Address: Calwerstr. 7
72076 Tübingen

E-mail address: face@​med.​uni-​tuebingen.​de

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Robin sequence

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

A wide variety of treatment methods are commonly used worldwide to correct the narrowing or obstruction of the upper airway in infancy. In Tübingen, the treatment with the so-called Tübingen palatal plate (TTPP) has become established due to the low stress for the child and also for the parents. This plate has an extension which prevents the tongue from falling back, eliminates the tightness in the throat and helps to stimulate the growth of the lower jaw. In children who are also affected by a cleft palate, this plate leads to a functional separation of the oral and nasal cavities, analogous to the palatal plate (see "Further information on cleft palates").

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



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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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).


  • 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).

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