Percutaneous Dilational Tracheotomy for Airway Management in a Newborn With Pierre-Robin Syndrome and a Glossopharyngeal Web

Abstract

Pierre-Robin syndrome (PRS) is often associated with difficulty in endotracheal intubation. We present the use of percutaneous dilational tracheotomy (PDT) for airway management of a newborn with PRS and a glossopharyngeal web. A 2-day-old term newborn with PRS and severe obstructive dyspnea was evaluated by the anesthesiology team for airway management. A direct laryngoscopy revealed a glossopharyngeal web extending from the base of the tongue to the posterior pharyngeal wall. The infant was spontaneously breathing through a 2 mm diameter fistula in the center of this web. It was decided that endotracheal intubation was impossible, and a PDT was planned. The trachea of the newborn was cannulated, using a 20 gauge peripheral venous catheter and a 0.71 mm guide wire was introduced through this catheter. Using 5 French, 7 French, 9 French, and 11 French central venous catheter kit dilators, staged tracheotomy stoma dilation was performed. By inserting a size 3.0 tracheotomy cannula, PDT was successfully completed in this newborn. This case describes the successful use of PDT for emergency airway management of a newborn with PRS and glossopharyngeal web.

Anesthetic management of an adolescent with congenital glossopharyngeal web

“…[ 10 11 ] Airway management includes emergency tracheostomy for respiratory distress[ 10 ] or tracheostomy for securing the airway during surgery. [ 11 ] Pirat et al . have described retrograde intubation for a child even after the excision of the glossopharyngeal web.…”

“…have described retrograde intubation for a child even after the excision of the glossopharyngeal web. [ 11 ] Some patients, although asymptomatic may need fibreoptic intubation.…”