Airway Management in Children with Craniofacial Anomalies

Abstract

Craniofacial anomalies (CFA) predispose children to airway obstruction. A retrospective study was conducted to describe airway intervention required to manage patients with craniofacial syndromes and diseases involving the midface and mandible (i.e., Pierre Robin, Apert, Treacher Collins, Saethre-Chotzen, CHARGE, Nager, Stickler, Goldenhar, and Pfeiffer). The type of airway intervention, duration of intervention, and associated physical and medical conditions were evaluated. One hundred nine patients had charts available for review and met inclusion criteria. Sixty-five of these patients required airway management, most commonly in the first month of life, ranging from positioning to tracheotomy. Nineteen patients required a tracheotomy. Associated medical conditions and feeding difficulties were associated with airway obstruction. This study evaluates factors that predispose children with CFA to have airway problems that need treatment, as well as the types of airway management that are necessary.

Evaluation of airway volume changes in patients treated with distraction osteogenesis: a pilot study

“…Therefore, when proper technique and protocol are followed, the validity of this method may be considered high. Most of the patients with craniofacial anomalies require airway management ranging from prone positioning to tracheotomy and DO 11 . DO is accepted as a reliable surgical technique and an alternative to tracheotomy for long-term management of the airway 11,12,13 .…”

“…Most of the patients with craniofacial anomalies require airway management ranging from prone positioning to tracheotomy and DO 11 . DO is accepted as a reliable surgical technique and an alternative to tracheotomy for long-term management of the airway 11,12,13 . It has been observed that DO reduces the need for tracheotomy especially in pediatric patients and allows for early decannulation in patients who previously underwent tracheotomy 14,15 .…”

Síndrome de Treacher Collins com atresia coanal: relato de caso e revisão de suas características

“…These patients may present chronic obstruction of upper airways -which leads to nourishment and sleep damages -as well as increasing hospital admissions. Frequent findings include micrognathia, tongue posture impairment, pharyngeal hypoplasia and laryngeal and tracheal narrowing, which result in respiratory obstruction and obstructive sleep apnea syndrome 6,10,12 . Computed tomography of rhinopharynx proved to be a useful diagnostic method to identify anatomical airway obstruction 13 , once it provides details of choanal atresia or other occasional malformation that are causative conditions to obstruction.…”

“…Transpalatal approach is preferred for older children and adults 14 . Advanced mandibular surgical procedure has been successfully described for improvement of respiratory obstruction in patients with retrognathia and upper airway narrowing 10 .…”

“…A multidisciplinary team should follow up these patients -craniofacial surgeon, ophthalmologist, speech therapist, dental surgeon and otorhinolaryngologist -in order to achieve appropriate airways control 10 . This study reports a case of Treacher Collins syndrome with bilateral choanal atresia besides a review of the disease.…”