Stanford Orthodontic Airway Plate (SOAP) Program

Infants born with conditions such as Pierre Robin sequence often face serious challenges with breathing and oral feeding due to a small jaw, tongue position, or cleft palate. Traditionally, the primary treatment option has been mandibular distraction osteogenesis—jaw elongation surgery. While effective, surgery is invasive and carries risks.

At Stanford Medicine, we offer a pioneering, nonsurgical alternative: the Stanford Orthodontic Airway Plate (SOAP). Developed through rigorous research and clinical expertise, this program represents a transformative approach to neonatal airway management.

A Research-Driven Alternative to Surgery

Every baby deserves the ability to breathe and feed comfortably. The SOAP Program offers an effective, noninvasive solution for infants born with airway and feeding challenges caused by abnormal tongue position—conditions often associated with micrognathia (small jaw) or cleft palate. Historically, these babies faced surgical interventions such as tongue-lip adhesion, jaw distraction, or tracheostomy. SOAP changes that paradigm.

A Precision-Designed Device

The SOAP is a removable oral appliance, similar in concept to an orthodontic retainer, but engineered for airway management. Using advanced medical imaging and a proprietary design method developed by HyeRan Choo, DDS, DMD, MS, each plate is custom-made for the individual infant. Once placed, the device immediately opens the airway and supports proper tongue positioning, improving breathing and feeding.

Rapid Development and Placement

Fabrication typically takes only a few days. Placement is performed under nasal endoscopy to ensure optimal positioning—without general anesthesia or intubation. This minimally invasive approach allows babies to begin benefiting from improved airway function right away.

Adaptation and Feeding Training

Babies usually adjust to the SOAP within a few days. Initial pressure spots are common but resolve with minor adjustments. Once comfortable, structured oral feeding exercises begin, helping infants learn coordinated suck-swallow-breathe patterns. These exercises strengthen facial and neck muscles, promoting natural jaw growth and airway expansion.

Care and Maintenance

The SOAP is worn continuously, removed only once daily for cleaning. Parents receive hands-on training during the hospital stay—typically about two weeks—and become confident in managing the device within a week.

Treatment Timeline

Total duration varies from weeks to months, depending on jaw size and growth rate. Outpatient visits for adjustments occur every 4–6 weeks, ensuring the device accommodates natural growth and accelerates mandibular development.

Babies complete the SOAP program when their tongue maintains healthy positioning and the lower jaw aligns with the upper gumline. By graduation, most infants feed entirely by mouth, without surgical intervention.

Upper airway obstruction by the tongue

Upper airway obstruction by the tongue is a condition where the airway from the back of the nose to above the voice box (larynx) is obstructed by an abnormal tongue position. This blockage of the airway can result in difficulty breathing in neonates and infants.

Glossoptosis

Glossoptosis is a condition where the tongue is abnormally positioned backward and/or upward inside a baby’s mouth, narrowing the airway. This condition often gets worse while the baby is asleep.

Micrognathia / retrognathia / microretrognathia / bimaxillary retrognathia

Micrognathia means a small lower jaw (mandible), and retrognathia means a normal-size lower jaw positioned farther back than usual. Microretrognathia means that both conditions are present. Bimaxillary retrognathia (retrusion) means both the upper and lower jaws are positioned farther back than usual. Even though they are smaller than usual during infancy, many of these mandibles have strong growth potential as the infant grows older, a phenomenon called mandibular catch-up growth.

Cleft palate

Cleft palate is an opening in the roof of the mouth, a defect where the tissues in the palate do not join completely during pregnancy. It can affect either or both the soft and hard palates.

Oral feeding difficulties

Some babies experience difficulty in coordinating their suck-swallow-breathe while feeding by mouth. This difficulty can be related to many factors, including abnormal tongue position, upper airway obstruction, micrognathia or retrognathia, or cleft palate. A feeding tube is often needed until the baby can take in all necessary nutrition by mouth.

Pierre Robin sequence

Pierre Robin sequence is a rare congenital craniofacial disease with symptoms of breathing difficulty and/or feeding difficulty. Severity of these symptoms varies significantly among babies. It is often recognized by a combination of features, including a small lower jaw, an unusual tongue position, and a cleft palate.

Innovation Rooted in Research

The Stanford OAP Program is the first of its kind in the United States. Created by craniofacial airway orthodontist HyeRan Choo, DDS, DMD, MS, this technique leverages advanced medical imaging and precision design to address airway obstruction from the moment the plate is placed. For many infants, this simple intervention is as effective as jaw surgery—without the need for an operation.

Comprehensive, Multidisciplinary Care

Our program integrates expertise across Stanford Medicine, including Neonatology, Pediatric Otolaryngology (ENT), Gastroenterology, Pulmonary and Sleep Medicine, Cardiology, Neurology, Genetics, Pediatric Plastic Surgery, and specialized nursing. This collaborative model ensures individualized, evidence-based care for every patient.

Proven Outcomes

Since Stanford Medicine Children’s Health launched the OAP Treatment Program in 2020, we have successfully treated more than 50 babies from across the United States, as of August 2025. Families benefit from a treatment plan informed by cutting-edge research and supported by a team committed to advancing pediatric craniofacial care.

When your baby begins the Stanford Orthodontic Airway Plate (SOAP) treatment, you can expect a collaborative, supportive experience from start to finish. After a thorough evaluation, our team will design a custom airway plate tailored to your child’s needs. Placement is quick and minimally invasive—no general anesthesia required.

Your baby will stay in the hospital for about two weeks to adapt to the device and begin oral feeding exercises. During this time, you’ll receive hands-on training to confidently manage the plate at home. Most families master insertion and removal within a week.

Treatment continues with periodic outpatient visits for adjustments as your baby grows. The entire process typically spans weeks to months, depending on jaw development. By graduation, most babies breathe and feed comfortably by mouth—without surgery.