the tip of the tongue and the lower labial sulcus. Results: Tongue-lip adhesion failed in two patients because of wound dehiscence. The primary surgical success rate was 66.7%. In the two tongue-lip adhesion procedures performed with the alveolar protector, we observed no postoperative complications. Conclusion: Resistance to traction of the tongue can be encountered with nonunionized symphysis menti, causing loosening of the traction suture through the symphysis menti. This can lead to backward positioning of tongue, resulting in dehiscence of tongue lip adhesion. The alveolar protector is a good adjunct to tongue-lip adhesion because this method avoids postoperative loosening of the traction suture and wound dehiscence. It is a simple and effective auxiliary method that yields functional improvement.

키워드

참고문헌

  1. Caouette-Laberge L, Bayet B, Larocque Y: The Pierre Robin sequence: review of 125 cases and evolution of treatment modalities. Plast Reconstr Surg 93: 934, 1994 https://doi.org/10.1097/00006534-199404001-00006
  2. Kirschner RE, Low DW, Randall P, Bartlett SP, McDonald-McGinn DM, Schultz PJ, Zackai EH, LaRossa D: Surgical airway management in Pierre Robin's sequence: Is there a role for tongue-lip adhesion? Cleft Palate Craniofac J 40: 13, 2003 https://doi.org/10.1597/1545-1569(2003)040<0013:SAMIPR>2.0.CO;2
  3. Douglas B: The treatment of micrognathia associated with obstruction by a plastic procedure. Plast Reconstr Surg 1: 300, 1946 https://doi.org/10.1097/00006534-194611000-00007
  4. Shprintzen RJ: The implication of the diagnosis of Robin sequence. Cleft Palate Craniofac J 29: 205, 1992 https://doi.org/10.1597/1545-1569(1992)029<0205:TIOTDO>2.3.CO;2
  5. Schaefer RB, Stadler JA, Gosain AK: To distract or not to distract: an algorithm for airway management in isolated Pierre Robin sequence. Plast Reconstr Surg 113: 1113, 2004 https://doi.org/10.1097/01.PRS.0000110323.50084.21
  6. Lehman JA, Fishman JR, Neiman GS: Treatment of cleft palate associated with Robin sequence: appraisal of risk factors. Cleft Palate Craniofac J 32: 25, 1995 https://doi.org/10.1597/1545-1569(1995)032<0025:TOCPAW>2.3.CO;2