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Pharyngeal abscess presenting with upper airway obstruction and atlanto-axial subluxation in a small infant
1Specialist Registrar; Consultant, Department of Anasthesia, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
Insights
Cosmetic ear piercing in an infant led to a pharyngeal abscess, causing upper airway obstruction and atlanto-axial subluxation. This rare combination presented significant anesthetic challenges requiring careful preparation.
Area of Science:
- Pediatric Anesthesiology
- Otolaryngology
- Infectious Disease
Background:
- Cosmetic ear piercing is a common procedure in infants.
- Pharyngeal abscesses can lead to serious complications.
- Atlanto-axial subluxation is a rare but critical condition affecting the upper spine.
Observation:
- An infant presented with symptoms of upper airway obstruction.
- The infant also exhibited signs of atlanto-axial subluxation.
- A pharyngeal abscess, secondary to cosmetic ear piercing, was identified as the cause.
Findings:
- The combination of upper airway obstruction and atlanto-axial subluxation created a complex anesthetic scenario.
- The abscess compromised the patient's airway, necessitating specialized management.
- The spinal instability added further risk to airway manipulation.
Implications:
- This case highlights the potential risks associated with seemingly minor procedures like cosmetic ear piercing in infants.
- It underscores the importance of a thorough pre-anesthetic evaluation, especially in cases with unusual presentations.
- Effective anesthetic management requires a multidisciplinary approach and detailed planning for such complex pediatric cases.
Abstract:
We describe an infant who presented with a combination of upper airway obstruction and atlanto-axial subluxation, secondary to a pharyngeal abscess resulting from cosmetic ear piercing. This combination posed a number of difficulties for the anasthetist and a detailed plan was formulated to prepare the child for anasthesia.