Airway Obstruction Risk in Unique Infant Cleft Phenotype: PSIO Protocol Modification Recommendations

The Cleft Palate-craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
Aaron M FoglioJoseph E Losee

Abstract

Patients presenting with a unique unilateral cleft phenotype may be at risk of nasal airway obstruction which can be exacerbated by presurgical infant orthopedic (PSIO) appliance therapy and lip taping. Four patients presented to the UPMC Children's Hospital of Pittsburgh Cleft-Craniofacial Center with a cleft phenotype characterized by: An anteriorly projected greater alveolar segment and medial collapse of the lesser segment posteriorly, leading to cleft alar base displacement posteromedial to the anteriorly projected greater segment. Resultant bilateral nasal airway obstruction: cleft ala drape over the leading edge of the greater segment's alveolus (cleft side obstruction) and caudal septum displacement secondary to attachments to the orbicularis oris from the noncleft side (noncleft side obstruction). The patient described presented at 3 months old from an outside institution, where PSIO therapy was undertaken. A second opinion was sought due to concern of significant difficulty in breathing and feeding with the PSIO oral plate. Lip-nose adhesion (LNA) was elected and airway obstruction was immediately relieved after this intervention. Lip-nose adhesion releases the tethered cleft side alar base from the pyriform rim of th...Continue Reading

References

Nov 10, 2009·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Viktor Rosival
Nov 26, 2009·The Cleft Palate-craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association·Daniel Levy-BercowskiPedro E Santiago
Feb 9, 2010·Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery·Gian Luca GattiAlessandro Massei
Dec 29, 2012·Plastic and Reconstructive Surgery·Perry van der HeijdenSieneke M Goorhuis-Brouwer
Feb 6, 2019·Current Opinion in Pediatrics·David C Bellinger, Johanna Calderon

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