Upper Airway Computed Tomography Measures and Receipt of Tracheotomy in Infants With Robin Sequence

Lee, Victoria S.; Evans, Kelly N.; Perez, Francisco A.; Oron, Assaf P.; Perkins, Jonathan A.

doi:10.1001/jamaoto.2016.1010

Cited by 25 publications

(29 citation statements)

References 30 publications

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“…25 Lee et al demonstrated that infants with shorter tongue length as measured on computed tomography scan had a higher rate of tracheostomy. 26 In a prospective study of 8000 consecutive fetal ultrasounds, Bronshtein et al found 2 subjects with glossoptosis and confirmed this finding on postmortem examination. 12 These authors also identified glossoptosis on 4 ultrasound studies of fetuses suspected to have RS and corroborated these findings postnatally in all four.…”

Section: Discussionmentioning

confidence: 54%

“…Figueroa et al found differences in tongue shape on cephalometric radiographs of children under 2 years of age with RS compared with other groups . Lee et al demonstrated that infants with shorter tongue length as measured on computed tomography scan had a higher rate of tracheostomy . In a prospective study of 8000 consecutive fetal ultrasounds, Bronshtein et al found 2 subjects with glossoptosis and confirmed this finding on postmortem examination .…”

Section: Discussionmentioning

confidence: 93%

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An algorithm for predicting Robin sequence from fetal MRI

et al. 2018

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 93%

An algorithm for predicting Robin sequence from fetal MRI

et al. 2018

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“…Also, the scout films from CT images can demonstrate the tongue base position. A sleep study is obtained, with the above caveats of a lack of normative data as well as the knowledge that any child with a cleft palate will have a higher likelihood of having an abnormal result 46,50…”

Section: Treatment – Surgical/invasive Management (Cleft/craniofacialmentioning

confidence: 99%

Robin sequence: what the multidisciplinary approach can do

Cohen¹,

Greathouse²,

Rabbani³

et al. 2017

JMDH

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Robin sequence (RS) is a commonly encountered triad of micrognathia, glossoptosis, and airway obstruction, with or without a cleft palate. The management of airway obstruction is of paramount importance, and multiple reviews and retrospective series outline the diagnosis and treatment of RS. This article focuses on the multidisciplinary nature of RS and the specialists’ contributions and thought processes regarding the management of the RS child from birth to skeletal maturity. This review demonstrates that the care of these children extends far beyond the acute airway obstruction and that thorough monitoring and appropriate intervention are required to help them achieve optimal outcomes.

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“…Computed tomography can be used to evaluate infant bony and soft tissue anatomy of the upper airway in 2 and 3 dimensions, which is not possible with cephalometrics [27–29]. While CT scanning does require radiation exposure, maxillofacial CT is a routine preoperative examination for MDO [16–18], so this evaluation method will not require additional exposure. Further, cone-beam delivery can markedly reduce total radiation dose, so there is no additional safety limitation for clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Cone-beam computed tomography (CBCT) allows for extensive anatomic characterization while avoiding excessive radiation exposure [14, 15]. At present, craniofacial CBCT is routinely used to determine the location of upper airway obstruction and depict the mandibular anatomy of infants with RS under consideration for surgical intervention [16–19]. In this retrospective study, we identified quantitative parameters derived from CBCT images that differed between RS patients with normal or difficult intubation and tested their predictive efficacies by receiving operating characteristic (ROC) analyses.…”

Section: Introductionmentioning

confidence: 99%

A clinical prediction rule to identify difficult intubation in children with Robin sequence requiring mandibular distraction osteogenesis based on craniofacial CT measures

2019

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BackgroundAirway management is challenging in children with Robin sequence (RS) requiring mandibular distraction osteogenesis (MDO). We derived and validated a prediction rule to identify difficult intubation before MDO for children with RS based on craniofacial computed tomography (CT) images.MethodThis was a retrospective study of 69 children with RS requiring MDO from November 2016 to June 2018. Multiple CT imaging parameters and baseline characteristic (sex, age, gestational age, body mass index [BMI]) were compared between children with normal and difficult intubation according to Cormack−Lehane classification. A clinical prediction rule was established to identify difficult intubation using group differences in CT parameters (eleven distances, six angles, one section cross-sectional area, and three segment volumes) and clinicodemographic characteristics. Predictive accuracy was evaluated by receiver operating characteristic (ROC) curve analysis.ResultsThe overall incidence of difficult intubation was 56.52%, and there was no significant difference in sex ratio, age, weight, height, BMI, or gestational age between groups. The distance between the root of the tongue and posterior pharyngeal wall was significantly shorter, the bilateral mandibular angle shallower, and the cross-sectional area at the epiglottis tip smaller in the difficult intubation group. A clinical prediction rule based on airway cross-sectional area at the tip of the epiglottis was established. Area > 36.97 mm2 predicted difficult intubation while area < 36.97 mm2 predicted normal intubation with 100% sensitivity, 62.5% specificity, 78.6% positive predictive value, and 100% negative predictive value (area under the ROC curve = 0.8125).ConclusionComputed tomography measures can objectively evaluate upper airway morphology in patients with RS for prediction of difficult intubation. If validated in a larger series, the measures identified could be incorporated into airway assessment tools to guide treatment decisions.This was a retrospective study and was granted permission to access and use these medical records by the ethics committee of Guangzhou Women and Children’s Medical Center.Trials registrationRegistration No. ChiCTR1800018252, NaZhang, Sept 7 2018.

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Upper Airway Computed Tomography Measures and Receipt of Tracheotomy in Infants With Robin Sequence

Cited by 25 publications

References 30 publications

An algorithm for predicting Robin sequence from fetal MRI

An algorithm for predicting Robin sequence from fetal MRI

Robin sequence: what the multidisciplinary approach can do

A clinical prediction rule to identify difficult intubation in children with Robin sequence requiring mandibular distraction osteogenesis based on craniofacial CT measures

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