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Airway management for infants with severe micrognathia having mandibular distraction osteogenesis
1Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Insights
Mandibular distraction osteogenesis improved airway obstruction in infants with severe micrognathia. This surgical intervention offered an alternative to tracheostomy, enhancing breathing and feeding for affected neonates and infants.
Area of Science:
- Craniofacial Surgery
- Pediatric Airway Management
- Neonatal Care
Background:
- Severe micrognathia often causes upper airway obstruction in neonates and infants.
- These patients frequently require airway interventions and may experience feeding difficulties.
- Long-term tracheostomy is a common management but has associated morbidities.
Purpose of the Study:
- To evaluate the effectiveness of mandibular distraction osteogenesis (MDO) as an alternative to tracheostomy in infants with severe micrognathia and airway obstruction.
- To assess the impact of MDO on airway grade, intubation duration, and overall clinical outcomes.
Main Methods:
- Retrospective chart review of seven neonates and infants with severe micrognathia and upper airway obstruction.
- Patients underwent MDO between 2004 and 2007.
- Data collected included airway interventions, laryngoscopy grades, intubation duration, and feeding status.
Main Results:
- Five out of seven patients showed an improved laryngoscopy grade post-MDO.
- The mean duration of endotracheal intubation after surgery was 8.17 days.
- Patients often had multiple comorbidities and required numerous anesthetic procedures (mean 6.7 per child).
Conclusions:
- Mandibular distraction osteogenesis is a viable alternative to long-term tracheostomy for severe micrognathia-related airway obstruction.
- MDO can lead to significant airway improvement in affected infants.
- Careful anesthetic management is crucial due to frequent airway challenges in this patient population.
Abstract:
We retrospectively reviewed the charts of seven neonates and infants with severe micrognathia and upper airway obstruction who underwent mandibular distraction osteogenesis as an alternative to long-term tracheostomy at the Children's Hospital at Westmead, Sydney, from 2004 to 2007. All patients required a variety of airway interventions at an early age and had poor feeding or failure to thrive. These children had other anomalies and required many investigations and procedures and presented repeated airway challenges for the anaesthetist. The mean number of anaesthetics per child in this series was 6.7 (range 4 to 13). Under anaesthesia, four patients had grade 4 laryngoscopy, one was grade 3 but two were only grade 2. Patients with a preoperative grade 4 laryngoscopy were very likely to need fibreoptic endotracheal intubation. Duration of intubation after surgery for mandibular distraction was a mean of 8.17 days (range 1 to 19). Three were extubated in the operating theatre and three in intensive care. Five patients had an improved laryngoscopy grade after completion of mandibular distraction and one remained grade four The remaining patient had a tracheostomy from birth.
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