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Published on: January 17, 2011
Airway management in children with hemifacial microsomia: a restropective study of 311 cases
Jin Xu1, Xiaoming Deng2, Fuxia Yan3
1Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China.
Background:
Hemifacial microsomia (HFM) is a congenital craniofacial malformation which is associated with difficult airway. Anesthesiologists may experience difficult intubation in children with HFM. Mandibular distraction could increase the length of the mandible. Theoretically, it should be advantageous to laryngeal view during tracheal intubation. This study reviewed airway management in children with HFM, assessed the efficiency of direct laryngoscopy versus airway-visualizing equipment during the tracheal intubation and determined whether mandibular distraction could improve the laryngoscopic view in children with HFM.
Methods:
A retrospective review of cases involving children with HFM aged 5 to 17 years old underwent anesthesia from December 2016 to April 2019 at a single center was performed. The demographic data, preoperative airway assessments, procedure type, anesthetic technique, method of airway management, anesthetists' comments on mask ventilation, laryngoscopy and intubation parameters were collected.
Results:
At last, 136 HFM children entered this study, a total of 311 anesthesia procedures were completed during the study period. Face mask ventilation was possible for most of children except 1 child (bilateral involvement) required two practitioners. The success rates of intubation for the primary video laryngoscopy and fibroscopy were both 100%, but 79.5% for direct laryngoscopy (P < 0.001). 95 (38.9%) children who had difficult laryngoscopic view (DLV) were significantly correlated with failed direct laryngoscopy (P < 0.001). Airway-visualizing equipment (video laryngoscope and Fiberscope) was the primary airway technique in 3 (75%) bilaterally involved children. 60 children underwent both mandibular distraction osteogenesis and the removal of distractor. The laryngoscopic views improved in 26 (43%) children after treatment with mandibular distraction (P < 0.001).
Conclusions:
Airway-visualizing equipment can be effectively utilized for intubation in HFM children with DLV. Mandibular distraction could improve the laryngeal view effectively.
Insights
Airway-visualizing equipment is effective for intubating children with hemifacial microsomia (HFM) and difficult airways. Mandibular distraction surgery can significantly improve the view during laryngoscopy for these patients.
Area of Science:
- Craniofacial Surgery
- Pediatric Anesthesiology
- Airway Management
Background:
- Hemifacial microsomia (HFM) is a congenital condition often associated with difficult airways in children.
- Anesthesiologists face challenges with intubation in pediatric patients with HFM.
- Mandibular distraction surgery aims to lengthen the mandible, potentially improving laryngeal visualization.
Purpose of the Study:
- To review airway management strategies in children with HFM.
- To compare the effectiveness of direct laryngoscopy versus airway-visualizing equipment for tracheal intubation.
- To determine if mandibular distraction surgery improves laryngoscopic view in HFM patients.
Main Methods:
- Retrospective review of 136 children (aged 5-17) with HFM undergoing anesthesia between 2016-2019.
- Collected data on demographics, airway assessments, anesthetic techniques, and airway management methods.
- Analyzed intubation success rates and laryngoscopic view quality with and without mandibular distraction.
Main Results:
- Airway-visualizing equipment (video laryngoscopy, fibroscopy) achieved 100% intubation success, compared to 79.5% for direct laryngoscopy.
- Difficult laryngoscopic view (DLV) was significantly correlated with failed direct laryngoscopy.
- Mandibular distraction improved laryngoscopic views in 43% of treated children.
Conclusions:
- Airway-visualizing equipment is highly effective for intubation in HFM children, especially those with DLV.
- Mandibular distraction osteogenesis can lead to significant improvements in laryngeal visualization during intubation.
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