Infant identified to have Robin sequence

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  Classic triad of micrognathia, glossoptosis, and airway obstruction with or without cleft palate

Mandible appears hypoplastic

Apparently intubated with nasal feeding tube in place

Multidisciplinary team approach of cleft/craniofacial specialists to address mandibular hypoplasia, feeding difficulties, and airway obstruction

Genetic evaluation may be warranted

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  Stickler syndrome, chromosome 22q11.2 deletion (velocardiofacial syndrome), hemifacial microsomia, Treacher Collins syndrome, Nager syndrome, CHARGE syndrome

Airway evaluation is most important

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  Obstructive sleep apnea assessment with polysomnography (sleep study)

  
  
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  Bronchoscopy and nasoendoscopy to identify site(s) of airway obstruction

  
  
  
  
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    Can provide crucial information regarding subglottic pathology including laryngomalacia, tracheomalacia, and subglottic webs

    
    
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    May be more than 1 level of obstruction

  
  
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  Magnetic resonance imaging (MRI) and computed tomography (CT) scans can be used for three-dimensional reconstructions to evaluate airway patency

Stratification of severity guides treatment strategies

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  Above work-up should identify additional obstructive pathology

  
  
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  Attempt prone positioning for mild cases (70% of cases)

  
  
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  Severe airway obstruction necessitating tracheostomy placement (10%) should undergo operative intervention

  
  
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  Management of intermediate severity (20%) is controversial

  
  
  
  
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    Nasopharyngeal airway

    
    
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    Tongue–lip adhesion

    
    
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    Distraction osteogenesis

Characterizing mandibular hypoplasia

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  Smaller volume

  
  
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  Shorter ramus

  
  
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  Obtuse symphyseal angle