Evaluating the efficacy of the Tübingen Palatal Plate in managing upper airway obstruction in Pierre Robin Sequence: Experience from a tertiary hospital in Sydney, Australia

Abstract Study objective: To evaluate the efficacy of the Tübingen Palatal Plate in managing upper airway obstruction in Pierre Robin Sequence during its introduction into a tertiary hospital in Sydney, Australia. Methods We evaluated polysomnography and treatment outcomes in children diagnosed with PRS and managed with TPP from October 2023 - March 2025 at the Children’s Hospital in Westmead. A level 1 polysomnography was performed at baseline, prior to discharge from hospital and at the end of treatment. Sleep study parameters were compared between initial and follow-up studies. Results From 14 admissions of infants with PRS, ten infants completed TPP treatment. At baseline all ten had severe obstructive sleep apnea (OSA) with a median apnea-hypopnea index (AHI) of 53.9 events/hr, and mixed and obstructive apnea index (MOAI) of 37.8 events/hr. There was evidence of impaired gas exchange with an oxygen nadir of 88% (71–91%) and peak carbon dioxide (CO 2 ) level of 51.7mmHg (46.1–65.8). The final median AHI of 8.1 (2.9–13.3) events/hr, and MOAI of 2.9 (1.3–8.8) events/hr. When compared to baseline there were statistically significant improvements in AHI, OAHI, MOAI and peak CO 2 levels. Excluded Infants included one patient with an intact soft palate, and three others with clinical and/or practical issues preventing implementation of the TPP. Conclusions This study demonstrates that when first introduced in a new health setting, TPP therapy is effective for treating airway obstruction in infants with PRS.