Airway management for infants with severe micrognathia having mandibular distraction osteogenesis

We retrospectively reviewed the charts of seven neonates and infants with severe micrognathia and upper airway obstruction who underwent mandibular distraction osteogenesis as an alternative to long-term tracheostomy at the Children's Hospital at Westmead, Sydney, from 2004 to 2007. All patient...

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Bibliographic Details
Published in:Anaesthesia and intensive care 2010, Vol.38 (1), p.43-49
Main Authors: BROOKER, G. E, COOPER, M. G
Format: Article
Language:English
Subjects:
Airway obstruction (Medicine)
Airway Obstruction - surgery
Anesthesia
Anesthesia, Inhalation
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Care and treatment
Continuous Positive Airway Pressure
Demographic aspects
Female
Fracture fixation
Humans
Infant
Intubation
Intubation, Intratracheal - methods
Jaw diseases
Laryngoscopy
Male
Mandible - abnormalities
Mandible - surgery
Medical sciences
Methods
Micrognathism - surgery
Osteogenesis, Distraction
Patient outcomes
Pediatric anesthesia
Respiration, Artificial
Retrospective Studies
Trachea
Tracheostomy
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Summary:We retrospectively reviewed the charts of seven neonates and infants with severe micrognathia and upper airway obstruction who underwent mandibular distraction osteogenesis as an alternative to long-term tracheostomy at the Children's Hospital at Westmead, Sydney, from 2004 to 2007. All patients required a variety of airway interventions at an early age and had poor feeding or failure to thrive. These children had other anomalies and required many investigations and procedures and presented repeated airway challenges for the anaesthetist. The mean number of anaesthetics per child in this series was 6.7 (range 4 to 13). Under anaesthesia, four patients had grade 4 laryngoscopy, one was grade 3 but two were only grade 2. Patients with a preoperative grade 4 laryngoscopy were very likely to need fibreoptic endotracheal intubation. Duration of intubation after surgery for mandibular distraction was a mean of 8.17 days (range 1 to 19). Three were extubated in the operating theatre and three in intensive care. Five patients had an improved laryngoscopy grade after completion of mandibular distraction and one remained grade four The remaining patient had a tracheostomy from birth.
ISSN:0310-057X
1448-0271
DOI:10.1177/0310057x1003800109