Newborns with Pierre Robin Sequence (PRS) experience glossoptosis (tongue displacement) that can put their feeding, growth and even their lives at severe risk.
But a less invasive, non-surgical treatment long practiced in Europe is finally making its way to the US – and Children’s HealthSM is one of the first centers to offer it.
Oral airway plates (OAPs) are retainer-like devices with a flange that curls down behind the back of the tongue, pushing it forward and out of the airway, counteracting the glossoptosis. The devices can achieve remarkable outcomes after just a few months of use.
OAP contributors include:
Young Jong Park, D.D.S., Pediatric Craniofacial Orthodontist at Children's Health and Adjunct Professor at UT Southwestern.
Alex Kane, M.D., Plastic and Craniofacial Surgeon at Children’s Health and Professor at UT Southwestern.
Paymon Sanati-Mehrizy, M.D., Craniofacial Surgeon at Children’s Health and Assistant Professor of Plastic Surgery at UT Southwestern.
Cynthia Wang, M.D., Pediatric Otolaryngologist at Children’s Health and Assistant Professor at UT Southwestern.
Children’s Health is one of a few centers in the country offering and specializing in OAP. The multidisciplinary team works closely together to share best practices and build experience with this leading-edge treatment.
Complexities of surgery call for less-invasive treatment for Pierre Robin Sequence
PRS has three interrelated hallmarks: 1) a small and receded lower jaw (microretrognathia) that causes 2) tongue displacement (glossoptosis) and 3) respiratory distress, especially when sleeping on the back or feeding.
In cases with severe difficulty breathing, mandibular distraction is the most common treatment. It addresses the problem by cutting the lower jaw and encouraging it to grow longer with metal screws and hardware. This creates more space for the tongue, but has surgical risks:
Surgeons must take care to avoid cutting nerves and future adult teeth.
Care teams can accidentally dislodge the hardware and endanger the treatment while the child is healing from surgery.
As the bone grows, some patients develop TMJ (jaw joint) problems that may prevent opening and closing the mouth.
While mandibular distraction is an operation the team at Children’s Health is well-trained to perform, they’ve been on the lookout for less-invasive alternatives. Some children have severe airway problems but only minor retrognathia. “Is extending the jaw by a few millimeters worth the risks of surgery? And will it deliver the needed airway relief?” asks Dr. Kane.
The team also receives many patients who developed TMJ ankylosis after surgery at other centers. “This is a challenging complication to fix, so I like to avoid mandible distraction if possible,” says Dr. Sanati.
After success in Europe, OAPs are slowly spreading in the US
OAPs have been used for decades in Europe, where they are commonly known as Tübingen Palatal Plates. Evidence from Germany shows a number of benefits, including:
Reducing mixed obstructive apnea down to near-normal levels.
Reducing the size of cleft palates and minimizing surgical complications with cleft palate closure.
Possibly inducing mandibular catch-up growth.
The technique was first adopted in the United States in 2020, and pediatric orthodontist Dr. Park oversaw the first OAP case at Children’s Health in 2025. OAPs have spread slowly for two reasons: the multidisciplinary knowledge and coordination required to administer care, and the lack of pediatric orthodontists nationwide.
“Not many pediatric centers have someone with Dr. Park’s experience, let alone his ingenuity,” says Dr. Kane.
Orthodontists lead the team but lean on many others
Specialties and roles necessary for an OAP team include:
Pediatric orthodontics, to lead all aspects of the OAP itself, from getting impressions of the patient’s mouth to fitting, monitoring and adjusting the final device.
ENT, to monitor airway obstruction and perform nasal scoping.
Plastic surgery, for patients needing cleft palate surgery.
Pulmonology, to perform and interpret sleep studies.
Speech and language pathologists (SLPs), to assist with feeding and oral skill development.
Critical care, for round-the-clock monitoring and management of the feeding tube.
A unique asset for the Children’s Health team is the Analytical Imaging and Modeling Center (AIM), which Dr. Park uses to design and manufacture the trial and final versions of a patient’s OAP.
“When all these pieces come together, you can enable innovations that lower risk and are gentler to the patient and family,” says Dr. Kane.
Patient example: Marked improvement after one month
The second patient receiving an OAP at Children’s Health experienced dramatic airway improvement after only one month with the device. The child’s first sleep study yielded a respiratory disturbance index of 60/hr with desaturations down to SpO2 of 80%.
“A month later, with the OAP in place, that number was 22,” says Dr. Park.
The child’s jaw position changed as well. Exterior images show a dramatic shift from baseline to the first, second and third months using the device. The team completed all fitting and placement of OAPs at bedside, aided by nasal endoscopy.
An important consideration for this patient was feeding. Many infants with PRS require G-tubes followed by years of feeding therapy to wean from enteral nutrition.
“This child was having some success feeding by mouth prior to the OAP, and we didn’t want the device to interfere with that progress,” says Dr. Park.
So Dr. Park and SLPs from the NICU and craniofacial team customized the care plan. Dr. Park removed the device a few times a day so the SLPs could train the parents on positioning techniques and trial different bottles and nipples, and the child could continue practicing feeding.
Usually OAPs are worn 24 hours a day except for cleaning. But the team knew an adjustment was worth it in this case.
“The child graduated from the OAP device after four months of treatment and is now feeding entirely by mouth,” says Dr. Park.
Learning and innovating to make oral airway plates as effective as possible
The team is developing best practices for this treatment as it gains experience.
“Right now we’re focused on developing a protocol for patient feeding regimens, finding the ideal timing for sleep studies and determining when a scope is necessary,” says Dr. Wang.
A unique aspect of the Children’s Health approach is to use the AIM Center to 3D print a handful of different versions of the OAP before manufacturing a final acrylic one. With these trial devices, Dr. Park can test and find the best fit for the patient – particularly when it comes to the flange that dips behind the back of the tongue – much more quickly than the standard method of heating and reshaping a thermoplastic prototype.
“We want the process to be quick and easy for the patient so they can start breathing, eating and growing stronger right away,” Dr. Park says.
Learn more about craniofacial conditions and treatments at Children’s Health.
