Value of Imaging Measurements in Micrognathia‐Related Fetal Airway Obstruction Within a Fetal Center

• Published in: The Laryngoscope 2025-01, Vol.135 (1), p.393-401
• Main Authors: Eyring, J.B., Allen, Wesley P., Bayazid, Leith O., Hemeyer, Brandon M., Walker, Stephen, Orb, Quinn T., Grimmer, J. Fredrik, Rampton, John, Meier, Jeremy D.
• Format: Article
• Language: English
• Subjects: Adult; airway; Airway management; Airway Management - methods; Airway Obstruction - diagnostic imaging; Airway Obstruction - etiology; Female; fetal; Fetal Diseases - diagnostic imaging; Gestational Age; Humans; imaging; Infant, Newborn; Intervention; Intubation; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; micrognathia; Micrognathism - complications; Micrognathism - diagnostic imaging; Original Report; Ostomy; Otolaryngology; Pediatrics; Pierre Robin; Pregnancy; Retrospective Studies; Ultrasonic imaging; Ultrasonography, Prenatal - methods
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.31747

Objective Fetal imaging often identifies signs of upper airway obstruction due to micrognathia that may require airway intervention at delivery. This study investigated the role of quantitative fetal imaging measurements in predicting the need for otolaryngology consultation and intervention within a multidisciplinary Fetal Center. Methods Data were retrospectively collected from expectant mothers attending a multidisciplinary Fetal Center from January 2017 to October 2023. Cases of fetal micrognathia associated with potential upper airway obstruction were analyzed, focusing on prenatal ultrasound and magnetic resonance imaging (MRI) findings, genetic testing results, and interventions at birth. Results Among 25 pregnancies identified, diverse prenatal diagnoses were observed. Post hoc quantitative fetal ultrasound/MRI measurements included inferior facial angle, anteroposterior diameter, biparietal distance, and Jaw Index. Otolaryngology teams were present at delivery for a subset of cases, with various interventions performed, including tracheostomy and intubation. Lower gestational age at birth, rather than more severe quantitative measurements, was associated with the need for intervention. Intubation failure due to airway difficulty was also predicted by lower gestational age. Conclusion While certain quantitative fetal imaging measurements are often used for clinical decision‐making regarding airway management at birth, they did not clearly predict the need for airway intervention in our sample. Gestational age is an important consideration in decision‐making for fetal teams and should be considered in preterm fetuses to plan for airway difficulties. The findings highlight the complexity of fetal micrognathia management and highlight the need for further research to refine predictive models and optimize clinical decision‐making in this challenging clinical scenario. Level of Evidence 3 Laryngoscope, 135:393–401, 2025 Fetal imaging can guide airway management planning in cases of micrognathia. This study found that the utility of the inferior facial angle and Jaw Index in predicting otolaryngology intervention was unclear; however, intervention was strongly associated with lower gestational age.