Cleft Palate South Wales Management Pathway – download

The combination of micrognathia and cleft palate may be part of Pierre Robin sequence or part of a more complex syndrome. Simple Pierre Robin sequence will improve with growth and any airway obstruction has usually resolved by 9 months. We use a nasopharygeal airway to manage airway obstruction during this 9 month period. Usually the NPA remains in-situ 24/7 for 3 months, and the child is exclusively NG fed. At 3 months we resize the NPA and re-study with overnight polygraphy. There may be an opportunity from 3 months to remove the NPA for short periods during the day, and to potentially start feeding by mouth during these periods. At 6 months we re-study with overnight polygraphy and aim to remove the NPA for the daytime thereafter. At 9 months we re-study with overnight polygraphy with the NPA removed. We re-study on one further occasion after the cleft is repaired.

Guidelines for the management of NPA can be found here.