Airway Management in Children with Limited Oral Opening

Abstract

Objectives:

1) Describe largest population reported in the literature of children with limited oral opening that does not allow for routine orotracheal intubation with direct laryngoscopy. 2) Analyze incidence and outcome of airway compromise or loss in this population. 3) Identify factors that preclude decannulation in children with limited oral opening.

Methods:

Retrospective chart review of children who were identified by the Children’s Hospitals and Clinics of Minnesota craniofacial team over the last 15 years as having limited oral opening that did not allow for routine orotracheal intubation by direct laryngoscopy.

Results:

Ten children (mean age 13 years, range 7-17 years) were identified for inclusion into the study. A total of 109 operations requiring general anesthesia (average of 10.9 per patient, range 0-23) were performed on patients without a tracheostomy in place. Flexible fiberoptic nasal intubation was performed in 58 cases, 37 by otolaryngology (64%) and 21 by anesthesiology (36%). The remainder of airway control was by mask ventilation (33 cases), various methods of orotracheal intubation (12 cases), and unknown (6 cases). There was a total of 118 patient years without a tracheostomy tube in place (average of 11.8 years per patient). During this period there were no episodes of acute airway compromise that resulted in neurologic deficits.

Conclusions:

Select children with limited oral opening that does not allow for routine orotracheal intubation with direct laryngoscopy can be safely managed without a tracheostomy, even when the child requires frequent procedures under general anesthesia.