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[Difficult airway in a child with multiple juvenile xanthogranulomas]
Ryouko Matsuyama1, Hiromi Yamase, Hiroyuki Yamamoto
1Department of Anesthesiology, Toranomon Hospital, Tokyo 105-0001.
Insights
Juvenile xanthogranuloma (JXG) surgery presents airway challenges. This case study details successful anesthetic management for a child with multiple JXG lesions, improving surgical outcomes.
Area of Science:
- Dermatology
- Pediatric Surgery
- Anesthesiology
Background:
- Juvenile xanthogranuloma (JXG) is a rare, benign skin condition.
- Multiple JXG lesions can cause significant cosmetic and functional issues, such as scar contractures.
- Surgical intervention may be necessary for JXG-related complications, posing potential anesthetic risks.
Observation:
- A 4-year-old boy with multiple JXG lesions required plastic surgery for neck scar contracture.
- The patient presented with anticipated difficult airway due to facial and neck JXG nodules and limited neck mobility.
- Initial scar resection under local and inhalation anesthesia improved neck mobility.
Findings:
- A staged surgical approach was employed, including scar resection and subsequent skin grafting.
- Anesthetic management for the second stage involved a spiral endotracheal tube via the nostril for manual ventilation.
- Bronchofiberscope-assisted tracheal intubation through a laryngeal mask airway was successfully achieved under general anesthesia.
Implications:
- This case highlights successful anesthetic strategies for patients with complex JXG.
- Effective airway management is crucial for children undergoing surgery for JXG-related complications.
- Multidisciplinary collaboration between surgery and anesthesiology ensures optimal patient outcomes.
Abstract:
Juvenile xanthogranuloma (JXG) is a benign and self-healing histiocytosis on the skin. A 4-year-old boy with multiple JXG was scheduled for plastic surgery to correct the scar contraction of the neck. The patient was expected to have difficult airway caused by small mouth, limitation of neck movement and numerous nodular lesions located at the face. Initially he underwent resection of the neck scar under local anesthesia with added inhalation anesthesia via mask, and the restricted neck recurvation was improved. One week later, he underwent skin grafting under general anesthesia. We used a spiral tube of 3 mm diameter inserted to the nostril for manual ventilation, and bronchofiberscope-aided tracheal intubation was successfully performed through the laryngeal mask airway under general anesthesia without any problems.
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