Difficult Airway Identification and Management in Patients With Moebius Syndrome

Telich-Tarriba, José E; Guevara-Valmaña, Osvaldo Iván; Ruiz-Beltran, Sandra M; Aguiar-Rosas, Sebastian; Cárdenas-Mejía, Alexander

doi:10.1097/scs.0000000000005692

Cited by 6 publications

(12 citation statements)

References 16 publications

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“…The oral abnormalities, such as a small jaw or extreme dental stenosis, can cause difficulties in mask ventilation and intubation. There are several reports on airway management of patients with Moebius syndrome [ 11 – 15 ], and mask ventilation has often been reported to be easy [ 13 ]. We estimated that mask ventilation was available based on his physical findings.…”

Section: Discussionmentioning

confidence: 99%

“…Although it was not possible due to lack of patient cooperation, we believe it would have been safer to perform awake fiberoptic intubation or to secure the airway with spontaneous breathing remaining. Previous reports have found that overweight and obesity [ 15 ], abnormalities of mandibular/palatal structures, and four cranial nerves (IX, X, XI, XII) are statistically significant factors associated with tracheal intubation difficulties in patients with Moebius syndrome [ 13 ]. Although our patient was not overweight, several factors made tracheal intubation difficult, including mandibular/palatal abnormalities (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The cause is thought to be fetal ischemia (watershed infarction) [ 8 ] due to abnormal fetal positioning, exposure to teratogens (benzodiazepines, misoprostol, cocaine, alcohol, hyperthermia, hypoxia, and rubella) during the first trimester of pregnancy [ 9 ], or developmental disorders of the brainstem (rhombencephalon) due to genetic factors [ 10 ]. Perioperative airway management in Moebius syndrome patients can be difficult owing to morphological and functional abnormalities of the orofacial region [ 11 – 15 ]. This disorder can lead to problems not only in airway management but also in perioperative anesthesia management, such as postoperative aspiration pneumonia [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Difficult intubation and postoperative aspiration pneumonia associated with Moebius syndrome: a case report

et al. 2022

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Background Moebius syndrome is a rare congenital disorder characterized by non-progressive palsy of the abducens (VI) and facial (VII) cranial nerves. Its common features include dysfunctions associated with other cranial nerves, orofacial abnormalities, skeletal muscle hypotonia, and other systemic disorders of differing severities. There are several concerns in the perioperative management of patients with Moebius syndrome. Case presentation We present a report on the management of general anesthesia of a 14-year-old male patient with Moebius syndrome who was scheduled for mandibular cystectomy. The patient was diagnosed with Moebius syndrome at the age of 7 years based on his clinical manifestations of nerve palsy since birth and cranial nerve palsy of the trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), and sublingual nerves (XII). The patient’s oral morphological abnormalities made intubation difficult. He also experienced dysphagia and aspiration pneumonia on a daily basis. Oral secretions were frequently suctioned postoperatively. However, after discharge, the patient developed aspiration pneumonia and was readmitted to the hospital. Conclusions The main problem arising when administering general anesthesia to patients with this syndrome is difficult airway management. The oral abnormalities in these patients, such as small jaw and extreme dental stenosis, make mask ventilation and intubation difficult. Furthermore, this syndrome often involves respiratory impairment and dysphagia due to cerebral nerve palsy, so there is a high risk of postoperative respiratory complications. Since multiple organs are affected in patients with Moebius syndrome, appropriate perioperative management strategies must be prepared for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Difficult intubation and postoperative aspiration pneumonia associated with Moebius syndrome: a case report

et al. 2022

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“…Management of the clinical problems present in patients afflicted with Moebius syndrome requires intervention by a multidisciplinary team, including pediatricians, ophthalmologists, stomatologists, rehabilitation specialists, plastic, orthopedic, and craniofacial surgeons. 10,11…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Hand Malformations in Patients With Moebius Syndrome and Their Management

Telich-Tarriba

Navarro-Barquin

Verdezoto-Gaibor

et al. 2021

Hand (New York, N,Y.)

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Background: Moebius syndrome is a disorder characterized by facial and abducens nerve paralysis. Patients can present a wide range of upper extremity malformations. Literature focused on orthopedic manifestations of Moebius syndrome shows variability in the prevalence and clinical presentation of upper extremity anomalies. The aim of this work is to evaluate the prevalence of upper extremity malformations in patients with Moebius syndrome, clarify its various clinical presentations, and present treatment strategies for their management. Methods: This is a retrospective, cross-sectional study including patients with Moebius syndrome and upper extremity malformations between 2012 and 2019. Data include demographic characteristics, Moebius syndrome subtype, type of malformation, affected extremity, and surgical procedures underwent. Quantitative data were recorded as mean (standard deviation [SD]), and qualitative data were expressed in terms of totals and percentages. Statistical association between Moebius syndrome subtype and development of upper extremity anomalies was evaluated using binary logistic regression. Results: Twenty-five out of 153 patients (16.3%) presented upper extremity malformations (48% male). Mean age of presentation was 9.08 ± 9.43 years. Sixty-eight percent of the malformations were unilateral. The most common presentations included Poland syndrome and simple syndactyly with 8 cases each (32%), followed by 5 cases of brachysyndactyly (20%), 3 cases of amniotic band syndrome (12%), and 1 case of cleft hand (4%). No statistical association was found between Moebius syndrome subtype and odds ratio for development of upper extremity anomalies. Thirteen patients (52%) underwent reconstructive procedures. Conclusion: Poland syndrome and syndactyly are the most common anomalies in patients with Moebius syndrome. Patients may present with a wide range of hand malformations, each patient should be carefully evaluated in order to determine whether surgical treatment is needed and to optimize rehabilitation protocols.

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“…This assessment is made according to the american society of anesthesiologists (ASA) is an important data, so that the anesthesiologist has the dimension of the potential risk during the anesthetic procedure (MCISAAC and colab., 2017). It is also performed the airway viability assessment, which can be done according to the Mallampati scale, which is the predictor of airway difficulty most commonly used by anesthesiology today (TELICH-TARRIBA and colab., 2019).…”

Section: Introductionmentioning

confidence: 99%

Distribution by physical status ASA and Mallampati Scale of patients submitted to inguinal herniorrhapiers by laparoscopy

Bedin¹,

Schultz²,

Guimarães³

et al. 2020

Revista Científica Multidisciplinar Núcleo do Conhecimento

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In the preanesthetic evaluation, which should always occur before elective surgeries, the anesthesiologist performs the evaluation of the physical state. This study verified the profile of patients referred for inguinal herniorrharhary surgery in Joinville according to the criteria of the American Association of Anesthesiology from August 2016 to August 2017. The physical status was evaluated according to the classification of the American Association of Anesthesiology (ASA), identifying the classification of physical status (ASA 1, 2, 3, 4, 5 and 6) of patients undergoing inguinal herniorrhamy surgery in Joinville. The prevalence of airway 1, 2, 3 and 4 second Mallampati scale was verified. And it correlated the data for verification and elaboration of individualized therapeutic approaches according to the profiles found for the improvement of patient care. This was a retrospective epidemiological clinical study conducted from August 2016 to August 2017. 328 patients participated in the study, age 45.80±11.60, weight 81.22±13.32 and body mass index 27.28±3.79. The most frequent physical state, according to the American Society’s classification of Anesthesiology (ASA). Mallampati tracheal intubation difficulty was 1. This study aimed to quantify the prevalence of physical status ASA and mallampati classification of patients undergoing inguinal herniorrhacupia surgery in the city of Joinville between August 2016 and August 2017. In addition, demographic data (gender, age, weight and body mass index) were collected, as well as physical status and the mallampati intubation difficulty forecast classification.

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Difficult Airway Identification and Management in Patients With Moebius Syndrome

Cited by 6 publications

References 16 publications

Difficult intubation and postoperative aspiration pneumonia associated with Moebius syndrome: a case report

Difficult intubation and postoperative aspiration pneumonia associated with Moebius syndrome: a case report

Prevalence of Hand Malformations in Patients With Moebius Syndrome and Their Management

Distribution by physical status ASA and Mallampati Scale of patients submitted to inguinal herniorrhapiers by laparoscopy

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