Feeding obturator as an airway adjunct during complete unilateral cleft palate repair

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Craniofacial Surgery

Background:

• Cleft palate presents challenges in airway management due to palatal defects and abnormal dentition.
• Mask ventilation and laryngoscopy are often difficult in infants with cleft palate.
• Feeding obturators are used in cleft palate management, but their impact on airway procedures is not well-established.

Purpose of the Study:

• To evaluate the effect of a feeding obturator on the laryngeal view during laryngoscopy in infants with unilateral complete cleft palate.
• To assess the impact of the obturator on mask ventilation, ease of laryngoscopy and intubation, and associated side effects.

Main Methods:

• A randomized controlled trial involving 90 infants with unilateral complete cleft palate.
• Infants were assigned to either a group without a feeding obturator (Group A) or a group using an obturator during induction and intubation (Group B).
• Primary outcome was the Cormack-Lehane grade; secondary outcomes included mask ventilation difficulty, intubation ease, and trauma.

Main Results:

• No significant difference in Cormack-Lehane grade between groups.
• Group B (obturator) showed significantly shorter intubation duration compared to Group A.
• Group B experienced significantly less difficulty with mask ventilation and required fewer intubation attempts and maneuvers; no trauma was reported in Group B versus ten in Group A.

Conclusions:

• A pre-sized obturator does not improve laryngoscopic view in infants with unilateral cleft palate.
• However, obturator use significantly enhances face mask ventilation, making laryngoscopy and intubation easier and faster.
• Feeding obturators represent a valuable tool for improving airway management in this patient population.