ROBIN-SEQUENCE - OBSTRUCTIVE SLEEP-APNEA FOLLOWING PHARYNGEAL FLAP

Objective: We reviewed 24 children with Robin sequence who underwent c left palate repair. Method: All patients were 5 years of age or older at the time of review, allowing for accurate assessment of speech in r elation to velopharyngeal function. All infants had palatal closure be tween 9 and 14 months of age, either V-Y repair (n = 16) or von Langen beck repair (n = 8). Results: Only 1 of 16 children who had V-Y repair had borderline velopharyngeal dysfunction (VPD). For reasons that are unclear, in the von Langenbeck repair group, six of eight children ha d VPD, and four of six underwent pharyngeal flap. Three additional pat ients with nonsyndromic Robin sequence had palatoplasty and subsequent pharyngeal flap. Six of the combined total of seven children with non syndromic Robin sequence developed obstructive sleep apnea and require d flap take-down. Conclusion: Since conventional pharyngeal flap for V PD in nonsyndromic Robin sequence children resulted in a high incidenc e of obstructive sleep apnea, alternative management should be conside red: modification of the standard pharyngeal flap, palatal lengthening (V-Y or double-opposing Z-plasty), or construction of a speech bulb.