Neonates with Robin sequence (micrognathia, cleft palate and glossoptosis) frequently have severe upper airway obstruction. Depending on the range of severity, treatment modalities include positioning the infants face down, inserting an oropharyngeal airway, endotracheal intubation or long term tracheostomy. Many of these infants may require intubation due to inadequacy of nasal CPAP in presence of a cleft palate. Intubation of these neonates may also be challenging and sometimes impossible. Long term tracheostomy may carry the risks of pneumonia, and impairment of speech development and pharyngeal growth. The use of a LMA (size #1) for anesthesia and in the aid for difficult intubation has been described. We present our experience with three cases of Robin sequence who were treated with long term use of a LMA to relieve upper airway obstruction and deliver CPAP.

  • Case #1. A 2400 gm male child with Marshall-Smith syndrome was initially treated with nasopharyngeal CPAP and an oral airway (size 00) yet developed frequent episodes of obstruction. He was switched to CPAP with a LMA for two days' and was then able to tolerate nasopharyngeal CPAP.

  • Case #2. A 3010 gm male infant with Charge Syndrome required intubation at birth with extreme difficulty. Infant was extubated on day#3, but due to severe upper airway obstruction was treated with a LMA delivering CPAP for 7 days with no untoward effect.

  • Case #3. A 2100 gm neonate with Fryns syndrome was treated with CPAP with a LMA for 1 day after which the infant required intubation due to PPHN.

Conclusion: Laryngeal mask airway is a useful device to relieve upper airway obstruction and deliver CPAP in neonates with Robin sequence thus decreasing the need for intubations or tracheostomy and their associated complications.