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Kaban-Pruzansky Grade Predicts Airway Severity in Hemifacial Microsomia
Carlos E Barrero1, Matthew E Pontell1, Isabel A Ryan2
1From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia.
Background:
Children born with hemifacial microsomia (HFM) can experience airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between the degree of micrognathia and airway insufficiency in the HFM population.
Methods:
Patient demographics, airway function, Kaban-Pruzansky (KP) grade, and Cormack-Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022.
Results:
Seventy patients underwent 365 operations with KP grading as follows: 34% KP grade I, 23% KP grade IIA, 11% KP grade IIB, and 33% KP grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade ( P < 0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status ( P < 0.001), with 75% of difficult airways in KP grade III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age ( P > 0.05). Most CL grades were I (61%) or IIA (13%), with fewer grade IIB, grade III, and grade IV (4% to 7%). KP grade predicted CL grade ( P < 0.001), with 71% of grade IV views and 64% of grade III views seen in KP grade III patients.
Conclusions:
KP grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP grade III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for a challenging airway is a critical part of caring for patients with HFM.
Clinical Question/Level Of Evidence:
Risk, III.
Insights
The Kaban-Pruzansky (KP) grade effectively predicts airway severity in hemifacial microsomia (HFM) patients. Higher KP grades, particularly grade III, are strongly associated with difficult airways and increased risk of airway insufficiency.
Area of Science:
- Craniofacial surgery
- Pediatric otolaryngology
- Anesthesiology
Background:
- Hemifacial microsomia (HFM) can lead to airway compromise in children.
- Limited data exists correlating HFM severity with airway difficulty.
Purpose of the Study:
- To determine the relationship between micrognathia severity (Kaban-Pruzansky grade) and airway insufficiency in HFM patients.
Main Methods:
- Retrospective review of 70 HFM patients treated between 2000-2022.
- Analysis of patient demographics, airway function, Kaban-Pruzansky (KP) grade, and Cormack-Lehane (CL) grade.
Main Results:
- KP grade significantly predicted airway-affecting procedures and difficult airway status (P < 0.001).
- 75% of difficult airways and 71% of grade IV views were in KP grade III patients.
- No association found between airway compromise and Goldenhar syndrome, laterality, or age.
Conclusions:
- KP grade is a reliable indicator of airway severity in HFM.
- Patients with higher KP grades, especially grade III, face persistent airway insufficiency risk.
- Early identification and preparation for challenging airways are crucial for HFM patient care.
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