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[Airway difficulty associated with multiple teratisms of the oral cavity in a newborn infant]
A Matsuno1, E Narimatsu, N Kanaya
1Department of Anesthesiology, Sapporo Medical University School of Medicine.
Insights
Managing the airway in infants with complex oral cavity teratisms, like epignathus and submandibular tumors, presents significant challenges during endotracheal intubation. Successful intubation required careful observation and specialized techniques.
Area of Science:
- Pediatric surgery
- Anesthesiology
- Congenital abnormalities
Background:
- Infants with multiple oral cavity teratisms, including epignathus, submandibular tumors, bifid tongue, and cleft palate, present unique anesthetic challenges.
- The significant oral space occupation by these anomalies can severely compromise airway management.
Observation:
- A 13-day-old infant with multiple oral teratisms, including a large epignathus and submandibular tumor, faced anticipated difficulties with endotracheal intubation.
- Initial attempts at awake laryngoscopy were hindered by the hard submandibular tumors obstructing midline laryngoscope management, despite the epignathus not impeding insertion.
Findings:
- Successful endotracheal intubation was ultimately achieved under deep sedation using a stylet after multiple attempts, following a better airway exposure.
- This case highlights the critical importance of a thorough pre-anesthetic evaluation of oral cavity anatomy in infants with congenital abnormalities.
Implications:
- Careful pre-operative assessment of anatomical abnormalities is paramount for securing the airway in infants with complex oral conditions.
- Anesthesiologists and surgeons must be prepared to employ alternative intubation strategies and equipment when standard methods are compromised by congenital oral malformations.
- This case underscores the need for tailored airway management protocols for neonates with multiple congenital oral teratisms.
Abstract:
A 13-day-old infant with multiple teratisms of the oral cavity was scheduled for resection of the epignathus. Her oral cavity was occupied by large epignathus, submandibular tumor, congenital bifid tongue and cleft palate, but she had no other congenital abnormalities. We anticipated that an endotracheal intubation would be difficult because of the large size of the tumor in relation to the oral cavity. Initially, awake intubation using a standard laryngoscope was attempted. Although a large elastic epignathus did not interrupt the insertion of the curved laryngoscope blade, the hard submandibular tumors protruded from the submaxillary ramport interfered with mid-line management of the laryngoscope. After several attempts of intubation, a better exposure was obtained and she was successfully intubated using a stylet under deep sedation. We recognized that a careful observation of anatomical abnormalities in the oral cavity is important to keep airway in an infant with multiple abnormalities of the oral cavity.