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Anesthetic concerns of external maxillary distraction osteogenesis
Granger B Wong1, Charles Nargozian, Bonnie L Padwa
1Division of Plastic and Oral Surgery, Children's Hospital, Boston, Massachusetts, USA. granger.wong@ucdmc.ucdavis.edu
The Journal of Craniofacial Surgery
|January 6, 2004
Summary
External maxillary distraction in craniofacial patients has minimal anesthetic impact. Safeguards, like removing the vertical bar for airway access, ensure safe extubation and reintubation.
Area of Science:
- Anesthesiology
- Craniofacial Surgery
- Pediatric Anesthesia
Background:
- External maxillary distraction presents unique anesthetic challenges in craniofacial patients.
- The distraction hardware can obstruct oronasal airway access.
Purpose of the Study:
- To evaluate the anesthetic management and airway outcomes of external maxillary distraction.
- To identify key factors influencing perioperative airway management in these patients.
Main Methods:
- Retrospective review of 16 patients undergoing external maxillary distraction.
- Analysis of perioperative records including airway assessment, intubation, and extubation data.
- Exclusion of patients with pre-existing tracheostomies.
Main Results:
- Most patients had favorable laryngoscopy views (Grade 1).
- One patient with syndromic craniosynostosis required fiberoptic intubation; another required reintubation.
- No patient with cleft lip/palate required fiberoptic intubation, and all had successful extubation.
Conclusions:
- External maxillary distraction has minimal impact on anesthetic management with proper precautions.
- Facilitating airway access by potentially removing hardware is crucial for safe extubation/reintubation.
- Availability of tools and trained personnel for hardware manipulation is essential.