Biomedical subjects

Lun-Jou Lo

Publications and source records attributed to Lun-Jou Lo.

At least 19 recordsLinked to original sources

PubMed2006

The volume of muscles of mastication in patients receiving mandibular contouring surgery: a comparative study.

PURPOSE: As the management of prominent mandibular angle and masseter muscle hypertrophy becomes increasingly popular, proper understanding of the volumetric component of the related structures becomes important but is currently lacking. MATERIALS AND METHODS: Three-dimensional computed tomographic (CT) scans of 18 female and eight male adult patients with square-face appearance were used for volumetric measurement of the osseous hemi-mandible, masseter, medial and lateral pterygoid muscles. CT scans of 28 female and 17 male adult patients without square-face appearance were selected from the imaging laboratory archive to serve as controls. RESULTS: Compared with the sex-matched controls, the square-faced patients had significantly higher volume of the osseous hemi-mandible as well as the masseter and medial pterygoid muscles. There was no significant difference in the volume of the lateral pterygoid muscle between the two groups. This study confirms a significantly greater volume in the osseous mandible and masseter muscle in patients complaining of square-face appearance. The implication of this information on treatment is discussed.

Adult↗

PubMed2006

Distraction osteogenesis in adolescents with maxillary arch deficiency and dental crowding: a 3-year follow-up.

BACKGROUND: In this study, the authors evaluated the long-term results after using anterior segmental osteotomy and distraction osteogenesis for the correction of sagittal maxillary deficiency associated with dental crowding. METHODS: Six young adolescents (four boys and two girls) underwent surgery and distraction at a mean age of 11.2 years (range, 10 to 12 years) and were followed up for 3 years. A tooth-borne distraction device was used for interdental distraction. The evaluation consisted of hard- and soft-tissue profile analysis and dental arch measurements before, immediately after, and 3 years after distraction. RESULTS: The results showed that the facial profile, the occlusion, and the dental crowding could be successfully corrected and that the results were stable after 3 years' follow-up. The mean facial convexity angle was changed from 1 to 8 degrees. The average advancement at point A was 4 mm and the SNA increased by an average of 4 degrees. Lengthening of the dental arch by an average of 4 mm created approximately 8 mm of new space, sufficient to resolve the dental crowding in all patients, thus avoiding an extraction of healthy teeth. CONCLUSION: The results of this study demonstrated that anterior segmental maxillary osteotomy combined with distraction osteogenesis offers an alternative for the treatment of adolescents suffering from sagittal maxillary deficiency with dental crowding.

Child↗

PubMed2005

Volumetric change of the muscles of mastication following resection of mandibular angles: a long-term follow-up.

Mandibular angle resection is an accepted procedure for the correction of square face appearance due to mandibular angle prominence. Long-term follow-up of the changes in volume that occurs in the muscles of mastication and osseous structures has been inadequate in the literature. In this study, 3-dimensional computed tomography data were used to extract the mandible, masseter, medial pterygoid, and lateral pterygoid muscles for assessment of the volumetric changes that took place after angle reduction in 7 patients (14 hemimandibles) with an average age of 24.9 years and a mean follow-up time of 4.5 years. All measurements were performed twice to assure accuracy, with a difference of 1.2 +/- 1.1% noted. The hemimandible volume was reduced by 12.6% immediately after the reduction procedure and 8.2% at final follow-up. Osseous regeneration was observed as thickening of the bone and partial regrowth of the angles. None of the 14 hemimandibles had a complete return of the preoperative angular shape. The volumetric changes that occurred in the muscles of mastication were inconsistent among the patients. The masseter muscle was reduced by 5.2%, the medial pterygoid muscle was reduced by 14.4%, and the lateral pterygoid muscle was increased by 5.7% at final follow-up. The medial pterygoid muscle change was more significant than that of the masseter muscle (P = 0.00361). The objective findings of this study were not in agreement with the conventional thought and clinical impression that the masseter muscle becomes atrophic after mandibular angle resection. Only a slight reduction occurred in some patients in the volume of the muscles, with some actually displaying a slight increase. The end result was a satisfactory esthetic outcome for the patients in the long term despite the minor changes in muscle volume and slight bony regeneration that occurred.

Adolescent↗

PubMed2005

Intracranial space, brain, and cerebrospinal fluid volume measurements obtained with the aid of three-dimensional computerized tomography in patients with and without Crouzon syndrome.

OBJECT: The authors attempt to provide a standard for volumes of the intracranial space, brain, and cerebrospinal fluid (CSF) in healthy control individuals by using in vivo three-dimensional (3D) computerized tomography (CT) data and to compare these data with those obtained from a group with Crouzon syndrome. METHODS: Fifty-seven individuals underwent 3D head CT scanning for nonintracranial-related disease to produce a set of normal volumes for the intracranial space, brain, and CSF. Prediction limits of 95% were obtained to provide a range of acceptable volumes throughout the growing period and early adulthood. Eleven patients (seven boys and four girls, age range 2.2 months-13.4 years) with Crouzon syndrome underwent identical measurements, which were compared with those of the control patients. The control group comprised 35 boys and 22 girls who ranged in age from 0.26 months to 24.4 years. Intracranial space and brain volume showed a progressive increase with age, with three different slopes from birth to adulthood. Male patients were found to have larger volumes than female patients in the same age group. Volume patterns for CSF were not significantly different within a given age or sex. Six patients with Crouzon syndrome had intracranial and brain volumes within the 95% prediction limit, three patients measured above the limit, and two measured below. CONCLUSIONS: A standard for volumes of intracranial space and structures provides a guideline for the evaluation of patients with intracranial disease. Volumes in patients with Crouzon syndrome can be matched to their normal age- and sex-matched counterparts.

Adolescent↗

PubMed2005

Tongue-lip adhesion in the management of Pierre Robin sequence with airway obstruction: technique and outcome.

BACKGROUND: Airway obstruction and feeding difficulty can occur in patients born with Pierre Robin sequence. In select patients with pronounced micrognathia, surgical intervention to relieve the airway obstruction is necessary. The surgical indications and appropriate surgical procedure continue to have a great deal of controversy. The purpose of this study was to evaluate our experience of tongue-lip adhesion in the management of upper airway obstruction associated with Pierre Robin sequence. METHODS: From March 1995 through May 2002, a total of 14 patients with Pierre Robin sequence, who were admitted to the pediatric neonatal intensive care unit either with prolong intubation, poor body weight gain, or repeated airway infection, underwent tongue-lip adhesion (TLA). The operation was performed by raising mucosa flaps and approximated the muscles between tongue and lower lip. Retention sutures were used. The patients were evaluated for clinical responses. RESULTS: Our successful rate with tongue-lip adhesion was 70%. Ten of the 14 patients showed clinical improvements including extubation of the endotraccheal tube, body weight gain, return for home care, reduced episodes of respiratory infection, and improvement in O2 saturation and blood gas. The surgical procedure was simple to perform without major complications. CONCLUSIONS: This retrospective review showed that with a thorough preoperative airway evaluation, TLA could be successfully used to treat select patients with Pierre Robin sequence suffering from severe upper airway obstruction. Thus, TLA should be first considered when surgical relief of airway obstruction is indicated and when obstruction is limited to the classic tongue base obstruction type.

Airway Obstruction↗

PubMed2004

Craniofacial deformity in patients with uncorrected congenital muscular torticollis: an assessment from three-dimensional computed tomography imaging.

Congenital muscular torticollis is caused by idiopathic fibrosis of the sternocleidomastoid muscle that restricts movement and pulls the head toward the involved side. Deformation of the craniofacial skeleton will develop if the restriction is not released and result in aesthetic and functional problems. The purpose of this study was to use three-dimensional computed tomography imaging for qualitative and quantitative evaluation of the craniofacial deformity in a series of patients with uncorrected congenital muscular torticollis, and to assess age as a precipitating factor for severity of the deformity. A total of 14 patients from 1 month to 24 years of age were included. The skull images were rotated into standard orientation and reconfigured for evaluation of the cranium, endocranial base, and facial skeletal structures. The midlines of cranial base and facial bone, angle of midline deviation, width of each hemicranium and hemiface, and the orbital index were defined and measured. The results showed that the cranium and cranial base deformation took place as early as in infant stage, with the most prominent change occurring in the posterior cranial fossa. Facial bone asymmetry started to appear after 5 years of age, at which time the mandibular and occlusal abnormalities were observed. The deformity of the orbits and maxilla occurred at an older age, characterized by the deviation and decreased vertical height on the affected side. The severity of the observed deformities increased with age. The angle of midline deviation was 2.48 +/- 1.68 degrees in the cranial base and 3.26 +/- 3.28 degrees on the facial bone. Both of the midline deviations were significantly correlated with age. Compared with the contralateral side, the width of the ipsilateral posterior hemicranium was longer (54.36 +/- 6.72 mm versus 50.81 +/- 6.55 mm), and the width of the ipsilateral lower hemiface was shorter (35.30 +/- 7.27 mm versus 43.49 +/- 11.34 mm). Both differences were statistically significant. Measurement of the orbital index demonstrated a significantly flatter orbit on the ipsilateral side (89.48 +/- 0.11 versus 92.74 +/- 0.08). This study showed that the cranium and cranial base deformity occurred early in patients with uncorrected torticollis, while the facial bone deformity occurred in childhood stage. The cranial and facial deformity became more severe with age. Early release of the muscle restriction is advised to prevent craniofacial deformation.

Adolescent↗

PubMed2004

Microtia reconstruction with adjuvant 3-dimensional template model.

For auricular reconstruction of external auricle, the goals of the surgery are (1) in the fabrication of the morphologically complete 3-dimensional costal cartilage framework (3-dimensional frame) of the auricle, and (2) in the attainment of ample skin surface area to cover the grafted 3-dimensional frame, so that more than satisfactory results can be achieved. In review of the published literature, the cartilage framework used for auricular reconstruction is either insufficient or incomplete in the fabrication of the anatomic structures or inappropriate in proportion. We herein introduce the 3-dimensional resin template model (3-dimensional template model) and 3-dimensional frame used in our daily surgical practice. The 3-dimensional template model is proportionally fabricated with all the essential morphologic structures of the auricle. It can be used intraoperatively for reference in fabricating the 3-dimensional frame and simulation of the surgery. The 3-dimensional template model is very useful as an adjuvant tool in adjusting the skin flaps, prevention of mistake in fabrication of the 3-dimensional frame, and for educational purposes of junior resident surgeons.

Acrylic Resins↗

PubMed2004

The position of the inferior alveolar nerve at the mandibular angle:: an anatomic consideration for aesthetic mandibular angle reduction.

Mandibular angle reduction is a popular contouring surgery in Asia. Avoidance of injury to the inferior alveolar nerve is crucial during these procedures. Anatomic data regarding the position of the nerve in the mandibular angle area are sparse. The purpose of this study was to use 3-dimensional computed tomographic data to evaluate the nerve in patients with prominent mandibular angles and to compare the nerve position with a normative group. A total of 28 female and 5 male adult patients who presented with a complaint of prominent angles or a "square-face" look, as well as 20 female and 22 male adult normal subjects were included, for a total of 150 hemimandibles for extraction of the inferior alveolar nerve. The nerve and the mandible were displayed. Point O was defined on the oblique line along the anterior cortex of ramus, where it intersected with a line extending from the alveolar arch. From the O point, linear distances were defined, including horizontal distances to the posterior cortex, oblique distances to the gonion, and the vertical distances to the inferior cortex. Mandibular width was defined as the distance between the 2 gonion points. Results demonstrated significant differences mainly in the oblique distances (ie, from the O point to the nerve [O1], from the nerve to the gonion [O2], and from the O point to the gonion [O1-O2]) in both female and male patients. The O2 distance was 23.69 mm versus 20.66 mm in women and 27.30 mm versus 23.28 mm in men (square face vs norm). The mandibular width was significantly larger in the male square-face patients, but the difference was not significant between the female groups. These results provide useful information for surgeons planning mandibular angle reduction. These findings suggest that the mandibular contouring procedure should be aimed at correcting regional osseous dysmorphology in the angle area and improving the relationship to the chin, rather than merely reducing the mandibular width.

Adult↗

PubMed2004

Computer-aided reconstruction of traumatic fronto-orbital osseous defects: aesthetic considerations.

BACKGROUND: In addition to functional goals, a satisfactory aesthetic outcome is important for reconstruction of fronto-orbital osseous defects. The purpose of this study is to report on a method for presurgical fabrication of custom implants using 3-dimensional (3-D) imaging data and computer-assisted manufacturing techniques. METHODS: Preoperative 3-D computed tomography data were processed and displayed for evaluation of defects. Implants were created by a computer-aided design/computer-aided manufacturing (CAD/CAM) program. A rapid prototyping system was applied for production of the physical models. Rehearsal of surgery was performed using the implants and skull models. Negative castings were created and were used during the operations to prepare the surgical implant utilizing methyl methacrylate. Traumatic fronto-orbital defects in 4 patients were reconstructed using this method. The follow-up period ranged from 29 to 55 months. RESULTS: Results showed that the custom implants perfectly fit the defects during the operation. Symmetry and normal fronto-orbital contours were achieved. There were no peri- or postoperative complications. All patients were satisfied with the results. CONCLUSIONS: Computer-aided presurgical simulation and fabrication of implants is a reliable and effective method for the reconstruction of traumatic fronto-orbital defects, with reduced anesthesia time and improved aesthetic outcomes.

Adult↗

PubMed2004

Vascular abnormalities in the head and neck area in velocardiofacial syndrome.

BACKGROUND: Velocardiofacial syndrome (VCFS) is a disorder commonly associated with a characteristic facial appearance, congenital heart disease, and velopharyngeal insufficiency. An association with vascular anomalies in the cervical area and skull base has been reported. In this study, we evaluated 7 consecutive patients who received vascular imaging for preoperative planning of velopharyngeal surgery. METHODS: From January 1996 to September 1997, 7 patients with VCFS were found in 1 of the senior author's service. All had documented velopharyngeal insufficiency and visible pulsations over the posterior pharyngeal wall by nasoendoscopy. Two patients had magnetic resonance angiography (MRA), 2 patients had computed tomographic angiography (CTA), and 3 patients had both. RESULTS: The angiographic study revealed abnormalities of the carotid and vertebral arteries in 5 patients (71%). Kinking and tortuosity of the internal carotid artery and its medial displacement were common. The observed pulsations did not correlate well with the angiographic findings. For surgical correction of the velopharyngeal sufficiency, a regular pharyngeal flap was used in 4 patients, a modified pharyngeal flap was used in 2 patients, and the surgery was abandoned in the remaining 1 patient. CONCLUSIONS: Expression of cervical vascular anomalies in VCFS was varied and did not correlate well with the observed pulsations from the nasopharyngoscopic examination. Preoperative vascular imaging study is essential for the purpose of planning and safety of surgical interventions in this area.

Carotid Arteries↗

PubMed2003

Palatal surface area measurement: comparisons among different cleft types.

The purpose of this study was to use three-dimensional imaging methods to measure the palatal surface of unrepaired cleft patients. The surface area of the palate was defined and measured on three-dimensional computed tomography images of dental plaster models in four different groups of cleft patients at 3 months of age. There were 30 unilateral complete cleft lips and palates (UCLP), 27 bilateral complete cleft lips and palates (BCLP), 23 isolated cleft palates of incomplete form (CP), and 19 unilateral cleft lips without cleft palates (UCL). These patients were nonsyndromic, unoperated, and without other major deformities. The dental casts were scanned, and the computed tomography data were transferred to an imaging laboratory for processing and reconstruction of three-dimensional images. Surface area of the palate was delineated, which was defined as within the alveolar crest and the line connecting both tuberosities. In UCLP and BCLP, the edge of cleft formed the medial boundary of the area for each palatal shelf, and the palatal surface area was the combination of both palatal shelves and the premaxillary area in BCLP group. The surface area was measured. Repeated definition and measurement tasks were performed for calculation of errors. The imaging data management and measurement were performed using the Analyze program (Biomedical Imaging Resource, Mayo Foundation, MN). In addition, linear distances were measured between the canine points on the alveolar crest (line C) and the tuberosity points (line T). The measurements were compared among the different groups. Analysis of variance and multiple comparisons were used for statistical analyses. The results showed that the mean error between repeated area definitions and measurements in this study was 1.86%. The bilateral complete cleft lip and palate (BCLP) and unilateral complete cleft lip and palate (UCLP) groups had significantly smaller palatal surface area than the unilateral cleft lip without cleft palate (UCL) and isolated cleft palate of incomplete form (CP) groups. There was no significant difference between the BCLP and UCLP groups. Line C and line T distances were significantly longer in BCLP and UCLP groups than in UCL and CP groups. The findings suggest that compared with UCL and CP patients, there is an intrinsic tissue deficiency in the palate/maxilla of BCLP and UCLP patients.

Cleft Lip↗

PubMed2003

Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: Abbé flap revisited.

The purpose of this retrospective study was to review the method of using the Abbé flap for correction of secondary bilateral cleft lip deformity in selected patients with tight upper lip, short prolabium, lack of acceptable philtral column and Cupid's bow definition, central vermilion deficiency, irregular lip scars, and associated nasal deformity. A total of 39 patients with the bilateral cleft lip nasal deformity received Abbé flap and simultaneous nasal reconstruction during a period of 6 years. Mean patient age at the time of the operation was 19.1 years, and ranged from 6.6 to 38.5 years. The average follow-up period was 1.8 years. Fourteen patients had prior orthognathic operations. The Abbé flap was designed 13 to 14 mm in length and 8 to 9 mm in width and contained full-thickness tissue from the central lower lip, with a slightly narrow reverse-V caudal end. The prolabium, including the scars and central vermilion, was excised. Lengthening procedures of the upper lip segments were performed if vertical deficiency existed. Part of the prolabial skin was preserved and mobilized for columellar elongation, if indicated. Open rhinoplasty was carried out with or without cartilage graft for columella and nasal tip reconstruction. Reduction of the alar width and nostrils was achieved by a Z-plasty or excision of scar tissue at the nostril floor. The Abbé flap was then transposed cephalad, insetting into the median defect and sutured in layers. The results demonstrated no flap problems or perioperative complications. Seven patients needed further minor revisions on the nose and/or lip. Laser treatment was used to improve the lip scars in three patients. The patients were satisfied with the final outcome and found the lower lip scars acceptable. In conclusion, the described technique of Abbé flap and simultaneous rhinoplasty is an effective reconstructive method for select patients with bilateral cleft lip and nasal deformity.

Adolescent↗

PubMed2003

Three-dimensional computed tomography imaging in craniofacial surgery: morphological study and clinical applications.

Three-dimensional carniofacial CT imaging has been developed and progressed during the past two decades. The advancement of the hardware and software has made the imaging study more convenient, user friendly, and affordable. Processing and analysis of the imaging data are readily performed on personal computers. Accuracy of the 3-dimensional measurement has been validated. Collaborative study can be achieved with other departments or disciplines, such as orthopedic, otolaryngologic, and dental departments, as well as mechanical engineering department. All the data should be adequately archived as medical imaging data bank for later use. The data can be transferred for production of rapid prototyping models to enhance clinical application. Inter-center sharing of imaging data can be done through common image format. Comprehensive morphological study and clinical information may help to improve or refine treatment planning, which in turn yield better treatment outcome.

Craniofacial Abnormalities↗

PubMed2003

Programmed database system at the Chang Gung Craniofacial Center: part I.

BACKGROUND: A database is a system for the management of information. Databases of different forms are widely used in everyday life from telephone books to online library catalogs. The Craniofacial Center at Chang Gung Memorial Hospital has seen over 20,000 patients during the past 20 years. All of the patient records need to digitally input into a computer database. METHODS: A database was custom designed using Paradox 8. The ACDSee Photo browser and DOS linked them to the original program. The Paradox 8 was programmed to a standard mode for the diagnosis and treatment data input to prevent typographical errors. RESULTS: We collected the records of 25,200 patients from 1987 to 2002, of which 24,331 underwent operations. The data for 14,828 patients were registered as complete and/or incomplete cleft and the proportions of unilateral to bilateral and female to male are presented in Table 1. CONCLUSION: This new database system was designed to ensure the accuracy of data input using a standard model that is capable of correct data programming using the custom designed coding system for the Craniofacial Center. The system also provides easy and reliable data retrieval when using the powerful search tools.

Cleft Lip↗

PubMed2003

Programmed database system at the Chang Gung Craniofacial Center: part II--digitizing photographs.

BACKGROUND: The archival tools used for digital images in advertising are not to fulfill the clinic requisition and are just beginning to develop. The storage of a large amount of conventional photographic slides needs a lot of space and special conditions. In spite of special precautions, degradation of the slides still occurs. The most common degradation is the appearance of fungus flecks. With the recent advances in digital technology, it is now possible to store voluminous numbers of photographs on a computer hard drive and keep them for a long time. METHODS: A self-programmed interface has been developed to integrate database and image browser system that can build and locate needed files archive in a matter of seconds with the click of a button. This system requires hardware and software were market provided. RESULTS: There are 25,200 patients recorded in the database that involve 24,331 procedures. In the image files, there are 6,384 patients with 88,366 digital pictures files. From 1999 through 2002, NT400,000 dollars have been saved using the new system. CONCLUSION: Photographs can be managed with the integrating Database and Browse software for database archiving. This allows labeling of the individual photographs with demographic information and browsing. Digitized images are not only more efficient and economical than the conventional slide images, but they also facilitate clinical studies.

Craniofacial Abnormalities↗

PubMed2003

Osseous regeneration after embolization of mandibular arteriovenous malformation.

A mandibular arteriovenous malformation (AVM) is rare, and unawareness of this condition can lead to catastrophic complications. Embolization is an effective means to treat these lesions. The osseous changes and long-term outcomes among the pediatric patients after embolization treatment remain unclear. We present a 6-year-old patient with mandibular arteriovenous malformation who had sustained hemorrhagic shock after a tooth extraction. She was referred to us after stabilization of the hemodynamic condition. The patient received transarterial and direct intralesional embolization. Local infection occurred 3 months after embolization, but was well controlled. Serial computed tomography and panoramic radiographs were performed during follow-up examinations. The imaging studies showed gradual obliteration of the vascular space followed by normal bone regeneration and remodeling. The processes were complete during a period of 2 years. There was no recurrence of the vascular malformation and no abnormal growth of the right side of the mandible after 4 years and 4 months of observation.

Arteriovenous Malformations↗

PubMed2002

Assessment of bilateral cleft lip nose deformity: a comparison of results as judged by cleft surgeons and laypersons.

Reconstruction of bilateral cleft lip nose deformity is difficult and the outcome is inconsistent. This study was conducted to evaluate the gross outcome and the difference in the assessment of nasal appearance as judged by two groups of raters, cleft surgeons and laypersons. Sixty-four patients with bilateral cleft lip were selected for review. The patients' ages ranged from 5 to 30 years. All patients had undergone primary cleft lip repair and secondary nasal reconstruction, and had been followed for at least 6 months. One image for each patient, which included a digitized frontal, lateral, and worm's-eye view, was projected for evaluation by the raters. The raters included five cleft surgeons and five laypersons. A rating scheme was used in which a score of 3 was given for a good, close to normal nasal appearance, 2 for an average result that needed minor revision, and 1 for a poor result that needed major reconstruction. The scores were averaged for each patient in each group and for each group as a whole. The final outcome was judged as good, fair, or poor on the basis of the mean score for each patient. Statistical analysis was performed. The mean score for all patients was 2.08 as assessed by the laypersons and 2.18 as assessed by the cleft surgeon group. There was no statistically significant difference between the two groups. Comparisons on rating scores among different raters revealed a fair agreement on the ratings within each of the two groups. The results were found to be good in 29.7 percent, fair in 64.1 percent, and poor in 6.3 percent of patients when evaluated by the surgeons. When rated by the laypersons, the nasal appearance was found to be good in 26.6 percent, fair in 60.9 percent, and poor in 12.5 percent of patients. This difference in distribution between the two groups was not statistically significant. When comparing the results given by the two groups of assessors, there was agreement on the nasal appearance in 65.6 percent of patients, and a difference in grading in the rest. For the patients who received different grading, the surgeons rated them one grade higher in 63.6 percent and one grade lower in 36.4 percent. There was no difference in grading between any of the evaluators that reflected a two-grade discrepancy in evaluation of results. This study shows that the surgical outcome of bilateral cleft lip nose deformity repair, at the authors' institution, is less than optimal. When assessing bilateral cleft lip nose appearance, the judgment of results by cleft surgeons was similar to that of the laypersons. However, different rating of results existed within each of the two groups, supporting the importance of clearly assessing patient/parent expectations and defining realistic surgical goals.

Adolescent↗

PubMed2002

Robin sequence: review of treatment modalities for airway obstruction in 110 cases.

OBJECTIVE: The objective of this paper is to assess the treatment protocols used in our institution for the management of airway obstruction among patients with Robin sequence and to suggest a rationale for management based on the findings. METHOD: A retrospective study of 110 children with Robin sequence seen from 1988 to 1997 at the Chang Gung Memorial Hospital was done. Results of the management in airway obstruction and feeding difficulty were studied. RESULTS: Prone posturing was effective in the treatment of mild airway obstruction in 82 patients who had noisy breathing sounds. Twenty-eight infants required endotracheal intubation due to severe respiratory distress. Seven received a tongue to lip adhesion (TLA) operation. Three of these patients showed a relief of airway obstruction, while four of them needed a tracheotomy to maintain a patent airway because of wound dehiscence. Two other patients underwent tracheotomy without TLA. All the six patients who received tracheotomy were eventually decannulated. A nasopharyngeal tube was inserted in two other patients, and one of them improved only temporarily. With regards to feeding difficulties, 46 patients needed nasogastric tube feeding, while the rest were aided through the use of a cleft palate bottle and nipple. A gastrostomy was not needed in any of the patients in this series. CONCLUSION: The morbidity and mortality among Robin sequence patients had been widely decreased through the teamwork of the pediatrician, anesthesiologist, otolaryngologist, dentist, and plastic surgeon. Based on our experience, conservative management was sufficient for those patients with mild airway obstruction, while endotracheal intubation was required for patients with cyanosis, respiratory failure and sleep apnea. Tracheotomy was a better option than TLA for airway management among patients with failed extubation.

Abnormalities, Multiple↗