Silvia Müller-Hagedorn

Background: The aims of the study were to describe facial morphology and analyze facial growth in adolescents with Robin sequence (RS) or Stickler syndrome. Methods: The facial morphology, mandibular size, and facial growth of 69 adolescents (ages 12–18) with RS were analyzed using existing cephalometric radiographs (n = 37) and photographs (n = 69). All participants were followed in our institution since birth. None underwent growth-modifying treatment for micrognathia during infancy, but all had conservative orthodontic treatment during adolescence. Results: Cross-sectional cephalometric analysis according to Tweed revealed differences in RS adolescents as compared with reference values, such as a proportionate retrusion of both jaws, as indicated by decreased SNA and SNB angles (p < 0.05). This finding was mostly associated with skeletal Class I (62.2%) and a vertical facial pattern as indicated by increased FMA and CoGoMe angles (p < 0.05). In Delaire’s analysis, patients showed decreased maxillary, maxillary alveolar (p < 0.05), and mandibular body territories (p > 0.05) but increased ramus (p > 0.05) and nasopremaxillary territories (p < 0.05). According to Ricketts’ analysis, mandibular width was decreased in half of our patients (p > 0.05). The mandibles were harmoniously downsized before and after the growth spurt (p < 0.05); however, they exhibited greater growth velocities than controls. A long-term study during puberty revealed an increase in SNB angles and a decrease in ANB angles (both p < 0.05), which improved the maxillomandibular relationship. Additionally, the vertical facial pattern attenuated (FMA, SNGoGn, and CoGoMe angles decreased; p > 0.05). On cross-sectional photographic analysis, 33.3% of patients had an orthofrontal (straight), 59.4% a cisfrontal (convex), and 7.3% a transfrontal (concave) profile. Their vertical facial proportions were normal. In the subjective profile analysis, most patients (approximately 84%) had good or acceptable profiles, with no major deficit of chin projection. The initial degree of neonatal retrognathia and type of cleft palate surgery did not affect major skeletal parameters (p > 0.05). However, the degree of neonatal functional impairment affected the vertical parameters (SNGoGn, FMA angle; p < 0.05). Conclusions: Overall, RS patients presented a bi-retrognathic profile, a normal jaw relationship, and a tendency toward a vertical growth pattern. Partial mandibular catch-up growth occurred during the pubertal growth spurt. The degree of neonatal retrognathia does not predict further mandibular growth.

Pediatric obstructive sleep apnea (OSA) is a highly prevalent, multifactorial, and often underdiagnosed condition with significant consequences for cognitive and behavioral development. Early detection and timely multidisciplinary interventions are essential, particularly in children with craniofacial anomalies or syndromes associated with increased OSA risks, to prevent long-term complications. This narrative review explores the orthodontists’ role in the interdisciplinary management of pediatric OSA, focusing on early screening for craniofacial risk factors and implementing interceptive orthodontic interventions that support favorable airway development and growth modulation. Through early and frequent interaction with pediatric patients, orthodontists are well-positioned to identify clinical signs of airway-related abnormalities and craniofacial risk factors such as mandibular and maxillary retrognathism, maxillary constriction, and high-arched palatal vaults. Orthodontic interventions such as rapid maxillary expansion (RME), mandibular advancement, and myofunctional therapy may improve airway patency in selected cases. These approaches should be coordinated and integrated within the multidisciplinary team, including orthodontists, pediatricians, sleep specialists, ENT specialists, and speech-language pathologists. Furthermore, caregivers’ involvement and patients’ compliance are keys to success. Despite encouraging clinical observations, current evidence is limited by heterogeneity and a lack of long-term outcome data. Future research should prioritize well-designed prospective trials, explore the effectiveness of combined therapeutic strategies, and support the development of standard diagnostic protocols. Equally important is a stronger focus on early diagnosis and preventive measures to enhance patient outcomes and long-term treatment strategies. Integrating orthodontists into early OSA care is essential for optimizing outcomes and reducing long-term morbidity.

Pediatric obstructive sleep apnoea (OSA) is a highly prevalent, multifactorial, and often under-diagnosed condition with significant consequences for cognitive and behavioral development. Early detection and timely multidisciplinary interventions are essential, particularly in children with craniofacial anomalies or syndromes associated with increased OSA risks, to prevent long-term complications. This narrative review explores the orthodontists’ role in the interdiscipli-nary management of pediatric OSA, focusing on early screening for craniofacial risk factors and implementing interceptive orthodontic interventions that support favorable airway develop-ment and growth modulation. Through early and frequent interaction with pediatric patients, orthodontists are well-positioned to identify clinical signs of airway-related abnormalities and craniofacial risk factors such as mandibular and maxillary retrognathism, maxillary constriction, and high-arched palatal vaults. Orthodontic interventions such as rapid maxillary expansion (RME), mandibular advancement, and myofunctional therapy may improve airway patency in selected cases. These approaches should be coordinated and integrated within the multidiscipli-nary team, including orthodontists, pediatricians, sleep medicine specialists, ENT specialists, and speech pathologists. Furthermore, caregivers’ involvement and patients’ compliance are keys to success. Despite encouraging clinical observations, current evidence is limited by heterogeneity and a lack of long-term outcome data. Future research should prioritize prospective trials, standardized diagnostic protocols, and evaluations of combined therapeutic approaches, as well as prevention and early screening. Integrating orthodontists into early OSA care is essential for optimizing outcomes and reducing long-term morbidity.

Background: Robin sequence (RS) is characterized by mandibular micro- and retrognathia, glossoptosis, upper airway obstruction and optionally a cleft palate. With an incidence of 1:8000, it belongs to the so-called rare diseases; 30–50% of patients have RS as part of a syndrome. A comparatively well-studied treatment option is the Tuebingen Palatal Plate (TPP), which has proven effective in both, isolated and syndromic RS, but often requires multiple endoscopies for perfect fit and effectiveness. We report on a new method for fitting the TPP with only one session of nasopharyngeal endoscopy resulting in the plate being finished in one day.Methods and results: First, a prototype is produced, consisting of a traditional acrylic palatal part and a velar extension made of thermoplastic resin, usually measuring 10x40mm. Using polymerization, a scale is added to the posterior part of the extension to help with determining its optimal length during endoscopic evaluation. The extension is pre-bent in the dental laboratory to achieve an approximate shape. During endoscopy, the prototype can be adjusted to the infant’s anatomy: first, the angulation is customized by controlled heating, bending and cooling of the thermoplastic spur. Second, the length of the spur is adapted by grinding its tip. Then the prototype is returned to the dental laboratory for completion; the final plate can be delivered to the patient on the same day. It acts by shifting the tongue into a more anterior position, thereby opening the airway and releasing upper airway obstruction, as well as by acting as a functional orthodontic appliance that stimulates mandibular growth through exerting pressure on the base of the tongue.Conclusions: With the thermoplastic spur presented here, a TPP can be produced within one day, requiring only one endoscopy. This approach may facilitate fabricating the TPP.

Treatment of Robin sequence is often either invasive or of unproven effectiveness. The pre-epiglottic baton plate (PEBP) is a well-studied alternative, yet is not widely applied internationally. We report on a prospective 3-center cohort study investigating this treatment. Based on an agreed protocol, parents of infants with Robin sequence referred to participating centers were offered enrollment, which involved taking a maxillary cast followed by endoscopy to fit the plate and sleep studies to monitor its effectiveness. Recordings were centrally analyzed by sleep specialists blinded to timing and center. Primary outcome was the mixed-obstructive apnea index, defined as the number of such apneas/h of sleep; secondary outcomes included the desaturation index to <80% pulse oximeter saturation and weight gain. Of 75 infants referred, 49 could be included; 1 center failed to perform appropriate sleep studies. Within a mean hospitalization of 3 weeks, the mixed-obstructive apnea index decreased (median; interquartile range) from 15.9 (6.3–31.5) to 2.3 (1.2–5.4); it decreased further to 0.7 (0.1–2.4) in the 32 infants who had a successful 3-month follow-up sleep study performed. The desaturation index normalized (from 0.38 (0–2.7) to 0.0 (0–0.1)). Mean standard deviation score for weight remained unchanged between admission and follow-up, while the proportion of tube-fed infants decreased from 74 to 14%. This prospective multi-center cohort study confirms retrospective audits on the effectiveness of PEBP treatment in improving upper airway obstruction and feeding problems, the main clinical problems of infants with Robin sequence. International collaboration is required to compare this with other treatment approaches. Number NCT02266043 , Registered 30/09/2014; registered partially retrospectively.