Tongue-lip adhesion

The management of Pierre Robin sequence is challenging and requires a multidisciplinary approach. A thorough workup must be done to exclude sites of airway obstruction other than the base of the tongue and to exclude central sleep apnea. Airway security is critical and can be managed nonoperatively in most children. When surgical management is necessary, the tongue-lip adhesion is the first step in many institutional algorithms. Multiple modifications have been described, but the basic premise is an anterior advancement of the tongue base and suture fixation of the tongue to the lip. This increases the diameter of the airway and results in safe and successful management in the overwhelming majority of patients. There are few sequelae with the most common being dehiscence. This can be prevented by intermuscular sutures, a circummandibular stitch, and release of the genioglossus muscle. Once mandibular “catch-up” growth has been achieved, the tongue-lip adhesion may be reversed.