Blind Nasal Intubation by Monitoring Capnography in a Neonate with Congenital Microstomia

Ad, Temperley; Walker, Peter

doi:10.1177/0310057x9502300415

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…Microstomia, which is defined as an abnormally small mouth, is typically identified at birth. Initial treatment involves securing an adequate airway with placement of a tracheostomy because of the difficulty in oral intubation with these patients (Temperley and Walker, 1995). Further management entails attempting to widen the oral stoma.…”

Section: Discussionmentioning

confidence: 99%

A Novel Nonoperative Technique in the Initial Management and Treatment of Congenital Microstomia

Rezak

Bouvier

Olack

et al. 2012

The Cleft Palate-Craniofacial Journal

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Congenital microstomia in the newborn can result in poor functional and aesthetic outcomes. In the past, treatment options have included surgical methods such as commissurotomies and z-plasties as well as nonsurgical treatments using oral splints. In severe microstomia, a surgical release may be required to permit splint placement. Because of the small diameter of the stoma, such surgical releases are not optimal and frequently must be repeated. We devised a nonoperative technique for the initial treatment of congenital microstomia that will slowly enlarge the stomal diameter without the need for surgical release. The patient is a newborn male born with multiple congenital anomalies including severe mandibular hypoplasia and retrusion, microstomia, and microglossia. The size of his oral cavity was less than 1 cm at birth with no clinical signs of a tongue. After initial dilation in the operating room with Hagar dilators, the oral stoma was serially dilated using Boston Scientific esophageal balloons. Once full dilation was achieved, we fabricated oral splints to continue the dilation process while maintaining oral competence with no surgical intervention.

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Section: Discussionmentioning

confidence: 99%

A Novel Nonoperative Technique in the Initial Management and Treatment of Congenital Microstomia

Rezak

Bouvier

Olack

et al. 2012

The Cleft Palate-Craniofacial Journal

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“…All airway management algorithms (1,2) show fibreoptic bronchoscopy as the final step in the management of a difficult airway. However, there are a few reports of its failure (3)(4)(5)(6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

Difficult paediatric intubation when fibreoptic laryngoscopy fails

Vas

Goel

2002

Pediatric Anesthesia

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We report an unusual problem with fibreoptic bronchoscopy in an 8-year-old girl with Negar syndrome. She had a history of difficult airway since birth, and had undergone mandibular distraction for severe obstructive sleep apnoea when she was aged 2 years. Nagar syndrome is a Treacher-Collins like syndrome with normal intelligence, conductive bone deafness and problems with articulation. The patients have malar hypoplasia with down slanting palpebral fissures, high nasal bridge, micrognathia, absence of lower eyelashes, low set posteriorly rotated ears, preauricular tags, atresia of external ear canal, cleft palate, hypoplasia of thumb, with or without radius, and limited elbow extension. Protracted attempts with a fibreoptic bronchoscope failed to visualize the glottis, and this was only possible when the tube was guided to the larynx by blind nasal intubation. Apparently, the healing of the wounds for the mandibular distraction in the mandibular space on the inside of the rami of the mandible had caused differential fibrosis on either side of the hyoid, leading to a triplane distortion of the larynx with a left shift, clockwise rotation to a 2-8 o'clock direction and a slight tilt towards the left pharyngeal wall. The large epiglottis overlying this had precluded a view of the larynx. Finally, the older technique of breathguided intubation facilitated fibreoptic bronchoscopy to achieve tracheal intubation.

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