A Novel Technique for Performing a Tongue-Lip Adhesion—The Tongue Suspension Technique

• Published in: The Cleft palate-craniofacial journal 2012-01, Vol.49 (1), p.27-31
• Main Authors: Mann, Robert J., Neaman, Keith C., Hill, Brian, Bajnrauh, Robert, Martin, Matthew D.
• Format: Article
• Language: English
• Subjects: Airway management; Biological and medical sciences; Birth defects; Dentistry; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Female; Humans; Infant, Newborn; Length of Stay - statistics & numerical data; Lip - surgery; Male; Medical sciences; Non tumoral diseases; Operative Time; Oral Surgical Procedures; Otorhinolaryngology. Stomatology; Pierre Robin Syndrome - surgery; Studies; Surgical techniques; Tongue - surgery; Treatment Outcome
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1597/10-036

Background The tongue-lip adhesion has undergone several modifications in an attempt to reduce surgical complications and failure rates. Current techniques rely on the use of a button at the tongue base for suspension, which raises concerns about possible aspiration and interference with oral motor function and bottle-feeding. A new technique for tongue-lip adhesion is proposed that adds a tongue suspension to the standard surgical adhesion. Methods A total of 22 patients with Pierre Robin sequence who received a tongue-lip adhesion via a tongue suspension technique were reviewed. The surgical technique differs from the standard surgical approach by the use of a suture weave across the base of the tongue instead of a standard button to suspend the tongue anteriorly. Results Average age at the time of tongue-lip adhesion was 13.9 days, with a mean operative time of 88.8 minutes. A marked improvement in postoperative oxygenation was seen in the majority of patients. One dehiscence occurred secondary to a traumatic postoperative extubation, eventually requiring a tracheostomy for subglottic stenosis. Conclusion A technical innovation for performing a tongue-lip adhesion using a tongue suspension in conjunction with a standard transverse adhesion of the lip is described. The advantage of the tongue-lip adhesion with suspension includes immediate postoperative extubation, as well as removal of concerns regarding button aspiration and possible interference in early developmental oral motor function and bottle-feeding. This technique is reproducible, expanding the craniofacial surgeon's armamentarium for the management of difficult airways in Pierre Robin sequence.