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Longer upper airway lengths in Robin Sequence: A case-control study using computed tomography.

Francisco A Perez1, Daniel G Hottinger2, Kelly N Evans3

  • 1Department of Radiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA.

Paediatric Anaesthesia
|April 12, 2020
PubMed
Summary
This summary is machine-generated.

Children with Robin Sequence have longer airway distances to the vocal cords, impacting intubation. These findings aid clinicians in selecting and placing endotracheal tubes to prevent malpositioning.

Keywords:
Robin Sequenceairway managementanesthesiacase-control studiescomparative studyintubation

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Area of Science:

  • Pediatric Anesthesiology
  • Craniofacial Anomalies
  • Airway Management

Background:

  • Direct laryngoscopy and intubation present challenges in children with Robin Sequence.
  • Existing research on airway differences in Robin Sequence focuses on patency, with limited data on intubation trajectories.
  • Understanding intubation depth and pathways is crucial for improving airway management and reducing endotracheal tube malpositioning.

Purpose of the Study:

  • To investigate differences in longitudinal airway parameters relevant to intubation in children with Robin Sequence compared to age-matched controls.
  • To provide quantitative data on specific airway measurements influencing intubation depth and trajectory.

Main Methods:

  • A case-control study involving 33 children with Robin Sequence (<4 years) and 33 age- and sex-matched controls.
  • Computed tomography (CT) scans of the head and neck were analyzed for measurements including nasopharynx, oropharynx, hypopharynx, tongue, hyoid, and distances from teeth/nares to vocal cords.
  • Statistical analysis utilized multiple ANCOVA models, controlling for height/length, weight, and age.

Main Results:

  • Patients with Robin Sequence exhibited significantly longer front teeth to vocal cord (1.2 cm) and nares to vocal cord (0.8 cm) distances.
  • The tongue was positioned higher (0.5 cm) and more posteriorly (0.9 cm) in Robin Sequence patients.
  • The hyoid bone was positioned more inferiorly (0.5 cm) and posteriorly (0.2 cm) in the Robin Sequence group.

Conclusions:

  • Children with Robin Sequence under 4 years have significantly altered airway anatomy affecting intubation.
  • Longer vocal cord distances and altered tongue/hyoid positioning necessitate adjustments in endotracheal tube selection and placement.
  • These findings can help reduce endotracheal tube malpositioning in this vulnerable pediatric population.