Orthodontic Airway Plate Therapy for Infants with Robin Sequence: Clinical Principles, Current Evidence, and Evolving Innovations

BACKGROUND: Robin sequence (RS) is characterized by the triad of mandibular micrognathia, glossoptosis, and upper airway obstruction (UAO), posing significant airway and feeding challenges in affected infants. Although mandibular distraction osteogenesis (MDO) is effective in selected cases, less invasive treatment approaches are emerging. The orthodontic airway plate (OAP), including the Tübingen Palatal Plate and Pre-Epiglottic Baton Plate, can be a reliable non-surgical modality for infants across a broad spectrum of UAO severity, alleviating airway obstruction by anteriorly repositioning the tongue and restoring pharyngeal patency. SUMMARY: This narrative review describes the biomechanical principles, clinical applications, therapeutic outcomes, and recent technological advances in OAP therapy in infants with RS. OAP treatment improves airway stability and promotes coordinated suck-swallow-breathe function, thereby facilitating oral feeding and growth. Clinical studies demonstrate improvements in polysomnographic parameters, oxygenation, feeding efficiency, and weight gain, with most infants avoiding surgical intervention. Emerging evidence also suggests potential functional orthopedic effects of OAP on mandibular development during early growth. Innovations including imaging-guided planning and CAD/CAM fabrication have enhanced treatment precision and reproducibility. However, long-term follow-up data indicate that soft tissue adaptation may remain incomplete, and risks of orthodontic complications and recurrent obstructive sleep apnea persist into childhood. These findings highlight the need for structured long-term surveillance. KEY MESSAGES: OAP therapy represents an effective, reversible, and non-invasive first-line option for infants with UAO associated with RS across a broad spectrum of UAO severity. Integration of digital technologies and multidisciplinary care pathways may further enhance the clinical applicability of OAP.