[Difficult intubation in Pierre-Robin children, a new method: the retromolar route]

The Pierre-Robin-children show a micro- and retrognathia of the lower jaw with the consequence of dorsal and cranial displacement of the basioglossal. It is well known that this can lead to serious difficulties in endotracheal intubation. As far as we know intubation via retromolar route has never been described at length. It has never been mentioned in the case of Pierre-Robin-children as an alternative to the unsuccessful classical method. This paper describes the problems intubation in these children and deals with the corresponding prophylactic measures of most importance before intubating. It describes in detail the technique of homolateral retromolar intubation - axis straight and distance shorter - and gives helpful guidelines that lead to a straight intubation axis in spite of anatomical abnormalities: pressure on the cricoid, pushing the larynx to the side, hyperextending, adjusting the degree of flexion, pushing or rotating the head to the other side or appropriate bending the end of the tube with a stylet.