This study retrospectively reviewed one institution's long-term outcomes associated with the palatal plate with velar extension in infants with syndromic and non-syndromic PRS. Previous studies have shown improved sleep study results, weight gain, and improved feeding with the MPP and velar extension (Mackay, 2011, Müller-Hagedorn et al., 2017). Meanwhile, the velar extension shifts the tongue anteriorly so that UAO is adequately relieved. The palatal plate covers any potential cleft palate and widens the hypopharynx. The MPP with velar extension is a non-surgical approach to UAO in syndromic and non-syndromic PRS. As a consequence, adequate treatment of UAO is based largely on expert opinion and surgeon preferences. These strategies can be complicated by genetic syndromes often associated with PRS such as Stickler syndrome, Treacher-Collins Syndrome, and DiGeorge Syndrome amongst nearly 50 others (Müller-Hagedorn et al., 2017). Alternatively, conservative management includes continuous positive airway pressure (CPAP), nasal cannula oxygen, prone positioning, and nasopharyngeal airways (Amaddeo et al., 2016). This approach, however, is very invasive and is hampered by the difficulties associated with long-term hardware placement and operating the distractors multiple times per day (Dong et al., 2014, Da Costa et al., 2018, Flores et al., 2015, Basart et al., 2015). The morbidity associated with each of these procedures along with improvements in surgical devices has led many surgeons to favor MDO. Surgical management has traditionally involved TLA or tracheotomy. There are a variety of surgical and non-surgical approaches to UAO in infants with PRS. Sequelae of UAO include congestive heart failure, pulmonary hypertension, neurocognitive impairment and death thus, treatment of UAO in infants with PRS is critical to the success of the child (Mackay, 2011). Today, PRS is diagnosed in newborns with micrognathia, glossoptosis and UAO (Buchenau et al., 2004). A century ago, the physician Pierre Robin described a condition that initially did not include a cleft palate and many fundamental problems with diagnosing remain unchanged (Robin, 1923).

Weight gain sequence