Robin sequence

The Robin sequence is a congenital malformation that affects about 80 children per year in Germany. It is characterized by an undersized lower jaw, mandibular recession (mandibular micrognathia and retrognathia) and a receding tongue into the pharynx (glossoptosis). This can result in obstruction of the airway, especially during sleep. In addition, the Robin sequence is associated with cleft palate in 90% of cases. This can lead to pronounced sucking and drinking problems
.

Baby drinks from a milk bottle — In Germany, about 80 children per year are affected by the malformation "Robin sequence (also Pierre Robin sequence)".

Contact

Clinic for Pediatrics and Adolescent Medicine
Ward 54 - Intensive care unit for premature and newborn infants (Neo 2)

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Calwer-Str. 7
72076 Tübingen, Germany

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Therapy

This is how therapy with the Tübingen Breathing Plate works

Step 1Early adaptation of the Tübingen Breathing Plate
- Orthodontics
- Pediatrics
On an inpatient basis, the child's clinical data are recorded and the severity of the respiratory disorders is clarified by means of a respiratory recording during sleep (polysomnography, so-called sleep laboratory). This examination is completely painless and is performed exclusively with adhesive sensors.

Furthermore, a low-risk 3D scan of your child's upper jaw is performed promptly using an intraoral scanner to fabricate and fit the Tübingen Breathing Plate.

An endoscopy is performed to rule out other causes of respiratory dysfunction and provides clues to the shape and size of the plate spur.

The Tübingen Breathing Plate is inserted with commercially available denture adhesive cream and stabilized with retaining bars. Once the child has become accustomed to the plate, the effectiveness of the Tübingen Breathing Plate is checked by means of a new breathing record.
Step 2 (in the 1st year of life)Drinking and swallowing training
- Pediatric caregivers
- Speech therapy
An important pillar in the concept of treatment is speech therapy, which contributes to the normalization of food intake and stimulation of mandibular growth via drinking and swallowing training by means of functional therapy (orofacial regulation therapy according to Castillo Morales and Pardovan).

Parents are involved in the treatment at an early stage. When they have mastered the daily change of the Tübingen Breathing Plate and important elements of functional therapy as instructed, and the child is taking nourishment independently and thriving, discharge is possible. A home monitor is prescribed in the first year of life to monitor oxygen saturation.

Due to the child's growth, 1 - 2 adjustments of the Tübingen Breathing Plate are usually necessary.
Step 3 (from 8 months)Surgical closure of cleft palate
- Oral and maxillofacial surgery
In the course of the outpatient check-ups, the time of surgery for the cleft palate operation is determined together with the parents. In order to give the child time to grow and the lower jaw time to post-develop, the surgery is generally not performed before the child is eight months old. No further plate treatment is necessary after surgery.
For more information on surgical palate closure, please also see
more information cleft palate surgery

Further information on the clinical picture

What does the Robin sequence mean for your child?

The Robin sequence is a congenital malformation that affects about 80 children per year in Germany.

These are signs of a Robin sequence

small lower jaw (microgenia)
mandibular retrognathia, due to a tongue displaced into the pharynx (glossoptosis)
usually a cleft palate

It can cause these problems

pronounced sucking and drinking problems and a resulting failure to thrive
falling back of the tongue during sleep with partially or completely closed airways (obstructive breathing pauses)
resulting in disturbances in the physical and mental development of the child up to the danger of life

Therapy FAQ

Frequently asked questions about the therapy of the Robin sequence with the Tübingen Breathing Plate

Problems with food intake, failure to thrive
Small lower jaw with mandibular recession and a tongue displaced into the pharynx
Breathing disorder (e.g. strained breathing, pauses in breathing or breathing sounds)
Mostly cleft palate

Due to the respiratory disorders there is a risk of obstructive breathing pauses and associated oxygen deficiency
Oxygen deficiency, malnutrition and failure to thrive can delay mental development

The treatment is particularly promising if it begins in the first days after birth.

Average therapy duration for fitting the Tübingen Breathing Plate with spur, drinking and swallowing training, duration until independent drinking without gastric tube and teaching parents how to change the Tübingen Breathing Plate (approx. 3 weeks).

Afterwards:

Tübingen breathing plate (4-6 months)
Surgical closure of the cleft palate (around the first year of life) - no need for a palate plate thereafter.
If necessary: Interdisciplinary treatment concept between pediatrics, orthodontics, otolaryngology, phoniatrics, speech therapy (from infancy to the end of growth).

The therapy concept with the Tübingen Breathing Plate is not a surgical procedure and is therefore not very stressful for the child (and the parents).