BACKGROUND: The compromised airway in Robin sequence demands prompt operative intervention. Tongue-lip adhesion is one alternative; however, the outcome of this technique is variable. The purpose of this study was to identify variables that preoperatively predict the success of adhesion in Robin sequence patients with life-threatening respiratory distress. METHODS: This is a retrospective review of infants with severe (Laberge grade II or III) Robin sequence managed by tongue-lip adhesion. Variables analyzed included diagnosis (syndromic versus nonsyndromic), age at operation, preoperative and postoperative airway management, duration of intubation, length of intensive care and hospital stay, serial weight, and postoperative complications. RESULTS: Fifty-three infants had tongue-lip adhesion for airway compromise: 47 (89 percent) were successfully managed and treatment failed in six. Preoperative intubation, days of intubation, intensive care unit days and hospitalization, and reintubation were more common in syndromic infants (p < 0.05). Those infants who had adhesion within 14 days of birth required shorter duration of postoperative ventilator support and intensive care unit/hospital stay (p < 0.05) than those who had a later procedure. Significant variables were gastroesophageal reflux (p = 0.002), intubation preoperatively (p = 0.002), late operation (older than 2 weeks) (p = 0.001), low birth weight (<2500 g) (p = 0.01), and syndromic diagnosis (p < 0.001). The acronym GILLS summarizes these predictive findings; one point was assigned for each variable present. Adhesion was successful in 100 percent of infants with a GILLS score of 2 or less (n = 39) but failed in 43 percent (six of 14 infants) with a score of 3 or more. CONCLUSION: The GILLS score may improve patient selection and predict outcome of tongue-lip adhesion in infants with Robin sequence. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.(Figure is included in full-text article.).