Difficult intubation in an infant with Pierre Robin syndrome and concomitant tongue tie

Area of Science:

• Pediatric Anesthesiology
• Craniofacial Surgery
• Neonatal Care

Background:

• Pierre Robin syndrome is characterized by micrognathia, glossoptosis, and cleft palate, often leading to significant airway obstruction.
• Infants with craniofacial anomalies present unique challenges for airway management and intubation.
• Tongue tie (ankyloglossia) can further restrict tongue mobility, potentially exacerbating airway difficulties.

Observation:

• A six-month-old infant with Pierre Robin syndrome and a history of cleft palate repair presented with a concurrent tongue tie.
• The infant experienced severe airway difficulties during the attempted intubation procedure.
• The presence of a tongue tie was noted to significantly compound the existing airway challenges.

Findings:

• Successful intubation was ultimately achieved using a specialized two-anesthetist technique.
• The case highlights the critical role of tongue tie in exacerbating airway difficulties in infants with Pierre Robin syndrome.
• Assessment suggests that tongue tie can be a significant, often overlooked, contributing factor to intubation challenges in this population.

Implications:

• Clinicians should maintain a high index of suspicion for tongue tie in infants with Pierre Robin syndrome presenting with airway issues.
• Pre-operative assessment should meticulously evaluate for ankyloglossia in infants with craniofacial syndromes.
• Consideration of adjunctive techniques, such as the two-anesthetist approach, may be necessary for safe airway management in complex cases.